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Am J Perinatol. 2008 Apr 24 [Epub ahead of print]
Stillbirth at Term in Women of Advanced Maternal Age in the United States:
When Could the Antenatal Testing Be Initiated?
Bahtiyar MO, Funai EF, Rosenberg V, Norwitz E, Lipkind H, Buhimschi C, Copel
JA.
Yale University School of Medicine, Section of Maternal-Fetal Medicine, New
Haven, Connecticut.
We sought to determine if advanced maternal age (AMA) is a risk factor for
intrauterine fetal demise (IUFD). We used a U.S. Centers for Disease Control
and Prevention database and analyzed outcomes in women 15 to 44 years of age
with term singleton gestations. Cox proportional hazards models and
Cochran-Mantel-Haenszel tests were used. Results were controlled for
maternal race and smoking. After excluding congenital anomalies and medical
complications, 6,239,399 singleton term deliveries were identified. When
compared with women 25 to 29 years of age, the risk of IUFD increased with
advancing age: 30 to 34 years, odds ratio [OR] = 1.24 (95% confidence
interval [CI], 1.13 to 1.36); 35 to 39 years, OR = 1.45 (95% CI, 1.21 to
1.74), and 40 to 44 years, OR = 3.04 (95% CI, 1.58 to 5.86). The risk of
IUFD for women 40 to 44 years of age at 39 weeks is comparable with that of
42 weeks in those 25 to 29 years of age. We concluded that AMA is an
independent predictor of IUFD, and a strategy of antenatal testing in those
>/= 40 years of age beginning at 38 weeks may be considered.
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