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Keywords:

  • advanced maternal age;
  • marital characteristics;
  • reproductive characteristics;
  • sociodemographic characteristics

Abstract

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Background

Recent studies have reported that primiparous women of advanced maternal age (AMA) appear to constitute a heterogeneous group, emphasizing the need to revise stereotyped views. The aims of this study were the following: 1) to describe the sociodemographic and marital characteristics of Portuguese couples who experienced first childbirth at advanced maternal age (the AMA group) compared with their younger counterparts (the comparison group); 2) to compare the reproductive characteristics of both groups and identify distinct reproductive trajectories within the AMA group; and 3) to distinguish among different subgroups of couples within the AMA group, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics.

Methods

The sample consisted of 250 couples. Both partners completed sociodemographic, marital, and reproductive health forms during pregnancy.

Results

Despite being more highly educated, having a higher socioeconomic status, and having been employed longer, the AMA group displayed diverse conjugal configurations and reproductive trajectories over time. Within the AMA group, two subgroups were distinguished: couples who experienced infertility problems and couples who did not.

Conclusions

Couples who experience first childbirth at AMA constitute a heterogeneous group, which includes distinct subgroups with different psychosocial needs during the transition to parenthood. To revise stereotyped views of these couples, protective social policies should be improved, and health professionals should assume nonjudgmental attitudes and promote informed reproductive decisions. Psychoeducative programs concerning the transition to parenthood should take into account the distinct subgroups of couples who experience first childbirth at AMA.

First childbirth at advanced maternal age (AMA), defined as maternal age of 35 years or over at the time of delivery [1], is an increasing trend in industrialized countries [2]. In the United States, the percentage of live births at AMA has increased from 4.9 to 14.2 percent between 1980 and 2009 [3, 4]. Canada has followed this trend with 18.3 percent of live births at AMA in 2009 [5]. Similar changes have been observed in Europe with a growing expression in southern countries [6]. In Portugal, the proportion of live births at AMA was 20.6 percent in 2009 [7]. Despite changing demographic trends, AMA continues to be associated with higher rates of cesarean birth, fetal and neonatal mortality, and morbidity [8-13], engendering increased financial costs for welfare systems [14].

Based on sociodemographic data from Northern Europe, the United States, Canada, and Australia, first childbirth at AMA has been frequently understood as a deliberate choice that characterizes well-educated women of higher socioeconomic status who perceive work as important and are less oriented toward motherhood than their younger counterparts [15-21]. This reproductive trend has been related to stereotypes of ambition, selfishness, and violation of the natural order [22] that interfere with women's well-being and with their relationships with health care practitioners [23, 24]. Recent studies have reported that primiparous women of AMA constitute a more heterogeneous group than previously believed [25], emphasizing the need to revise these stereotypes [24] and adopt a broader perspective to understand later motherhood [26, 27].

Beyond the influence of sociodemographic factors, first childbirth at AMA also depends on a complex interplay of marital and reproductive circumstances that are sometimes outside women's control [24]. Contrary to the established view in the few studies that have explored couples’ characteristics in past decades [28, 29], primiparous women of AMA do not always report stable first-time marriages, characterized by gender equity, dual-earner patterns, and high socioeconomic statuses. These women often display second unions with men who already have children or short-time relationships that may be related to women's socioeconomic independence or vulnerability [18, 19, 25]. Despite the diversity of marital realities underlying first childbirth at AMA [30], women's partners and within-couple characteristics have remained quite unexplored in the present-day context. More knowledge on these topics may enable a broader understanding of this reproductive trend and contribute to the development of appropriate social policies.

