Authors’ response to comment on ‘‘Pregnancy outcome in primiparae of advanced maternal age’’ Eur J Obstet Gynecol Reprod Biol; in press

Document Type



Obstetrics and Gynaecology (East Africa)


We appreciate the interest of Marasinghe et al. in our paper on pregnancy outcome in primiparae of advanced maternal age [1]. We agree that one should not alarm or stigmatise expectant women aged 35 or over. Fortunately, it is true that a large proportion of these women will experience an uncomplicated pregnancy and will deliver a healthy child. Considerable efforts have been put forward in the last decade in order to decrease the incidence of congenital malformations and perinatal death, particularly in children of older women. However, the incidence of preterm birth and the caesarean section rate are rising, part of which is attributable to the increasing number of older parturients. Furthermore, we would like to remark that the mentioned evidence for advanced maternal age not to impair pregnancy outcome is based on limited evidence form literature, stemming from the unicenter studies with sample sizes not exceeding 500 patients [2–5]. Most of the quoted studies nevertheless found incidences of preterm birth, low birth weight and other complications to be more common in older mothers, as did the absolute majority of larger studies assessing this subject [6–8]. In our study, incidences of caesarean section, extreme preterm birth, extreme low birth weight and perinatal death were more than twice as high in women of advanced age (35 years) compared with younger women (25–29 years). Since these findings are not anecdotal, neither for the concerned children and their families nor for the community in terms of health-economy, it is recommended to encourage motherhood at a younger age. Finally, it is true that children of older mothers may be better off in terms of material conditions and psychological factors, especially compared to teenage mothers. We would like to emphasize, however, that encouraging women not to postpone motherhood until after their late thirties does not imply a plea for teenage motherhood. The 15 years between these two extremes have been numerously assessed as the most favourable for human reproduction


This work was published before the author joined Aga Khan University.


European Journal of Obstetrics & Gynecology and Reproductive Biology 1