ABSTRACT
Pregnancy at the extremes of maternal age is not just a subject for the curious mind but is of importance owing to concerns that both mother and fetus are at risk of heightened morbidity and mortality. The definition of the ‘lower’ maternal age is much clearer than ‘upper’, for which controversies exist as to the cut-off point beyond which adverse birth outcomes become more frequent. Most, if not all, clinicians and researchers agree that low maternal age (generally below 20 years) represents a distinct obstetric entity in terms of risk thresholds1-5. For the upper limit, however, no agreement is present concerning what constitutes the cut-off. In the 1980s and most of the 1990s, women who were 35 years or over were considered to be of advanced age and representing a special high-risk obstetric entity that warranted intense monitoring. As the cohort of women undergoing assisted reproduction procedures increased, however, more women over 35 became pregnant, and what had been uncommon became common. At the same time, intensive antenatal-care monitoring improved, as did the survival rate of infants born to these mothers. Thus, the cut-off point for advanced maternal age has now shifted to around 40 years, on average. Some authors use the term ‘older mothers’ or ‘advanced maternal age’ to describe pregnancies among women beyond 50 years of age6,7, but this is not what is commonly understood by the term ‘older’. The latter cases reflect the dynamics of improved obstetric care and the continuous success of medical technology to reverse the course of dwindling reproductive function even beyond the menopause.
