From the Guidelines
The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) guidelines for Advanced Maternal Age (AMA) pregnancy management are not directly addressed in the provided evidence, which focuses on fetal growth restriction (FGR) management. However, based on general knowledge and guidelines from these organizations, it is known that AMA pregnancies require specialized care due to increased risks of complications such as chromosomal abnormalities, gestational diabetes, preeclampsia, and fetal growth restriction.
Key Recommendations for AMA Pregnancy Management:
- Early prenatal care with comprehensive risk assessment
- Genetic counseling with options for aneuploidy screening or diagnostic testing
- Closer monitoring with serial growth ultrasounds starting at 28-32 weeks
- Antenatal testing with twice-weekly NSTs or BPPs for women over 40 starting at 36-37 weeks
- Consideration for delivery by 39-40 weeks to reduce stillbirth risk
- Low-dose aspirin (81mg daily) starting at 12-16 weeks for those with additional risk factors for preeclampsia, as recommended by 1.
Fetal Growth Restriction Management:
While the provided evidence does not directly address AMA pregnancy management, it does offer guidelines for FGR management, which can be relevant to AMA pregnancies due to the increased risk of FGR in this population.
- FGR should be defined as an ultrasonographic EFW or AC below the 10th percentile for gestational age, as recommended by 1.
- Population-based fetal growth references should be used in determining fetal weight percentiles 1.
- Detailed obstetrical ultrasound examination should be performed with early-onset FGR (<32 weeks of gestation) due to the association with fetal or chromosomal abnormalities 1.
- Serial umbilical artery Doppler assessment should be performed to assess for deterioration once FGR is diagnosed 1.
- Delivery timing should be based on the severity of FGR and presence of abnormal umbilical artery Doppler waveforms, with recommendations for delivery at 37 weeks for pregnancies with FGR and decreased diastolic flow, at 33-34 weeks for pregnancies with FGR and absent end-diastolic velocity (AEDV), and at 30-32 weeks for pregnancies with FGR and reversed end-diastolic velocity (REDV) 1.
From the Research
Advanced Maternal Age (AMA) Pregnancy Management
The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) guidelines for Advanced Maternal Age (AMA) pregnancy management are not explicitly stated in the provided studies. However, the studies discuss the risks associated with AMA pregnancies, which can inform management decisions.
Risks Associated with AMA Pregnancies
- Increased risk of spontaneous miscarriage, preterm labor, gestational diabetes mellitus, pre-eclampsia, stillbirth, chromosomal abnormalities, and cesarean delivery 2, 3, 4
- Adverse fetal outcomes, including infants small for gestational age, intrauterine growth restrictions, low Apgar score, admission to neonatal intensive care units, and autism spectrum disorder 2, 4
- Reduced fertility and increased incidence of pregnancy complications 5
Prenatal Screening and Diagnosis
- Next-generation sequencing (NGS) is the recommended method for prenatal screening among women of AMA 6
- Noninvasive prenatal testing (NIPT) can be used in combination with soft ultrasound markers to enhance the detection rate of clinically significant chromosomal abnormalities 6
- The incorporation of soft ultrasound markers and NIPT can significantly increase the detection rate of clinically significant copy number variations (CNVs) in women of AMA 6