Juan Balasch1, Eduard Gratacós. 1. Institut Clínic of Gynecology, Obstetrics and Neonatology, Hospital ClínicInstitut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Abstract
PURPOSE OF REVIEW: The proportion of women who are intentionally delaying pregnancy beyond the age of 35 years has increased greatly in the past few decades because of the clash between the optimal biological period for women to have children with obtaining additional education and building a career. This article highlights the effects of delayed childbearing on fertility and obstetric and perinatal outcome. RECENT FINDINGS: Demographic studies indicate that fertility rates are falling in many countries, Europe being the continent with lowest total fertility rate. Female employment and childrearing can be combined when the reduction in work-family conflict is facilitated by state of policy intervention. It has been traditionally accepted that fertility is more related to the age of the female than the male partner but recent literature suggests trends that increased paternal age is also associated with lower fertility, an increase in pregnancy-associated complications and an increase in adverse outcome in the offspring. Delayed childbearing is rarely a conscious choice and women are unaware that, at present, with the exception of egg donation, assisted reproductive technology has no answer yet to age-related decline of female fertility. There is no evidence of a beneficial effect of preimplantation genetic screening for women of advanced maternal age. Concerning perinatal outcomes, apart from the known effects of advanced maternal age on common fetal and obstetric complications, recent evidence increasingly points toward an independent association between maternal (and paternal age) and cerebral palsy, neurocognitive and psychiatric disorders. SUMMARY: The consequences of advancing maternal and paternal age are not only relevant for the risk of natural and assisted conception, but also for the outcome of pregnancy. Although the absolute rate of poor pregnancy outcomes may be low from an individual standpoint, the impact of delaying childbearing from a public health perspective cannot be overestimated and should be in the agenda of public health policies for the years to come.
PURPOSE OF REVIEW: The proportion of women who are intentionally delaying pregnancy beyond the age of 35 years has increased greatly in the past few decades because of the clash between the optimal biological period for women to have children with obtaining additional education and building a career. This article highlights the effects of delayed childbearing on fertility and obstetric and perinatal outcome. RECENT FINDINGS: Demographic studies indicate that fertility rates are falling in many countries, Europe being the continent with lowest total fertility rate. Female employment and childrearing can be combined when the reduction in work-family conflict is facilitated by state of policy intervention. It has been traditionally accepted that fertility is more related to the age of the female than the male partner but recent literature suggests trends that increased paternal age is also associated with lower fertility, an increase in pregnancy-associated complications and an increase in adverse outcome in the offspring. Delayed childbearing is rarely a conscious choice and women are unaware that, at present, with the exception of egg donation, assisted reproductive technology has no answer yet to age-related decline of female fertility. There is no evidence of a beneficial effect of preimplantation genetic screening for women of advanced maternal age. Concerning perinatal outcomes, apart from the known effects of advanced maternal age on common fetal and obstetric complications, recent evidence increasingly points toward an independent association between maternal (and paternal age) and cerebral palsy, neurocognitive and psychiatric disorders. SUMMARY: The consequences of advancing maternal and paternal age are not only relevant for the risk of natural and assisted conception, but also for the outcome of pregnancy. Although the absolute rate of poor pregnancy outcomes may be low from an individual standpoint, the impact of delaying childbearing from a public health perspective cannot be overestimated and should be in the agenda of public health policies for the years to come.
Authors: Ashley H Woodson; Kimberly I Muse; Heather Lin; Michelle Jackson; Danielle N Mattair; Leslie Schover; Terri Woodard; Laurie McKenzie; Richard L Theriault; Gabriel N Hortobágyi; Banu Arun; Susan K Peterson; Jessica Profato; Jennifer K Litton Journal: Oncologist Date: 2014-06-20
Authors: Liona C Poon; Andrew Shennan; Jonathan A Hyett; Anil Kapur; Eran Hadar; Hema Divakar; Fionnuala McAuliffe; Fabricio da Silva Costa; Peter von Dadelszen; Harold David McIntyre; Anne B Kihara; Gian Carlo Di Renzo; Roberto Romero; Mary D'Alton; Vincenzo Berghella; Kypros H Nicolaides; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2019-05 Impact factor: 3.561
Authors: Aladdin H Shadyab; Margery L S Gass; Marcia L Stefanick; Molly E Waring; Caroline A Macera; Linda C Gallo; Richard A Shaffer; Sonia Jain; Andrea Z LaCroix Journal: Am J Public Health Date: 2016-11-17 Impact factor: 9.308
Authors: Xiong Lili; He Jian; Zeng Mengjun; Wu Yinglan; Xie Donghua; Wang Aihua; Kong Fanjuan; Wang Hua; Liu Zhiyu Journal: PLoS One Date: 2018-11-26 Impact factor: 3.240
Authors: Ayesha C Sujan; Martin E Rickert; Quetzal A Class; Claire A Coyne; Paul Lichtenstein; Catarina Almqvist; Henrik Larsson; Arvid Sjölander; Benjamin B Lahey; Carol van Hulle; Irwin Waldman; A Sara Öberg; Brian M D'Onofrio Journal: Behav Genet Date: 2015-09-24 Impact factor: 2.805
Authors: Jason R Kovac; Josephine Addai; Ryan P Smith; Robert M Coward; Dolores J Lamb; Larry I Lipshultz Journal: Asian J Androl Date: 2013-08-05 Impact factor: 3.285