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Association of paternal age with perinatal outcomes between 2007 and 2016 in the United States: population based cohort study

BMJ 2018; 363 doi: (Published 31 October 2018) Cite this as: BMJ 2018;363:k4372

Linked editorial

Paternal factors in preconception care: the case of paternal age

Linked opinion

Don’t forget the father

  1. Yash S Khandwala, resident physician1,
  2. Valerie L Baker, professor2,
  3. Gary M Shaw, NICU nurses professor3,
  4. David K Stevenson, Harold K Faber professor3,
  5. Ying Lu, professor4,
  6. Michael L Eisenberg, associate professor12
  1. 1Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5118, USA
  2. 2Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
  3. 3Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
  4. 4Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
  1. Correspondence to: M L Eisenberg eisenberg{at} (or @drmeisenberg on Twitter)
  • Accepted 2 October 2018


Objective To evaluate the impact of advanced paternal age on maternal and perinatal outcomes in the United States.

Design Retrospective, population based cohort study.

Setting US.

Population 40 529 905 documented live births between 2007 and 2016.

Main outcome measures Primary perinatal outcomes were gestational age, birth weight, Apgar score at five minutes, admission to a neonatal intensive care unit, need for postpartum antibiotics, and seizures. Primary maternal outcomes were gestational diabetes and pre-eclampsia. Secondary outcome was the number of preventable perinatal events.

Results Higher paternal age was associated with an increased risk of premature birth, low birth weight, and low Apgar score. After adjustment for maternal age, infants born to fathers aged 45 years or older had 14% higher odds of premature birth (odds ratio 1.14, 95% confidence interval 1.13 to 1.15), independent of gestational age, and 18% higher odds of seizures (1.18, 0.97 to 1.44) compared with infants of fathers aged 25 to 34 years. The odds of gestational diabetes was 34% higher (1.34, 1.29 to 1.38) in mothers with the oldest partners. 13.2% (95% confidence interval 12.5% to 13.9%) of premature births and 18.2% (17.5% to 18.9%) of gestational diabetes in births associated with older fathers were estimated to be attributable to advanced paternal age.

Conclusions Advanced paternal age is associated with negative effects on both mothers and offspring. Given the relatively low prevalence of advanced paternal age in the US, population level impacts are currently modest. Nevertheless, as advanced paternal age has doubled in the US over the past generation, further investigation is warranted of the impact on birth outcomes and public health.


  • Contributors: All authors were involved in the design of the study, collection and analysis of the data, interpretation of the findings, and preparation and review of the manuscript. ME is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: None.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

  • Transparency: The lead author (ME) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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