Older Women at Greater Risk of Death in Childbirth

While the numbers are small, the threat exists

FRIDAY, Oct. 31, 2003 (HealthDayNews) -- Having a baby after age 35 could dramatically increase the risk of dying in childbirth, and older black women are the most vulnerable.

That's the word from the U.S. Centers for Disease Control and Prevention (CDC), which has just published new data that shows the risk of death from childbirth is nearly three times greater in women over 35 than in women aged 25 to 29.

The seven-year study, reported in the November issue of Obstetrics and Gynecology, also reveals that for black women over age 35, the mortality risk is seven times that of younger black women.

But the study authors say it's important to keep these figures in perspective.

"The actual absolute risk of death for any woman, including women who are 35, is still very small. But compared to a lower risk group, the threat of death during childbirth is still larger in the group of older women," says study author Dr. William M. Callaghan, a CDC researcher in Atlanta.

During the study period, which lasted from 1991 through 1997, the overall "pregnancy related mortality risk" was 11.5 deaths per every 100,000 live births, Callaghan says.

But when the women were subdivided by age, the difference in risk became apparent.

"In women 25 to 29, the pregnancy related morality risk is nine deaths per 100,000 births. In women aged 35 and older, the risk jumps to 25 deaths per 100,000 births -- or nearly three times the rate of the younger women. In black women, it jumped even higher," Callaghan says.

The major causes of death for all women included hemorrhage, infection, embolisms (blood clots) and blood pressure disorders. Ironically, however, Callaghan says he doesn't know if these conditions occur more frequently in older women, or if they simply have more devastating consequences when they do happen.

For New York University obstetrician Dr. Michael Silverstein, the study results are not surprising.

"We've known for a long time that the older a woman gets, the higher her risks for all sorts of pregnancy-related problems, including the risk of death," Silverstein says.

Still, he cautions that, overall, the risk of death from childbirth in the United States is still small and older women should not be afraid to get pregnant.

"A woman's peak fertility is around age 28, and if you can have your children during this general time period it's a plus, not only for your baby's sake, but for your sake as well," Silverstein says.

"However," he adds, "that said, it doesn't mean that older women should be afraid to get pregnant. But it also means they do need a bit more attention, and perhaps a more watchful eye concerning some of the potential complications that can occur."

Callaghan agrees: "The ultimate message isn't so much that women 35 and older should be afraid to get pregnant, but that all women, especially older women, need to have conversations with their health-care provider when they are contemplating pregnancy, and to have an overall health risk assessment before conceiving."

The study analyzed birth and death records nationwide. Deaths were considered pregnancy-related if they occurred during gestation or within one year of giving birth and resulted from complications of the pregnancy itself. The researchers further refined the study by considering age, race and obstetric variables, such as the type of delivery and the cause of death.

In a second study also published in the November issue of Obstetrics and Gynecology, doctors from the University of Alabama at Birmingham examined fetal health in pregnant women over age 50. Their finding: A baby born to a woman over age 50 had triple the risk of low birth weight, preterm delivery, and very pre-term delivery when compared to babies born to younger women.

In cases when the pregnancy involved more than one baby, the infants of women 50 or over had a greater risk of complications than those born to mothers aged 40 to 49.

More information

To learn more about prenatal counseling, visit The March of Dimes. The organization also has information on pregnancy after age 35.

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