With respect to reproductive history, studies have shown that primiparous women of AMA who conceive spontaneously do not always intensively plan and prepare for pregnancy [23]. These women exhibit similar or higher proportions of unplanned pregnancies than their younger counterparts [16, 25]. In addition, childbearing at AMA is frequently preceded by reproductive health problems [19]. Primiparous women of AMA are more likely to have experienced adverse pregnancy outcomes, primary or secondary infertility, and medically assisted reproduction treatments than their younger counterparts [15, 16, 19]. However, previous studies have rarely allowed a clear identification of the different reproductive trajectories that precede first childbirth at AMA, depending on the frequency and course of these reproductive health problems over time. A study of this topic may lead to the development of health care interventions that may promote conscious reproductive decisions [31].

Despite the apparent heterogeneity of the group [25], previous studies have rarely explored the possibility of distinguishing different subgroups of couples who experience first childbirth at AMA, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics. Nilsen et al [25] hypothesized that having an unplanned pregnancy in AMA may reflect either vulnerable socioeconomic and marital situations or an independent feminine lifestyle. Hammarberg and Clarke [18] suggested that primiparous women who face infertility at AMA display not only a focus on career but also marital realities that do not facilitate earlier childbearing, such as short-time relationships or second unions with men who already have children. Fertile couples who planned pregnancy [28] and infertile couples who underwent assisted reproduction treatments [20] usually have stable socioeconomic and marital situations. However, infertile couples often express a stronger childbearing desire than fertile ones [21]. According to Van Balen, infertile women also tend to report a stronger childbearing desire than their partners, whereas fertile couples tend to evidence equally strong childbearing desires. Further studies should distinguish among the different subgroups of couples who experience first childbirth at AMA, so that adequate perinatal care can be tailored to meet their specific psychosocial needs [32].

To overcome previous limitations, this study aimed to: 1) describe the sociodemographic and marital characteristics of Portuguese couples who experience first childbirth at AMA (the AMA group) compared with their younger counterparts (the comparison group); 2) compare the reproductive characteristics of both groups and identify distinct reproductive trajectories within the AMA group; and 3) distinguish among different subgroups of couples within the AMA group, depending on distinct patterns of sociodemographic, marital, and reproductive characteristics.

Methods

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Sample

A total of 232 couples in the AMA group (maternal age of 35 years or over) and 291 couples in the comparison group (maternal age ranging from 20 to 34 years) were initially contacted. Inclusion criteria for both groups were as follows: 1) woman should be primiparous; 2) couples should be married or cohabitating; 3) couples should not experience adverse outcomes during pregnancy; 4) couples should not have any indication of fetal anomalies or medical problems of the baby; and 5) both partners should have the ability to read and understand Portuguese.

In the AMA group, 11 couples (4.7%) refused to participate and 66 (28.4%) did not return the questionnaires (participation rate: 66.8%). Sixteen questionnaires (6.9%) were excluded because they were only completed by women. Eleven questionnaires (4.7%) were excluded because of adverse outcomes and indication of medical problems of the baby. In the comparison group, 14 couples (4.8%) refused to participate and 107 (36.8%) did not return the questionnaires (participation rate: 58.42%). Forty-eight questionnaires (16.5%) were excluded because they were only filled out by women. No couples in the comparison group experienced adverse outcomes or had any indication of fetal anomaly or medical problems of the baby during pregnancy. The final sample consisted of 128 couples in the AMA group and 122 couples in the comparison group.

Procedures

This study is part of an ongoing longitudinal investigation, focusing on the first assessment moment that took place during pregnancy. The study was approved by the Ethics Committee of the Centro Hospitalar e Universitário de Coimbra, Portugal. Data collection took place between April 2011 and September 2012, using a consecutive sampling method to minimize volunteerism and selection biases. During this time interval, all eligible couples in the AMA group were approached by the researcher before their prenatal diagnosis appointment, which is part of the standard obstetric procedures for all pregnant women of AMA in Portugal. All eligible couples in the comparison group were contacted before their standard obstetric appointment. The study aims were presented and an informed consent was signed by couples who agreed to participate in the investigation. Couples were given two versions of the questionnaires (one for each partner) and were told to return them to the researcher at the following obstetric appointment.

