Alderens betydning for fruktbarhet, svangerskap og fødsler Tom Tanbo Nasjonalt kompetansesenter for kvinnehelse Kvinneklinikken, Rikshospitalet
Kvinnens alder ved første fødsel 1968 2006 30 25 20 15 10 5 0 1968 1972 1976 1980 1984 1988 1992 1996 2000 2004
Aldersjusterte fruktbarhetsrater
Når man er sånn førti eller femti år, slutter damene å legge egg. Det vil si at de ikke lenger kan produsere folk. Hekkingen begynner sånn i fjortenårsalderen og varer helt til middelalderen.
The decreasing follicle pool and the corresponding reproductive events
Ekteskapelige fruktbarhetsrater på 5-års aldersgrupper i 10 historiske populasjoner. Menken et al. 1986
Sterilitet som funksjon av alder blant 209 nord-amerikanske hutterittkvinner 100 % 90 % 80 % 70 % 60 % 50 % 40 % 30 % 20 % 10 % 0 % < 25 25-29 30-34 35-39 40-44 45-49
Distribution of age at various reproductive events Broekmans et al. 2007
Frekvens av kromosomfeil i ubefruktede egg som funksjon av kvinnens alder Pellestor 2003 Aneuploidier 23,X
Crude maternal age-specific for Down syndrome and all chromosomal abnormalities Hsu LYF. 1998 Maternal age Liveborn data Amniocentesis data Down syndrome All abnormalities Down syndrome All abnormalities 33 1/625 1/345 1/416 1/208 34 1/500 1/277 1/333 1/151 35 1/385 1/204 1/250 1/132 36 1/303 1/167 1/192 1/105 37 1/227 1/130 1/149 1/83 38 1/175 1/103 1/115 1/65 39 1/137 1/81 1/89 1/53 40 1/106 1/63 1/69 1/40 41 1/81 1/50 1/53 1/31 42 1/64 1/39 1/41 1/25 43 1/50 1/30 1/31 1/19 44 1/38 1/24 1/25 1/15 45 1/30 1/19 1/19 1/12
Percent pregnancy loss by maternal age at conception Andersen et al. Postgrad Obstet Gynecol 2000 Maternal age Spontaneous abortion (%) Ectopic pregnancy (%) 12-19 13.3 2.0 5.0 20-24 11.1 1.5 4.2 25 29 11.9 1.6 4.0 30-34 15.0 2.8 4.4 35 39 24.6 4.0 5.0 40 44 51.0 5.8 6.7 > 45 93.4 7.0 8.2 Stillbirth rate (per 1000)
Are primiparous women of advanced maternal age at increased risk of adverse perinatal outcomes? Centre for Clinical Effectiveness Monash University Australia 1998
Are primiparous women. Cont. Utfall av svangerskap hos 3807 førstegangsfødende med alder >= 35 år fra 7 retrospektive register- studier sammenliknet mot svangerskapsutfall hos 30801 yngre førstegangsfødende Hos eldre førstegangsfødende er det: Økt risiko for keisersnitt Økt risiko for preeklampsi og hypertensjon i svangerskapet Økt risiko for svangerskapsdiabetes Ikke økt risiko for perinatal eller maternell død
Preconception health status of women who recently gave birth to a live-born infant D Angelo et al. MMWR Surveillance Summaries 2007;56 (SS10);1-35 Preconception exposure < 20 years 20 34 years > 35 years Tobacco use 31.1 + 2.2 24.0 + 0.8 13.4 + 1.5 Alcohol use 34.6 + 2.2 51.2 + 0.9 55.2 + 2.1 Multivitamin use 17.9 + 1.8 34.4 + 0.8 51.6 + 2.1 Health counselling 15.6 + 3.6 29.5 + 1.4 42.2 + 3.8 Underweight 22.1 + 2.0 12.8 + 0.6 9.0 + 1.2 Obesity 15.5 + 1.9 26.2 + 0.9 27.2 + 2.0 Diabetes 2.0 + 0.7 1.6 + 0.2 3.0 + 0.7 Hypertension* 2.5 + 1.8 1.8 + 0.6 4.1 + 1.6 Heart problems* 1.1 + 1.1 1.2 + 0.5 1.1 + 1.1 * 4 states
