Older maternal age and cesarean section rates - Tips From Other Journals

Date: August, 1991

The rate of deliveries by cesarean section has been increasing in the United States since the 1970s. Some clinicians are concerned that a growing number of these procedures are performed without adequate medical indications. Of particular concern is the high rate of cesarean section in women delivering their first child at the age of 35 years or older. Gordon and colleagues performed a population-based cohort study to determine whether older maternal age alone is a predictor of primary cesarean delivery.

The investigators reviewed data from the vital records of 2,985 women over 35 years of age who delivered live, singleton infants in 1986or 1987 in King County, Washington. Women with a history of cesarean section and those delivering infants with congenital abnormalities or infants weighing less than 500 g (1 lb, 6 OZ) were excluded from the analysis. Data on the older mothers were compared with data on 6,140 randomly selected women aged 20 to 29 years who gave birth over the same time period in the same geographic area.

The older women were of higher socioeconomic status, smoked less and were more likely to be white than the younger women. Infants born to the older women also tended to have higher birth weights than the other infants. Conversely, the older women had twice the rate of genital herpes and diabetes than the younger women.

Primiparous and multiparous women aged 35 years or older were at similar increased risk of cesarean delivery. Primiparous women of all ages experienced more complications of pregnancy and labor and had higher rates of cesarean delivery than multiparous women. However, among primiparous women with no complications of pregnancy or labor and delivery, older mothers were at significantly increased risk of cesarean delivery, compared with the younger mothers (relative risk: 2.5). This risk was not changed by adjustment for birth weight of the infant, race and income. In multiparous older women with complications, a slightly increased risk of cesarean section was noted (relative risk: 1.4).

The authors believe that older women are at increased risk of cesarean delivery, even in the absence of clear indications for the procedure. Older maternal age alone may influence a physician's decision regarding method of delivery and may place some women at unnecessary risk of surgery. (Obstetrics and Gynecology, April 1991, vol. 77, p. 493.)

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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