Maternal and neonatal outcomes of spontaneously conceived pregnancies in mothers over 45 years: a review of the literature.

PURPOSE: There is little published data on pregnancy outcomes in women who had conceived spontaneously after age 45 years. The aim of this review is to provide accurate information on the risks and probable outcomes of spontaneously conceived pregnancies in women over the age of 45 years, which will enable clinicians to counsel such women appropriately, carry out adequate risk assessment, and ensure better care for pregnancies in this population.

DESIGN

A literature search was performed using EmBase and PubMed for English language articles published between 1970 and 2011, with extractable data on mothers aged ≥45 at the time of delivery and with ≥95% spontaneous conception in the study population.

RESULTS

Six such studies with a total pooled number of 505 women were identified. Overall, there is increased maternal morbidity and rates of caesarean section, as well as higher incidence of premature births and admission to special care baby unit. Contrary to popular belief, career is not always an important factor in delaying childbearing, especially in developing countries. Other factors may include cultural acceptance of large families and lack of contraception, although more research may be carried out in order to explain these hypotheses.

CONCLUSION

Pooled retrospective data suggest that women who conceived spontaneously after the age of 45 years have increased maternal morbidity and rates of caesarean section, as well as higher incidence of premature births and admission to special care baby unit.