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Advanced Maternal Age

We want to give you some additional information about Advanced Maternal Age (AMA). AMA is the term used for women who are 35 years of age or older at the time of delivery. We have many AMA patients in our practice, and most deliver healthy babies without incident.

We want to give you some additional information about Advanced Maternal Age (AMA). AMA is the term used for women who are 35 years of age or older at the time of delivery. We have many AMA patients in our practice, and most deliver healthy babies without incident.


We want to provide the best care for you and your baby, and so we will begin some additional testing at 36 weeks in your pregnancy. This will consist of a non-stress test (NST) and a biophysical profile (BPP). A non-stress test consists of monitoring the fetal heart rate for at least 20 minutes. We are looking for certain patterns in the heart rate that suggest fetal well-being. A BPP is an ultrasound where we look at the amount of fluid around the baby and for fetal movement and practice breathing movements. Studies have shown that AMA mothers are at increased risk for high blood pressure and preeclampsia, gestational diabetes, preterm delivery, and low birth weight. AMA mothers are also more likely to have placenta previa, a condition where the placenta is located over the cervix. AMA women are at an increased risk for abnormal progression of labor and for cesarean delivery. They are also at an increased risk for stillbirth.

A study that looked at over five million pregnancies in the United States found the risk of stillbirth at 37 to 41 weeks was 3.73 per 1000 for women under the age of 35, 6.41 per 1000 for women age 35 to 39, and 8.65 per 1000 for women over the age of 40. This increased risk was present even after accounting for medical diseases and race/ethnicity. The risk of stillbirth increased with increasing gestational age. Many studies have found similar results. One meta-analysis concluded that there is a 65% increase in the odds of stillbirth among women over 35.

References:
Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in highincome
countries: a systematic review and meta-analysis. Lancet 2011; 377:1331.
Fox NS, Rebarber A, Silverstein M, et al. The effectiveness of antepartum surveillance in
reducing the risk of stillbirth in patients with advanced maternal age. Eur J of Obstet
Gynecol 2013; 170: 387.
Franz MB, Hussllein PW. Obstetrical management of the older gravida. Women’s health
2010; 6 (3) 463-8.
Page JM, Snowden JM, Chen YW, et al. The risk of stillbirth and infant death by each
additional week of expectant management stratified by maternal age. Am J Obstet
Gynecol 2013; 209:375.e1-7.
Reddy, UM, Ko CW, Willinger M. Maternal age and the risk of stillbirth throughout
pregnancy in the United States. Am J Obstet Gynecol 2006; 195:764.

 

We have also developed guidelines for timing of delivery:

- If you have a spontaneously conceived pregnancy and are age 35-39, we recommend delivery by 41 weeks.

- If you are over the age of 40 and have a spontaneous pregnancy, we will plan to deliver you by 40 weeks.

- IVF pregnancies are slightly higher risk, and as such, we deliver our 35-39 year old IVF moms by age 40 weeks, and our IVF patients who are over 40 will be delivered by 39 weeks.

**These are general guidelines and some patients may need to be delivered even earlier than the above dates if there are other concerns for maternal and fetal safety. Please ask your doctor any questions you may have about this information.