Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review

Authors

  • Hamideh Bayrampour MSc,

    1. Hamideh Bayrampour is a Doctoral Candidate in Applied Health Sciences; and Maureen Heaman is Professor and Canadian Institutes of Health Research (CIHR) Chair in Gender and Health, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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  • Maureen Heaman RN, PhD

    1. Hamideh Bayrampour is a Doctoral Candidate in Applied Health Sciences; and Maureen Heaman is Professor and Canadian Institutes of Health Research (CIHR) Chair in Gender and Health, Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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  • Maureen Heaman is supported by a Chair in Gender and Health Award from the Canadian Institutes of Health Research (CIHR), Ottawa, Ontario, Canada.

Address correspondence to Hamideh Bayrampour, MSc, Faculty of Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB, Canada R3T 2N2.

Abstract

Abstract:  Background:  The increasing pregnancy rate at advanced maternal age is contemporaneous with the increasing rate of cesarean birth. Several studies have found that advanced maternal age is a risk factor for cesarean birth. The objective of this systematic review was to assess the relationship between advanced maternal age and cesarean birth among nulliparous and multiparous women.

Methods:  To identify relevant studies, we searched the literature for articles published from January 1, 1995 to March 1, 2008, using Medline, EMBASE, PsychINFO, and CINAHL. We also hand-searched the bibliographies of retrieved articles to identify additional related studies. We included all cohort studies and all case-control studies that examined this association in developed countries. The Cochrane Collaboration’s Review Manager software (5.0) was used to summarize the data.

Results:  Twenty-one studies met the inclusion criteria and were included in the review. All studies demonstrated an increased risk of cesarean birth among women at advanced maternal age compared with younger women, for both nulliparas and multiparas (relative risk varied from 1.39 to 2.76). Because we found extreme heterogeneity (both statistical and clinical) among the included studies, we did not provide a pooled estimate of the risk of cesarean birth.

Conclusions:  All included studies illustrated an increased risk of cesarean birth among older women. Fifteen studies adjusted this association for potential confounders, which suggests that a valid and independent association is likely to exist between advanced maternal age and cesarean birth. However, the associated factors for this increased risk are not totally understood in the literature. (BIRTH 37:3 September 2010)

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