Measures

Sociodemographic form

Partners provided information on age, education, professional status (employed/unemployed, length of employed status), and socioeconomic status. Socioeconomic status was determined through an analysis of the socioeconomic status of both partners, which was categorized as low, medium, or high, using a Portuguese classification system [33]. Partners also responded to the questions “to what extent is work/parenthood important in your life?” using a visual analogical scale from 0 (Not important at all) to 100 (Extremely important).

Marital form

Partners reported their relationship length and whether they had prior marital relationships, identifying the number, length, and motive of relationship dissolution (separated/divorced, widow, or other). Men also indicated whether they had prior children and if so, specified their number and ages.

Reproductive health form

Women provided information on prior pregnancies (number, timing of occurrence, and type of adverse outcome), infertility (length and timing of onset), and medically assisted reproduction treatments (number and type of treatments). Information about prior reproductive health was also verified in the women's medical records. Women also reported the mode of conception (spontaneous or medically induced) and type of pregnancy (singleton or multiple). Both partners classified the current pregnancy as planned or unplanned. In the event of a discrepancy between partners, the pregnancy was classified as unplanned. Women reported whether they underwent preconception preparation through lifestyle changes, medical counseling, medical exams, extensive reading, and choice of maternal health services or other type of preparation.

Statistical Analyses

Analyses were conducted using the Statistical Package for Social Sciences (SPSS), version 20.0 (IBM Corp., Chicago, IL, USA). Descriptive statistics were used for characterization purposes. Between-groups comparisons were performed, using independent t tests or Mann–Whitney tests (for continuous variables) and Chi-squared tests (for categorical variables), with Monte Carlo correction if cells had frequencies lower than 5 [34]. Within-couple comparisons in each group were performed, using paired t tests or Wilcoxon tests. Effect sizes were computed for all comparison analyses (small: d ≥ 0.20, φc ≥ 0.01, r ≥ 0.10; medium: d ≥ 0.50, φc ≥ 0.03, r ≥ 0.30; high: ≥ 0.80, φc ≥ 0.05, r ≥ 0.50) [35, 36].

A two-step clustering analysis was used to evaluate the existence of different subgroups within the AMA group. Cluster analysis is an exploratory statistical technique that groups together participants who resemble each other on a defined set of variables [37]. The two-step cluster analysis was selected because it allows handling with categorical and continuous variables [38]. Because of the lack of conclusive findings in the literature, this clustering technique was conducted using the automatic assignment of the number of clusters. The log-likelihood criterion was used as the distance measure. The Schwarz's Bayesian algorithm was used to select the number of clusters. Comparison tests were performed (as previously described) to assess between-clusters and within-couple differences in each cluster.

For the between-group comparisons and the within-couple comparisons in each group, post hoc power calculations performed with a significance level of 0.05 and power ≥ 0.80 indicated that medium to large effects could be detected [39], that is, an effect size > 0.23. For the between-cluster comparisons and within-couple comparisons in each cluster, post hoc power calculations performed with a significance level of 0.05 and power ≥ 0.80 indicated that large effects could be detected (effect size > 0.76). Statistical significance was established at < 0.05, but marginally significant differences (< 0.10) were also reported for between-clusters comparisons and within-couple comparisons in each cluster.

Results

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Comparison of the Sociodemographic and Marital Characteristics of Both Groups

Table 1 shows that women and men in the AMA group had studied longer, had been employed longer, and attributed less importance to parenthood than couples in the comparison group. Both groups did not significantly differ in the importance attributed to work.

Table 1. Sociodemographic Characteristics of the Advanced Maternal Age (AMA) Group and the Comparison Group.
 AMA group (n = 128)Comparison group (n = 122)Between-groups
Mean [SD]Within-coupleMean [SD]Within-coupletd
tdtd
  1. *p < 0.05; **p < 0.01; ***p < 0.001.

