What is considered advanced maternal age (AMA), sometimes referred to as geriatric pregnancy, in the medical field? What are the specific age cutoffs used to define AMA for both the initial pregnancy and subsequent pregnancies? Does this cutoff vary depending on the country or medical organization (e.g., ACOG, WHO)? Furthermore, beyond just the age definition, what are the statistically significant risks and potential complications associated with AMA pregnancies compared to pregnancies in women of younger age groups (e.g., increased risk of gestational diabetes, preeclampsia, chromosomal abnormalities, miscarriage, stillbirth, cesarean delivery, etc.)? Finally, how do recommendations for prenatal care and screening differ for women classified as AMA, and what counseling is typically provided regarding these risks and options?
Answer
Advanced maternal age (AMA), also historically referred to as geriatric pregnancy, is generally defined as being 35 years or older at the time of delivery. This definition stems from observations of increased risks of certain pregnancy complications for women in this age group, relative to younger women. The term "geriatric pregnancy" is now considered outdated and insensitive.
Key Considerations & Details:
- Fertility: Fertility naturally declines with age, especially after age 35. This decline is primarily due to a decrease in the quantity and quality of a woman’s eggs. Older women may experience longer times to conceive and a higher risk of infertility.
- Increased Risk of Complications: Several pregnancy-related complications are more common in women of advanced maternal age, including:
- Gestational Diabetes: The risk of developing gestational diabetes increases with age, potentially leading to complications for both the mother and baby.
- Hypertension and Preeclampsia: High blood pressure and preeclampsia (a pregnancy-specific condition characterized by high blood pressure and protein in the urine) are more frequent in older mothers.
- Placenta Previa: This condition, where the placenta covers the cervix, is more common with increasing maternal age.
- Preterm Labor and Delivery: AMA is associated with a slightly increased risk of delivering prematurely.
- Multiple Gestation: Older women undergoing fertility treatments are more likely to conceive twins or higher-order multiples.
- Miscarriage and Stillbirth: The risk of miscarriage and stillbirth increases with age.
- Cesarean Delivery: Older mothers are more likely to require a Cesarean delivery.
- Fetal Chromosomal Abnormalities: The risk of fetal chromosomal abnormalities, such as Down syndrome (Trisomy 21), increases significantly with maternal age. Prenatal screening and diagnostic testing are typically offered to women of AMA.
- Overall Health: The presence of pre-existing medical conditions is more common in older women. These conditions (e.g., hypertension, diabetes, heart disease) can further complicate pregnancy.
- Prenatal Care: Close monitoring and comprehensive prenatal care are essential for women of advanced maternal age to identify and manage potential complications.
- Vaginal Birth After Cesarean (VBAC): Women with AMA may face some challenges in achieving successful VBAC, so this needs to be addressed carefully.
- Outcomes: Despite the increased risks, many women over 35 have healthy pregnancies and deliver healthy babies. Advances in medical care and prenatal screening have improved outcomes for this age group.
- Changing Demographics: As women increasingly delay childbearing, the number of pregnancies in women of advanced maternal age has increased significantly.