About Advanced Maternal Age

Women are overall waiting longer to have children, often while they pursue education and careers.  Medically, women who have children at age 35 or older are considered to be of advanced maternal age, even though 20% of all women have their first child at age 35 or after.  There are six pregnancy-related risk factors associated advanced maternal age: decreased fertility, miscarriage, genetic problems, high blood pressure, stillbirth, and maternal death.

Declining Fertility:  Negligent Fertility Treatments and Miscarriage

Statistically, older women are less fertile.  It is not an all-or-nothing degree of fertility like a light switch, but rather it is a sliding scale.  Among each age group, compared to the prior age group, there are fewer pregnancies where birth control is not practiced.  One study resulted in the following data (see Linda J. Hefner, Advanced Maternal Age—How Old Is Too Old?  N. Engl. J. Med. 351:19, 1927 (Nov. 4, 2004).

Maternal Age Group

Percentage of Spontaneous Abortions (approx.)

Fertility Rate (approx.)

20-24

12.0%

47.5%

25-29

13.0%

44.0%

30-24

15.0%

41.0%

35-29

24.0%

33.5%

40-44

51.0%

19.0%

45+

93.0%

25.0% 

This means that women aged 35 and older, as a group, have more difficulty becoming pregnant and delivering children.  There are two major reasons why this increased difficulty is important for medical malpractice.

First, women over age 35 are more likely to undergo fertility treatments to overcome an inability to become pregnant.  Those fertility treatments and the resulting pregnancies carry with them an increased risk that must be considered and monitored by doctors.  Though the choice of in vitro fertilization has a four percent higher risk of genetic abnormalities, many problems are preventable.  Some of the negligent risks of fertility treatments include:

    • Bleeding and death from egg retrieval procedures
    • Implanting the wrong embryo, using the wrong sperm, or using the wrong eggs
    • Failing to test donated products for sexually transmitted diseases
    • Failure to perform proper genetic testing or health/age background checks on donors and donated biological materials, resulting in children born with genetic injuries
    • Negligent destruction of viable embryos

Second, women aged 35 and older are more likely to have miscarriages.  Miscarriage is a spontaneous abortion before 20 weeks.  These risks are often caused by increased chromosomal abnormalities (see below).  In a small percentage of situations, doctors may be able to prevent miscarriage through medication and other interventions.  Doctors must timely diagnose a miscarriage to prevent maternal harm—if not properly diagnosed a harmful and perhaps fatal infection could be the result.

Chromosomal Abnormalities

Advanced maternal age is widely recognized as increasing the risk for chromosomal abnormalities.  These are genetic problems that can cause health problems for the baby, including Down Syndrome, Tay-Sach’s disease, cystic fibrosis and others. There is no cure for these conditions, however doctors may have a responsibility to timely diagnose genetic defects.  In many states, parents have a right to terminate the pregnancy because of genetic defects, when detected early enough.  A doctor who fails to give expectant parents that option may be responsible for the extraordinary medical care that the child will require over his or her lifetime.  Lawsuits of that nature are known as wrongful birth cases.

Courtesy New England Journal of Medicine

Hypertensive Complications

Increases in blood pressure (hypertension) can cause problems in pregnancy.  Women aged 40 and older are both more likely to have higher pre-pregnancy hypertension, and more likely to develop pregnancy-related hypertension.  High blood pressure can cause premature delivery, which means that “older” women are more likely to delivery premature or low-birthweight babies.  For more about the risks of hypertension, see Eclampsia and Preeclampsia Injuries.  Doctors must take care to identify hypertension and to treat it during the pregnancy to ensure the baby’s health.

Stillbirth

Also associated with advanced maternal age is stillbirth, the death of the baby after 20 weeks.  Women aged 40+ are two and-a-half times as likely to have a stillborn baby.  Stillbirth is not common under either circumstance, but wrongful death of the baby is still a risk.

Maternal Death

Finally, as women age there is an increased risk of maternal death during pregnancy, labor and delivery.  Some studies have indicated that women 35 and older may be three times as likely to die because of pregnancy or childbirth, compared to younger mothers.  Like stillbirth, however, maternal mortality is rare at any age.

Contact Us

If you want to talk to a medical malpractice lawyer about injuries or complications to the mother or baby, and to determine whether those injuries were related to the normal risks associated with “advanced maternal age,” or whether the doctors and health care team should have done more to prevent injury, contact us at (855) 712-7818 or online for a free consultation.

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