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SMFM: Women 40 and Older Have Triple the Risk of Term Stillbirth


SAN FRANCISCO, Feb. 12 -- Women in their 40s have a threefold greater risk for stillbirth at term than women in their mid-to-late 20s, researchers said here.

SAN FRANCISCO, Feb. 12 -- Women in their 40s have a threefold greater risk for stillbirth at term than women in their mid-to-late 20s, researchers said here.

"Our results support routine antenatal testing in those women who are over age 40, beginning at 38 weeks gestation," said Mert Ozan Bahtiyar, M.D., of Yale, and colleagues, at the Society for Maternal-Fetal Medicine meeting. "This will help identify women who are most at risk for stillbirth."

Older pregnant women are at increased risk for myriad complications of pregnancy, the authors noted, including gestational diabetes, preeclampsia, placenta previa, and intrauterine growth restriction -- all conditions that are associated with a higher incidence of still birth, Dr. Bahtiyar and colleagues said in a poster presentation.

"Antepartum fetal surveillance has been proposed as an effective means to prevent stillbirth," they said. "We sought to determine whether advanced maternal age was an independent risk factor for intrauterine fetal demise, and at what maternal age cutoff would fetal testing have the greatest impact on reducing stillbirth rates."

They extracted data from the CDC's perinatal mortality database for a cross-sectional study.

The database contains entries on 11,061,599 singleton deliveries between 1995 and 1997. They included in their analysis information on women from the ages of 15 to 44 who had term singleton pregnancies (more than 37 weeks gestation.

The authors used logistic regression analysis and created Cox proportional hazard modes to estimate relative risk. On the assumption that the risk of stillbirth could be reduced with antenatal testing, they also calculated the number needed to treat using the known cumulative hazard for intrauterine fetal demise.

After excluding for confounding factors such as congenital anomalies and maternal medical complications they identified a total of 6,239,399 singleton term deliveries.

They found that compared with women ages 25 to 29 years, the risk of stillbirth at term increased significantly with maternal age. For women 30 to 34 the relative risk was 1.24 (95% confidence interval, 1.13-1.36), for women 35 to 39 it was 1.45 (95% CI, 1.21-1.74), and for women 40 to 44 the relative risk was 3.04 (95% CI, 1.58-5.86).

"The cumulative risk of stillbirth at 38 weeks gestation in an uncomplicated patient who is over age 40 is similar to the risk of intrauterine fetal demise at 41 weeks gestation in an uncomplicated patient who is less than 35 years old," the investigators noted.

The time-to-event analysis indicated that the risk of stillbirth began to increase significantly beginning at 38 weeks of gestation.

"Our mathematical model suggests that for ages 35 to 39, initiation of fetal testing at 38 weeks of gestation would require at least 1,717 antepartum surveillance tests to be performed by 40 weeks of gestation to prevent one intrauterine fetal demise," the investigators said. "In contrast, for maternal age 40 to 44 years, 494 tests would be required to prevent a similar event by 40 weeks of gestation."

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