From the Guidelines
Advanced maternal age (AMA) pregnancy, also known as a geriatric pregnancy, is considered to be 35 years or older.
Factors Contributing to Advanced Maternal Age
- Age: Women aged 35 years or older are considered to be of advanced maternal age, with an elevated risk for pregnancy-related mortality 1.
- Chronic conditions: Women with multiple or more severe chronic conditions are more likely to experience severe maternal morbidity (SMM) or mortality 1.
- Other factors: Other factors that may contribute to adverse maternal health outcomes include obesity, substance use, mental health conditions, and racial and ethnic disparities 1.
High-Risk Pregnancy Factors
- Age: Age >35 years is considered a high-risk pregnancy factor 1.
- Previous complications: Severe complications in a previous pregnancy, such as multiple first trimester losses or second or third trimester pregnancy loss, are also considered high-risk factors 1. It is essential to note that these factors can increase the risk of adverse maternal health outcomes, and therefore, pregnant women aged 35 years or older should be considered high-risk and receive appropriate prenatal care and monitoring 1.
From the Research
Definition of Advanced Maternal Age (AMA) Pregnancy
- Advanced maternal age (AMA) pregnancy, also known as a geriatric pregnancy, refers to women older than 35 years 2, 3, 4, 5, 6.
- The definition of AMA is debated, but an increasing risk of complications is observed from the age of 35, with a threshold of 40 years old adopted internationally to adjust surveillance and set the term of delivery between 39 and 40 weeks 5.
Risks Associated with AMA Pregnancy
- Pregnancies at advanced maternal age are associated with increased risks of complications, including:
- Gestational diabetes mellitus 2, 3, 4, 5, 6
- Preeclampsia and eclampsia 2, 3, 4, 5, 6
- Spontaneous miscarriage and ectopic pregnancy 2, 3, 4, 5, 6
- Chromosomal abnormalities and congenital anomalies 2, 3, 4, 5, 6
- Premature birth and low birth weight 2, 3, 4, 5, 6
- Cesarean delivery and postpartum complications 2, 3, 4, 5, 6
- Maternal mortality and perinatal mortality 2, 3, 4, 5, 6
Management and Implications of AMA Pregnancy
- The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities 3.
- Educating providers and women of AMA is crucial to facilitate clinical decision making and should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues 3.
- Health care providers should counsel couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy and emphasize the importance of improving advanced age mothers' health through the utilization of contraception to reduce pregnancy in this age group 6.