Mr. Dinabandhu Barad
MSC TUTOR, SNC, SOA, DTU
• Scientific evidences shows that advance age, especially after the mid-
30s the women who conceive are at greater risk of pregnancy
• With use of assisted reproductive techniques (ART), births have been
reported in women as old as 66 years of age.
• The oldest woman to achieve a naturally conceived pregnancy was 57
PREGNANCY AT ADVANCED
MATERNAL AGE MAY BE DUE TO
1- Late marriage.
2- Long period of primary infertility.
3- Delayed childbearing.
ADVANCED AGE PREGNANCY ISSUES
• Older women are at risk for the same pregnancy complications as younger
women, but their risk is higher .
The calculated risk of spontaneous loss in each age group was :
<30 years of age (12 %),
30 to 34 years (15 %),
35 to 39 years (25 %),
40 to 44 years (51 %),
≥45 years (93 %).
• Down Syndrome (Trisomy 21)
• Edward Syndrome (Trisosomy 18)
• Ectopic pregnancy (Maternal age ≥35 years is associated with a 4-8
fold increased risk of ectopic pregnancy compared with younger
ADVANCED AGE PREGNANCY ISSUES
• More recent analysis suggests that, as women age, the risk of non-
chromosomal anomalies increases.
• Cardiac anomalies, in particular, seem to increase with maternal age
independent of aneuploidy.
• Clubfoot and congenital diaphragmatic hernia were also increased.
• Congenital malformation rate:
3.5%, in women 20-24 years of age
4.4% in women 35 to 39 years and
5% in women ≥40 years .
• Maternal and fetal morbidity and mortality related to hypertensive disorders
during pregnancy can be reduced with:
Careful monitoring and
Appropriately timed intervention,
But with an increase in :
• The prevalence of diabetes increases with maternal age.
• The rates of both preexisting diabetes mellitus and gestational diabetes increase
3-6 fold in women ≥40 years, compared with women aged 20 - 29 years
• The incidence in the general obstetric population of gestational diabetes is 3%
7 to 12% in women over age 40, and
20% in women over age 50.
• Preexisting diabetes is associated with increased risks of: congenital anomalies,
perinatal mortality, and perinatal morbidity,
• While the major complication of gestational diabetes is macrosomia and its
LATE PREGNANCY ISSUES
• Some obstetrical complications appear to be related to the aging process alone,
• While others are largely related to coexisting factors such as:
• multiple gestation, higher parity, and chronic medical conditions, which are less
likely to be observed in younger women.
Advanced maternal age is responsible for a substantial proportion of the increased
• low birth weight (LBW) and
• preterm delivery (PTD).
The relative risk of stillbirth increases with increasing maternal age (ie, it is higher
at age 40 than at age 35) and is most notable after about 37 weeks of gestation .
• The excess perinatal mortality is largely due to non-anomalous fetal deaths,
which are often unexplained, even after controlling for risk factors such as:
hypertension, diabetes, antepartum bleeding, smoking.
• Advancing age is associated with an increased prevalence of twin pregnancy, It is
related to both a higher risk of naturally-conceived twins and a higher use of ART
in older women.
1- Higher incidence of:
Chromosomal abnormalities. (triosmy 21 → 1/350 after age of 35 yrs) .
Congenital fetal malformation.
Preterm labor with all the hazards of prematurity.
2- ↑ Perinatal mortality rate
• Women should be advised about the risks of Down syndrome and other
chromosomal abnormalities. They should be made aware of:
Available screening techniques,
Their accuracy and effectiveness, as well as the
Inherent risks of definitive testing with amniocentesis or chorionic villus
• It is the study of abnormal development in embryos and the causes of
congenital malformations or birth defects.
• These anatomical or structural abnormalities are present at birth although they
may not be diagnosed until later in life.
• They may be visible on the surface of the body or internal to the viscera.
