From the Guidelines
Not all advanced maternal age (AMA) patients need to see a Maternal-Fetal Medicine (MFM) specialist, as routine MFM consultation is typically recommended for AMA patients with additional risk factors, not solely based on age. While women who are 35 years or older at delivery are considered AMA, the decision for MFM consultation should be individualized based on the specific risk profile of each pregnancy rather than age alone, as many AMA women have completely normal, uncomplicated pregnancies 1.
Key Considerations
- AMA patients with pre-existing medical conditions, such as diabetes, hypertension, or autoimmune disorders, may benefit from MFM consultation to discuss the risks and benefits of pregnancy and to optimize their care 1.
- Multiple gestations, abnormal genetic screening results, or previous pregnancy complications are also indications for MFM referral in AMA patients.
- For uncomplicated AMA pregnancies, standard prenatal care with an obstetrician is often sufficient, though these patients are usually offered additional genetic screening options like NIPT (non-invasive prenatal testing) or amniocentesis due to the slightly increased risk of chromosomal abnormalities with advancing maternal age.
- The Society for Maternal-Fetal Medicine recommends that all medical professionals be comfortable counseling women about the risks and benefits of contraception and pregnancy, or to provide referrals to Complex Family Planning or MFM subspecialists as needed 1.
Individualized Care
The American Journal of Obstetrics and Gynecology study published in 2021 emphasizes the importance of individualized care for AMA patients, taking into account their unique risk factors and medical history 1. By doing so, healthcare providers can ensure that AMA patients receive the most appropriate level of care, whether it be standard prenatal care or consultation with an MFM specialist. Ultimately, the decision for MFM consultation should be based on a thorough assessment of each patient's individual risk profile, rather than solely on their age.
From the Research
Advanced Maternal Age and the Need for Specialist Care
- Advanced maternal age (AMA) is associated with an increased risk of adverse maternal and perinatal outcomes, including spontaneous miscarriage, preterm labor, gestational diabetes mellitus, pre-eclampsia, stillbirth, chromosomal abnormalities, and cesarean delivery 2, 3, 4, 5.
- The risk of complications increases with age, and women aged 35 or older are considered to be at advanced maternal age 2, 3, 4, 5.
- While not all AMA patients may require specialist care, those with pre-existing medical conditions or a history of complications during previous pregnancies may benefit from seeing a Maternal-Fetal Medicine (MFM) specialist 2, 3.
- Studies have shown that AMA is associated with an increased risk of gestational diabetes mellitus, cesarean delivery, and other complications, highlighting the need for close monitoring and specialized care for these patients 4, 5.
Factors to Consider When Determining the Need for Specialist Care
- The presence of pre-existing medical conditions, such as hypertension or diabetes, may increase the risk of complications during pregnancy and necessitate specialist care 2, 3.
- A history of complications during previous pregnancies, such as miscarriage or preterm labor, may also indicate the need for specialist care 2, 3.
- The age of the mother, with those aged 35 or older considered to be at advanced maternal age, is also an important factor to consider when determining the need for specialist care 2, 3, 4, 5.
Current Understanding and Recommendations
- The current understanding of AMA and its effects on pregnancy outcomes highlights the need for close monitoring and specialized care for women aged 35 or older 2, 3, 4, 5, 6.
- Recommendations for the management of pregnancy in women of advanced maternal age include prepregnancy screening, intervention, and postpartum maintenance, as well as support strategies to mitigate the risks associated with AMA 6.