Age (years)
Women37.00 [2.22]0.060.0129.39 [3.17]−4.87***0.45  
Men36.98 [5.16] 30.93 [3.70]   
Education (yr)
Women14.87 [3.25]5.06***0.4714.01 [3.18]5.90***0.502.11*0.27
Men13.27 [3.59] 12.25 [3.81] 2.16*0.28
Length of employed status (yr)
Women9.15 [5.35]1.170.095.12 [3.25]−2.52*0.176.46***0.95
Men8.62 [6.55]6.43 [4.36]2.93**0.40
Importance of work
Women79.31 [18.53]−1.110.1677.42 [21.06]−0.570.120.730.10
Men82.30 [17.81]79.63 [17.29]1.180.15
Importance of parenthood
Women89.76 [14.77]−0.720.0794.04 [8.14]−0.310.03−2.82**0.37
Men90.75 [14.43]94.33 [9.97]−2.37*0.29

Women in the AMA group had studied longer than men. Partners had comparable ages, had been employed for similar lengths of time, and did not significantly differ in the importance attributed to work and parenthood.

Women in the comparison group were younger, had been employed for shorter lengths of time, and had studied longer than men. Partners did not significantly differ in the importance attributed to work and parenthood.

Table 2 shows that the two groups did not significantly differ in professional status and relationship length. Relationship length varied from 0.5 to 22 years in the AMA group and from 0.8 to 19 years in the comparison group. Couples in the AMA group had a higher socioeconomic status and were less likely to be in first-time marriages than couples in the comparison group.

Table 2. Marital and Reproductive Characteristics of the Advanced Maternal Age (AMA) Group and the Comparison Group.
 AMA group (n = 128)Comparison group (n = 122)Between-groups
Mean [SD]Mean [SD]td
  1. aOthers refers to fetal death, induced abortion and termination of pregnancy as a result of fetal abnormalities and ectopic pregnancy.

  2. *p < 0.05; **p < 0.01; ***p < 0.001.

Length of current relationship (yr)7.46 [5.41]7.11 [4.19]0.570.07
Length of prior marital relationships (yr)
Women6.76 [4.91]3.67 [1.53]  
Men9.06 [5.87]3.50 [2.18]  
Number of prior adverse pregnancy outcomes1.53 [1.04]1.19 [0.40]  
Length of infertility (yr)4.51 [3.65]2.54 [1.55]  
Number of medical assisted reproduction treatments2.07 [1.33]1.67 [1.32]  
 No. (%)No. (%) χ 2 φ c
Professional status
Dual-earner110 (86)92 (76)6.390.15
Only one earner16 (12)26 (21)
Both partners unemployed2 (2)4 (3)
Socioeconomic status
Low13 (10)26 (21)6.65*0.16
Medium75 (59)68 (56)
High40 (31)28 (23)
Prior marital relationships
None of the partners97 (76)113 (93)13.50**0.25
Only women10 (8)3 (3)
Only men17 (13)4 (3)
Both partners4 (3)1 (1)
Men had prior children15 (12)0 (0)15.21***0.25
Prior adverse reproductive outcomes32 (25)15 (12)5.69*0.15
Miscarriage29 (23)11 (9)
Others4 (3)4 (3)
Prior infertility34 (27)13 (11)10.35**0.20
Primary infertility24 (19)10 (8)
Secondary infertility10 (8)3 (3)
Prior medically assisted reproduction treatments29 (23)9 (7)11.31**0.21
In vitro fertilization and intracytoplasmic sperm injection22 (17)4 (3)  
Intrauterine insemination and ovarian stimulation7 (6)5 (4)  
Mode of conception
Spontaneous102 (80)115 (94)11.58***0.22
Medically induced26 (20)7 (6)
Type of conception
Singleton121 (95)122 (100)6.86**0.14
Multiple7 (5)0 (0)
Pregnancy planning
Unplanned23 (18)29 (24)2.080.07
Planned105 (82)93 (76)
Preconception preparation90 (72)82 (67)0.670.05
Medical exams81 (63)71 (58)
Medical counseling72 (56)61 (50)
Changes in lifestyles41 (32)39 (32)
Choice of maternal health services32 (25)22 (18)
Reading and information seeking17 (13)21 (17)