• Congenital malformations account for approximately 20% of deaths in the
• Teratogenic agents cause approximately 7% of congenital malformations.
• A teratogenic agent is a chemical, infectious agent, physical condition, or
deficiency that, on fetal exposure, can alter fetal morphology or subsequent
• Teratogenicity depends upon the ability of the agent to cross the placenta.
• Certain medications such as heparin cannot cross the placenta due to its high
molecular weight and are therefore not teratogenic.
• The embryo is most susceptible to teratogenic agents during periods of rapid
• The stage of development of the embryo determines susceptibility to
• The most critical period in the development of an embryo or in the growth of
a particular organ is during the time of most rapid cell division.
• For instance, the critical period for brain growth and development is from
three to 16 weeks.
• However the brain’s differentiation continues to extend into infancy.
• Teratogens can produce mental retardation during both embryonic and fetal
• In general, drugs, food additives, and pesticides are tested to determine their
teratogenicity to minimize exposure of pregnant women to teratogenic agents.
• It should be emphasized that less than 2% of congenital malformations are
caused by drugs or chemicals.
• There are small numbers of drugs that have been positively implicated as
teratogenic agents that should be avoided either during or prior to conception.
• However, because of the unknown, subtle effects of many agents, women
preparing to conceive or already pregnant refrain from taking any medications
that are not absolutely necessary.
EFFECT OF MATERNAL DRUGS
• Nicotine does not produce congenital malformations but nicotine does have a
effect on fetal growth.
• Maternal smoking is a well-established cause of intrauterine growth
• Heavy cigarette smokers were also more likely to have a premature delivery.
EFFECT OF MATERNAL DRUGS
• Nicotine constricts uterine blood vessels and causes decreased uterine blood
flow thereby decreasing the supply of oxygen and nutrients available to the
• This compromises cell growth and may have an adverse effect on mental
• Alcohol is a common drug abused by women of childbearing age.
• Infants born to alcoholic mothers demonstrate prenatal and postnatal growth
deficiency, mental retardation, and other malformations.
• There are subtle but classical facial features associated with fetal alcohol
syndrome including short palpebral fissures, maxillary hypoplasia, a smooth
philtrum, and congenital heart disease.
• Even moderate alcohol consumption consisting of 2 to 3 oz. of hard liquor per
day may produce the fetal alcohol effects.
• Binge drinking also likely has a harmful effect on embryonic brain
developments at all times of gestation.
• Tetracycline, the type of antibiotic, can cross the placental membrane and
is deposited in the embryo
• in bones and teeth. Tetracycline exposure can result in yellow staining of
the primary or deciduous
• teeth and diminished growth of the long bones. Tetracycline exposure after
birth has similar effects.
• Anticonvulsant agents such as phenytoin produce the fetal hydantoin
syndrome consisting of intrauterine growth retardation, microcephaly, mental
retardation, distal phalangeal hypoplasia, and specific facial features.
• Anti-neoplastic or chemotherapeutic agents are highly teratogenic as these
agents inhibit rapidly dividing cells.
• These medications should be avoided whenever possible but are occasionally
used in the third trimester when they are urgently needed to treat the
• Retinoic acid or vitamin A derivatives are extremely teratogenic in humans.
• Even at very low doses, oral medications such as isotretinoin, used in the treatment
of acne, are potent teratogens.
• The critical period of exposure appears to be from the second to the fifth week of
• The most common malformations include craniofacial dysmorphisms, cleft palate,
thymic aplasia, and neural tube defects
• This hypnotic agent was used widely in Europe in 1959, after which an
estimated 7000 infants were born with the thalidomide syndrome or
• The characteristic features of this syndrome include limb abnormalities that
span from absence of the limbs to rudimentary limbs to abnormally
• Additionally, thalidomide also causes malformations of other organs including
absence of the internal and external ears, hemangiomas, congenital heart
disease, and congenital urinary tract malformations.
• The critical period of exposure appears to be 24 to 36 days after fertilization.