Pregnancy after age 40 antepartum and intrapartum associated diseases (n=24032) Gilbert et al. Obstet Gynecol 1999 Diagnosis Nulli Parous(%) Adjusted OR Multi Parous(%) Adjusted OR 20 29 y > 40 y 20 29 y > 40 y Hypertension 0.3 1.6 4.7 (3.7,6.0) 0.2 1.8 8.9 (7.8,10.2) Diabetes 0.5 1.4 3.3 (2.5,4.2) 0.5 2.7 6.4 (5.8,7.1) Gest. diabetes 1.7 7.0 4.0 (3.6,4,5) 1.6 7.8 4.0 (3.6,4.5) Preeclampsia 3.4 5.4 1.8 (1.6,2.1) 1.0 2.7 3.1 (2.8,3.4) Placenta previa 0.03 0.25 10.5 (5.4,20) 0.05 0.13 2.7 (1.8,3.6) Prematurity 9.1 14.1 1.7 ( 1.6,1.9) 10.3 13.7 1.4 (1.3,1.5) Postmaturity 12.1 7.2 0.6 (0.5,0.7) 12.0 7.4 0.65 (0.6,0.7) Malpresentation 6 11 1.7 (1.6,1.9) 3.7 6.9 1.4 (1.3,1.5) Fetal disproportion 6.9 10.6 1.5 (1.4,1.7) 1.8 2.9 1.6 (1.4,1.7) Obstructed labor 10.8 12.6 1.3 (1.2,1.4) 6.3 7.8 1.4 (1.3,1.5) Prolonged labor 2.5 3.6 1.3 (1.1,1.6) 0.6 0.9 1.5 (1.3,1.8) Abnormal forces labor 10.8 16.0 1.5 (1.4,1.7) 6.3 7.8 1.2 (1.1,1.3)
Delivery mode (n=24032) Gilbert et al. Obstet Gynecol 1999 Diagnosis Nulli Parous(%) Multi Parous(%) 20 29 y > 40 y 20 29 y > 40 y Cesarean section 22.5% 47.0% 17.8% 29.6% Forceps 3.1% 4.5% 0.8% 1.2% Vacuum 9.8%* 9.7% 3.8% 5.1% Gestational age 278.5+0.1 d 273.4+0.4 d 278.3+0.1 d 274.0+0.2 d Birth weight 3317+1 g 3201+10 g 3387*+5 g 3381+5 g * *P = not significant. P < 0.05 for remaining statistical comparisons between age groups within the nulliparous and multiparous subgroups
Neonatal and infant complications Gilbert et al. Obstet Gynecol 1999 Diagnosis Nulli Parous(%) Adjusted OR Multi Parous(%) Adjusted OR 20 29 y > 40 y 20 29 y > 40 y Birth trauma 8.2 6.6 0.8 (0.7,0.9) 4.2 4.3 1.1 (1.0,1.2) Birth asphyxia 4.0 6.0 1.6 (1.4,1.8) 2.4 3.4 1.5 (1.4,1.7) Fetal growth restriction Intraventricular hemorrhage 1.4 2.5 1.9 (1.6,2.3) 1.0 1.4 1.6 (1.4,1.8) 0.1 0.2 1.9 (0.9,3.9) 0.08 0.14 1.9 (1.3,2.8) Infant death 0.53 0.54 1.2 (0.8,1.8) 0.71 0.96 1.5 (1.3,1.8) Neonatal death 0.35 0.4 1.4 (0.9,2.2) 0.39 0.6 1.7 (1.3,1.9)
Intrapartum characteristics and obstetric outcome in 10737 consecutive nulliparas in spontaneous term labor with singleton cephalic presentation Treacy A. et al. Am J Ob stet Gynecol 2006 Maternal age < 20 n=1039 20 24 n=2193 25 29 n=3202 30 34 n=3202 > 35 n=1091 Oxytocin augmentation 47% 53% 60% 63% 60% Prolonged labour 1.4% 2.4% 4.3% 4.3% 5.3% Instrumental delivery 7.5% 12% 18% 23% 25% C. Section - all 3.2% 5.0% 6.5% 7.4% 10.2% C.S. dystocia 1.3% 1.8% 2.9% 3.5% 4.5% Epidural 86% 83% 87% 88% 86% Mean gestation (weeks) 39.9 39.9 39.9 39.9 39.9 Mean birth weight (g) 3555 3597 3592 3604 3602
Risiko for ø. hjelp keisersnitt (mekanisk misforhold eller føtalt hypoxi) som funksjon av mors alder Main DM et al. Am J Ob Gyn 2000
Hazard (risk) of stillbirth for singleton births without congenital anomalies by gestational age, 2001-2002 Reddy et al. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 2006; 195:764
Maternal mortality rates by age United States and Canada 1982-1997 Hoyert DL et al. Birth 2000 Maternal age (years) Mortality rate* < 20 5.7 (3.8 8.2) 20 24 6.6 (5.1 8.5) 25 29 7.9 (6.3 9.8) 30 34 8.3 (6.5 10.4) 35 39 12.7 (9.5 16.7) > 40 33.9 (22.3 49.3) * Per 100 000 live births. 95% CI in brackets
Romanian Adriana Iliescu, now 67, gave birth to a daughter, Eliza Maria, in January 2005 after a decade of fertility treatment.