Independent of group, women who had prior marital relationships only reported one separation/divorce. In the AMA group, most men who had prior marital relationships only reported one divorce/separation, except for two participants (one of whose previous wife died; one who reported two divorces/separations). In the comparison group, men who had prior marital relationships only reported one separation/divorce. Only men in the AMA group reported that they had prior children. The median number of prior children was one (range: 1–2). The mean age of the first child was 17.08 years (SD = 7.60, range: 4–32). The mean age of the second child was 15.76 years (SD = 3.51, range: 10–19).

Comparison of the Reproductive Characteristics of the Groups and Identification of Distinct Reproductive Trajectories Within the AMA Group

Table 2 shows that couples in the AMA group were more likely to have experienced prior adverse pregnancy outcomes, infertility, and medically assisted reproduction treatments than couples in the comparison group. Couples in the AMA group were also more likely to report medically induced and multiple conceptions than couples in the comparison group. No differences were observed in pregnancy planning and preconception preparation, depending on group.

Figure 1 shows that most couples in the AMA group did not experience prior reproductive health problems. Couples who reported reproductive health problems mainly faced infertility that arose before or at AMA. Infertility that arose before AMA had a mean length of 6.63 years (SD = 3.35, range: 2–14). In this reproductive trajectory, secondary infertility was preceded by a mean number of 2.33 adverse pregnancy outcomes (SD = 1.97, range: 1–6). Couples who experienced infertility that arose before AMA underwent a mean number of 2.39 treatments (SD = 1.42, range: 1–7). Infertility that arose at AMA had a mean length of 1.83 years (SD = 1.75, range: 1–8). In this reproductive trajectory, secondary infertility was preceded by only one adverse pregnancy outcome. Couples who experienced infertility that arose at AMA underwent a mean number of 1.55 treatments (SD = 1.03, range: 1–4). Adverse pregnancy outcomes essentially arose at AMA. Couples who experienced adverse pregnancy outcomes before AMA had a mean number of 1.80 intercurrences (SD = 0.84, range: 1–3). Couples who experienced adverse pregnancy outcomes at AMA had a mean number of 1.13 intercurrences (SD = 0.34, range: 1–2).

image

Figure 1. Frequency of the distinct reproductive trajectories within the advanced maternal age (AMA) group.

Download figure to PowerPoint

Distinction of Different Subgroups Within the AMA Group

Table 3 shows that two clusters were identified. Cluster 1 (= 94) consisted of couples who did not experience prior infertility, did not undergo medically assisted reproduction treatments, and achieved a spontaneous pregnancy. These couples had shorter relationship lengths and a higher proportion of unplanned pregnancies than couples in Cluster 2. Cluster 2 (= 34) consisted of couples who experienced prior infertility, underwent prior medically assisted reproduction treatments, and typically achieved a medically induced conception. These couples had longer relationships and a lower proportion of unplanned pregnancies than couples in Cluster 1.

Table 3. Characteristics of the Clusters
 Cluster 1 (n = 94)Cluster 2 (n = 34)Between-clusters
No. (%)No. (%) χ 2 φ c
  1. *p < 0.05; **p < 0.01; ***p < 0.001; p < 0.10.

