Maternal age and fetal loss: population based register linkage study

doi:10.1136/bmj.320.7251.1708

BMJ 2000;320:1708-1712 ( 24 June )

General Practice

Maternal age and fetal loss: population based register linkage study

Editorial by Stein and Susser

Anne-Marie Nybo Andersen, research fellow, ^a Jan Wohlfahrt, statistician, ^a Peter Christens, statistician, ^a Jørn Olsen, professor of social medicine, ^b Mads Melbye, professor of epidemiology. ^a

^a Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, DK-2300 Copenhagen S, Denmark, ^b Institute of Epidemiology and Social Medicine, Danish Epidemiology Science Centre, University of Aarhus, DK-8000 Aarhus C, Denmark

Correspondence to: A-M Nybo Andersen any{at}ssi.dk

Objective: To estimate the association between maternalage and fetal death (spontaneous abortion, ectopic pregnancy,stillbirth), taking into account a woman's reproductivehistory.
Design: Prospective register linkagestudy.
Subjects: All women with a reproductive outcome (livebirth, stillbirth, spontaneous abortion leading to admission tohospital, induced abortion, ectopic pregnancy, or hydatidiformmole) in Denmark from 1978 to 1992; a total of 634 272 women and1 221 546 pregnancyoutcomes.
Main outcome measures: Age related risk of fetal loss, ectopic pregnancy,and stillbirth, and age related risk of spontaneous abortion stratifiedaccording to parity and previous spontaneousabortions.
Results: Overall, 13.5% of the pregnancies intendedto be carried to term ended with fetal loss. At age 42 years,more than half of such pregnancies resulted in fetal loss. Therisk of a spontaneous abortion was 8.9% in women aged 20-24 yearsand 74.7% in those aged 45 years or more. High maternal age wasa significant risk factor for spontaneous abortion irrespectiveof the number of previous miscarriages, parity, or calendar period.The risk of an ectopic pregnancy and stillbirth also increasedwith increasing maternalage.
Conclusions: Fetal loss is high in women in their late30s or older, irrespective of reproductive history. This shouldbe taken into consideration in pregnancy planning andcounselling.

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