Neonatal Outcome and Its Relationship with Maternal Age

EDITORIAL COMMENT: More women are delaying reproduction to an older age. In Victoria in 1983, 29% of parturients were aged over 30 years, 7% were 35 or more and 1% were 40 years or more; by 1988 these figures had risen to 37%, 10% and 1% respectively‘. Mostly older women believe that increasing age is associated with increased maternal and fetal hazards, yet with the exception of the greater incidence of Down syndrome this fear is unjustifiably exaggerated. This applies both to the risk of perinatal death and major fetal malformation“. This paper illustrates these findings from a hospital population in Hong Kong. In Victoria in 1988 there were 62,740 births and the overall perinatal mortality rate was 10.9 per 1,000; the most favourable rate was in the 30–34 age group (9.9), which was marginally better than in the 25–29 age group (10.0) in which most births occurred (39%); the mortality rates were 18.0 per 1,000 in the under 20 age group and 13.5 per 1,000 in those aged 35 years or more. The older woman is more likely to have diseases associated with increased age and parity (diabetes, hypertension, renal disease, fibromyomas, unstable lie). In the 1982‐84 triennium in Australia, the maternal mortality rate was lowest in the 25–29 age group (0.07 per 1,000 livebirths), increasing by 70% in the under 20 age group (0.12) and by a factor of 5.8 in the 35–39 year group (0.41), the overall rate being 0.13 per 1,000 livebirths c . The takeaway message from these reports is the fact that the older woman can usually be reassured that she should be able to successfully reproduce with safety, although she may be a candidate for chorion biopsy/genetic amniocentesis. Having said all this one might add that voluntary infertility can cause a multitude of problems in a marriage, not the least of which is subsequent involuntary infertility ‐ why do so many couples deny themselves, or defer unreasonably, the marvellous experience of being parents?A.  Annual Reports for the years 1983 and 1988, Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Victoria. B.  Baird PA, Sadovnick AD, Yee IML. Maternal age and birth defects: a population study. Lancet 1991; 337: 527–529. C.  Report on Maternal Deaths on Australia, 1982‐84.Summary: The relationship between maternal age and neonatal outcome was examined in 22,689 pregnancies using various determinants of neonatal well‐being which included evidence of fetal distress, birth‐weight, Apgar scores, the necessity for admission to the neonatal unit and other indicators of neonatal morbidity. Differences in the incidence of congenital malformations and perinatal mortality were also studied. There was a trend towards more frequent fetal heart monitoring, lower birth‐weight and a higher rate of neonatal unit admission for infants delivered by younger women. There was also a significant increase in the Caesarean section rate with advancing maternal age. Maternal age had no effect, however, on the incidence of fetal distress, Apgar score, the development of respiratory disease, the need for intubation and ventilation nor on subsequent neonatal central nervous system complications. There was also no association between maternal age and either perinatal mortality or the incidence of congenital malformations. The favourable outcome in teenagers in this study may have been influenced by the extremely low pregnancy rate amongst young adolescents in Hong Kong, but a similar outcome in the mature age women was likely to have reflected the recognition of risk and its appropriate management.