Quick (unscientific) poll - early induction due to maternal age...

[PlinkertyPlonk]

I posted some time ago on this topic and the variety of answers got me wondering...

If you were of 'advanced maternal age' when you were due ie over-40's (or over-35's in some areas):

1. Were you told you would be induced early, due to your advanced maternal age (ie not for any other reason)?
2. Which healthcare trust was it (if you are happy to share this)?
3. If you were told you'd be induced early, what was your decision and the final outcome?

I understand that some consultants recommend early induction before due date because of a slightly increased risk of early placental failure in older mothers, but I can't find the research to support this (based on age alone) and it seems many consultants don't even mention it. It's not mentioned in the NICE guidelines.

So I'm just curious to see if it's something that's common only in 'the provinces'.

My answers:

1. Yes (age 41. No 'other' complications)
2. Taunton
3. Have yet to decide

I think it's well documented that older mums have an increased risk of stillbirth
news.bbc.co.uk/2/hi/health/6347239.stm
Though the risk is still very low and the article above suggests increased monitoring of older mums from 38 weeks (not induction).

The study I gave a link to looked at 6 million pregnancies ( don't know if the link came up correctly) I think it's the same one referred to in the BBC article above.

I haven't been offered early induction but have the option of elcs which I may take up to get the baby out safely (I also know an older mum who had a stillbirth at term which is no doubt influencing my decision).

I was 40 when I had dc4 and the consultant sanctioned sweeps from 37 weeks because I always have homebirths - she did mention that they like to induce at 40 weeks for women of my age but I told her very politely to get stuffed - I have never got to 40 weeks pregnant yet and certainly not going to line myself up for a hospital birth if I can avoid it. Am pregnant with dc5 and have not seen the consultant yet but I expect she will offer the same thing. I am in West Sussex.

Ok, different link, same study. It's possible my friends didn't access the whole research paper, or only read one of the referenced contributing papers.

The researchers also found that foetal checks at 38 weeks of pregnancy had the greatest impact on reducing stillbirth rates in older women.

So now i'm wondering, if this was their finding, why aren't we being offered monitoring from 38wks?

Here's the text of the article in case the link wasn't clear. The last paragraph talks about delivery at 39 weeks for older mothers.

Advanced maternal age is associated with an increased risk of stillbirth. In one of the largest studies to evaluate the influence of maternal age on stillbirth risk, Reddy et al. conducted an analysis of more than 5 million singleton deliveries. In this analysis, advanced maternal age was associated with a higher rate of stillbirth, with a peak risk period for stillbirth occurring among older mothers between 37 and 41 weeks of gestation.

Smith and Fretts presented data from a literature search. They presented an OR for stillbirth of 1.8?2.2 for women between 35 and 39 years of age and an OR of 1.8?3.3 for women over 40 years of age. Other epidemiological risk factors were nulliparity (OR: 1.2?1,4), smoking (OR: 1.7?3.0), obesity (BMI ≥30; OR: 2.1?2.8), having had a previous SGA infant (OR: 2.0?4.6), multiple gestations compared with singleton gestations and black compared with white race (OR: 2.0?2.2).

A total of 6,239,399 singleton pregnancies in the USA were analyzed by Bahtiyar et al. in order to evaluate the influence of advancing maternal age on stillbirth. The ORs were referred to the group of 25?29-year-old mothers who had the lowest stillbirth risk. When compared with this group, the odds of stillbirth at term increased significantly with advancing maternal age (OR for mothers aged 30?34 years: 1.24; OR for mothers aged 35?39 years: 1,45; and OR for mothers aged 40?45 years: 3.04).

Interestingly, the risk of stillbirth for women aged 40?44 years at 39 weeks of gestation is comparable with women aged 25?29 years at 42 gestational weeks.

Therefore, the authors concluded that a strategy of antenatal testing beginning at 38 gestational weeks for women over the age of 40 years may be considered. According to the authors, delivery by 39 weeks may also be considered for women over 40 years of age since the cumulative risk of stillbirth in women aged 40?44 years at 39 weeks is nearly identical to the risk in those aged 25?29 years at 42 weeks.

Ok, that explains why my friends couldn't find the sample size - they only looked at the Smith & Fretts paper.

Increased monitoring would be a good alternative. It's not easy to make a decision. I'm not a fan of inductions - I've only had one and it resulted in emcs. This time it will be elcs or natural start to labour for me, though I am lucky to be monitored at the hospital from due date onwards.

I was 46 when I had ds. My age wasn't really raised as an issue, until I mentioned I wanted a home birth.

1. No, was booked for an induction at their standard date - 40+10 I think.

(ds came one day before this, so I was saved an argument as I had no intention of going along with induction, and every intention of staying at home.)

2.Derby City

The chances of placental failure and subsequent stillbirth may three times higher in women over 40, but its three times a very small number.