Characteristics of the clusters
Prior infertility0 (0)34 (100)128.00***1.00
Prior medically assisted reproduction treatments0 (0)29 (85)103.66***0.90
Mode of conception
Spontaneous94 (100)8 (24)61.69***0.84
Medically induced0 (0)26 (76)  
Pregnancy planning
Planned73 (78)32 (94)4.59*0.19
Unplanned21 (22)2 (6)  
Prior adverse pregnancy outcomes21 (22)11 (32)1.340.10
Dual-earner79 (84)30 (88)3.130.16
Socioeconomic status
Low11 (12)2 (6)1.840.12
Medium57 (60)19 (56)  
High26 (28)13 (38)  
Prior marital relationships  1.780.12
None of the partners70 (75)25 (74)  
 Women6 (6)3 (9)  
 Men14 (15)6 (17)  
Both partners4 (4)0 (0)  
Men had prior children11 (12)4 (12)0.000.00
  Within-couples Within-couplesBetween-clusters
 Mean [SD]TrMean [SD]TrUr
Relationship length (yr)6.80 [5.40]  9.30 [5.10]  1109.00**0.20
Other characteristics
Age (yr)
Women36.95 [2.07]−1.390.1037.15 [2.63]−2.050.201585.000.01
Men36.19 [4.66]39.15 [5.88]1168.00*0.20
Education (yr)
Women15.01 [3.28]−4.37*0.4014.47 [3.17]−1.410.101410.500.10
Men13.18 [3.60]13.50 [3.60]1511.000.04
Length of employed status (yr)
Women8.61 [5.43]−1.950.209.87 [5.57]−0.780.151165.500.10
Men7.37 [5.94]10.57 [7.75]1029.50*0.20
Importance of work
Women79.10 [18.96]−0.510.0578.20 [19.02]−1.950.351459.500.01
Men81.93 [16.63]85.79 [12.57]1491.500.03
Importance of parenthood
Women87.92 [16.48]−1.510.1694.83 [7.54]−1.510.251230.50*0.20
Men90.68 [13.93]89.35 [13.16]1270.000.10

Table 3 shows that men in Cluster 2 tended to be older and employed longer than men in Cluster 1. Women in Cluster 2 attributed more importance to parenthood than men in Cluster 1. Women in Cluster 1 had studied longer and tended to be employed longer than men. In Cluster 2, women tended to attribute less importance to work than men.

Discussion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

This study showed that couples in the AMA group were more educated, were employed longer, and had higher socioeconomic status than couples in the comparison group. Despite having similar professional statuses, the AMA group displayed more complex marital realities and reproductive trajectories than the comparison group. Within the AMA group, couples who experienced prior infertility were different from those who did not.

The findings corroborate previous studies that found that couples who experience first childbirth at AMA usually have advantaged educational levels, higher socioeconomic status, more stable professional situations, and attribute less importance to parenthood compared to younger couples [20, 28, 29]. Contrary to previous studies, the couples in our study who experienced first childbirth at AMA were not more likely to have a dual-earner pattern, or more likely to perceive work as more important than younger couples [17, 20, 28, 29]. These similarities between the couples who experienced first childbirth at AMA and at younger ages may be related to the increase in women's participation in the labor market and shifts in gender roles that constitute a generalized trend in the present-day context [40]. Couples’ characteristics that were observed either at AMA or at younger ages may also explain this pattern. These findings were consistent with the higher educational level of Portuguese women compared with men [41], which may contribute to the high female representation in the labor market [2] and gender equity with respect to the importance attributed to work.

The findings also support that couples who experienced first childbirth at AMA display more diverse marital realities compared with younger couples [30]. The variability in relationship length suggests that first childbirth at AMA may occur in stable first-time marriages [20, 28, 29] but may also result from a delay in union formation or difficulty in finding a suitable partner [24]. The findings also show that first childbirth at AMA seems to sometimes reflect the partnership shifts that have prevailed in the present-day context, namely the increase in divorce rates and second unions [40].

With respect to reproductive characteristics and trajectories over time, the findings seem to corroborate the higher reproductive vulnerability of the couples who experience first childbirth at AMA than younger couples [19]. However, first childbirth at AMA did not seem to result from more intensive pregnancy planning and preparation than at younger ages. The marital realities underlying first childbirth at AMA may explain these findings, influencing the perception of time pressure [24] or a last chance to have a baby [25]. The diversity of reproductive trajectories that precede first childbirth at AMA also seems to support that first childbirth at AMA is not always a deliberate or a conscious choice [24]. In addition to including couples who did not plan pregnancy, a substantial proportion of couples seemed to face infertility and adverse pregnancy outcomes as a result of later attempts to become pregnant and, possibly, an inaccurate awareness about maternal age-related risks [18]. First childbirth at AMA also appears to sometimes result from prolonged infertility and/or consecutive adverse pregnancy outcomes, as previously suggested [16].

Because of the heterogeneity of the AMA group [25], two distinct subgroups were identified. The first subgroup consisted of fertile couples who are more likely to report unplanned pregnancies and sometimes experience adverse pregnancy outcomes. As shown in prior studies, these reproductive characteristics coexist with shorter marital relationships and an independent lifestyle [18, 25] that characterizes women who attribute less importance to parenthood [21]. In this subgroup, partners embrace similar views about work and parenthood, supporting that fertile couples usually report equally strong childbearing desires [21]. The second subgroup consisted of infertile couples who sometimes faced adverse pregnancy outcomes before undergoing medically assisted reproduction treatments. As shown in prior studies, these complex reproductive histories [19] coexist with stable marriages and gender equity in sociodemographic characteristics [20]. In this subgroup, partners seem to embrace more traditional views concerning work and parenthood, supporting that infertile women tend to report stronger childbearing desires than men [21].

Some limitations should be acknowledged. Participants were recruited at only one public health center, focusing on married/cohabitating women whose partners agreed to participate. Nevertheless, single women who are part of the diverse context of pregnancy at AMA [19] were excluded and the sample sizes for the different reproductive trajectories and subgroups were small. As a result of these sampling limitations, the statistical power of the study only allowed us to detect medium to large effects. Despite the sensitivity of visual analogical scales, the subjective importance of work and parenthood were assessed using only one question. Future studies should overcome sampling limitations to allow a more detailed analysis of the distinct subgroups within the AMA group and could further assess work and parenthood motivations within the recent context of financial crisis.

In spite of these limitations, this study makes several contributions to this area of research. In addition to exploring the sociocultural specifics of southern European countries, it examined couples’ characteristics underlying first childbirth at AMA in the present-day context. The study also distinguished among different reproductive trajectories that precede first childbirth at AMA and identified different subgroups of couples, based on distinct patterns of characteristics.

This study also has several implications for social policies and clinical practice. Policies that further support families with children (such as improved childcare facilities, parental leave, or job flexibility) should be improved to help in reconciling the demands of family and work. Health care practitioners should be aware that stereotyped views may not actually be representative of couples who experience first childbirth at AMA. Practitioners should assume nonjudgmental attitudes to prevent feelings of stigmatization that may interfere with perinatal care.

Health care practitioners should also be aware that couples may be often unaware of maternal age-related risks. Preventive approaches should be developed, so that information about risks is discussed with couples of reproductive age during family planning and preconception to promote conscious reproductive decisions. During perinatal care, health care practitioners should be cautious in providing risk information to couples who experience first childbirth at AMA. This information should be balanced with the normalization of the process of childbearing at AMA, using a holistic approach that integrates risks with health-promoting behaviors, to enhance couples’ sense of control.

Antenatal preparation programs should be tailored to the specific psychosocial needs of the distinct subgroups of couples who experience first childbirth at AMA. Unrealistic or divergent expectations about parenthood and anticipated responsibilities should be discussed to improve shared negotiation strategies, particularly among couples who experienced prolonged reproductive health problems and/or a long-time couple lifestyle without children. Problem-solving strategies that may facilitate the conciliation between work and family should also be enhanced, especially among couples who display complex familial realities and/or are characterized by independent parental lifestyles.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

This study is part of the “Transition to parenthood in advanced maternal age: Individual, marital and parental adaptation” research project, integrated in the Relationships, Development & Health Research Group of the R&D Unit Institute of Cognitive Psychology, Vocational and Social Development of the University of Coimbra (PEst-OE/PSI/UI0192/2011). Maryse Guedes is supported by a scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/68912/2010).

References

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References
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