The Trend in Delayed Childbearing Age and Its Potential Impact on Adverse Maternal-Perinatal Outcomes in Developed and Developing Countries: A Narrative Review
Abstract
Due to the significant advancement of modern societies, higher education, career growth, and economic independence, more young girls are likely to delay childbearing beyond 30 years of age. The trend of delayed childbearing is more pronounced in industrialized countries but is also becoming common in emerging countries. Delayed childbearing has been linked with several adverse maternal-perinatal outcomes, including hypertensive disorders of pregnancy, abnormal placentation, gestational diabetes mellitus, preterm births, low birthweight, perinatal mortality, congenital birth defects, and chromosomal abnormalities. In this review, we have highlighted the trend of delayed childbearing age, the role of education and employment in delayed childbearing age, and its potential impact on adverse maternal-perinatal outcomes in developed and developing countries.
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8. Claramonte NM, Meler BE, Garcia MS, et al (2019). Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy and Childbirth, 19(1):342.
9. Martínez GJM (2016). La maternidad en madres de 40 años. Rev Cubana Salud Pública, 42:451-458.
10. Kim Y-N, Choi DW, Kim DS, et al (2021). Maternal age and risk of early neonatal mortality: a national cohort study. Sci Rep, 11(1):814.
11. Rosenberg E, Lev B, Bin NG, et al (2008). Healthy Israel 2020: a visionary national health targeting initiative. Public Health, 122 (11):1217-1225.
12. Hugo G (2007). Recent trends in Australian fertility. Climate Change, 9 (2):11-13.
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17. Kessler L, Lancet M, Borenstein R, et al (1980). The problem of the older primipara. Obstet Gynecol, 56 (2):165-169.
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20. Loghi M, Crialesi R (2017). La salute riproduttiva della donna. Roma: Istituto Nazionale di Statistica.
21. Kearney AL, White KM (2016). Examining the psychosocial determinants of women's decisions to delay childbearing. Hum Reprod, 31 (8):1776-1787.
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33. Steinberg S, Kruckman L, Steinberg S (2000). Reinventing fatherhood in Japan and Canada. Soc Sci Med, 50 (9):1257-1272.
34. Budig MJ (2003). Are women’s employment and fertility histories interdependent? An examination of causal order using event history analysis. Soc Sci Res, 32 (3):376-401.
35. Miller AR (2011). The effects of motherhood timing on career path. J Popul Econ, 24 (3):1071-1100.
36. Tower LE, Alkadry MG (2008). The social costs of career success for women. Rev Public Pers Adm, 28 (2):144-165.
37. O'Donoghue C, Meredith D, O'Shea E (2011). Postponing maternity in Ireland. Camb J Econ, 35 (1):59-84.
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48. Mutz DI, Scheier M, Jerabek KS, et al (2014). Perinatal mortality and advanced maternal age. Gynecol Obstet Invest, 77 (1):50-57.
49. Dhaded SM, Somannavar MS, Vernekar SS, et al (2015). Neonatal mortality and coverage of essential newborn interventions 2010-2013: a prospective, population-based study from low-middle income countries. Reprod Health, 12 Suppl 2(Suppl 2):S6.
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53. Naeye RL (1983). Maternal age, obstetric complications, and the outcome of pregnancy. Obstet Gynecol, 61 (2):210-216.
54. Gill SK, Broussard C, Devine O, et al (2012). Association between maternal age and birth defects of unknown etiology―United States, 1997–2007. Birth Defects Res A Clin Mol Teratol, 94 (12):1010-1018.
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56. Hagen A, Entezami M, Gasiorek WA, et al (2011). The impact of first trimester screening and early fetal anomaly scan on invasive testing rates in women with advanced maternal age. Ultraschall Med, 32 (3):302-306.
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58. Loane M, Dolk H, Morris J, et al (2009). Maternal age‐specific risk of non‐chromosomal anomalies. BJOG, 116 (8):1111-9.
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60. Ananth CV, Keyes KM, Wapner RJ (2013). Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ, 347:f6564.
61. Ben DA, Glasser S, Schiff E, et al (2016). Pregnancy and birth outcomes among primiparae at very advanced maternal age: at what price? Matern Child Health J, 20 (4):833-842.
62. Timofeev J, Reddy UM, Huang CC, et al (2013). Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol, 122 (6):1184-95.
63. Poon L, Kametas N, Chelemen T, et al (2010). Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach. J Hum Hypertens, 24 (2):104-110.
64. Ye C, Ruan Y, Zou L, et al (2014). The 2011 survey on hypertensive disorders of pregnancy in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One, 9 (6):e100180.
65. Ma R, Liu JM, Li S, et al (2005). Study on the descriptive epidemiology of pregnancy-induced hypertension from 1995-2000 in Jiaxing of Zhejiang province, China. Zhonghua Liu Xing Bing Xue Za Zhi, 26(12):960-3.
66. Yogev Y, Melamed N, Bardin R, et al (2010). Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol, 203 (6):558.e1-7.
67. Desplanches T, Bouit C, Cottenet J, et al (2019). Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age. Pregnancy Hypertens, 18:112-116.
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2. Waldenström U, Cnattingius S, Vixner L, et al (2017). Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population‐based register study. BJOG, 124 (8):1235-1244.
3. Goisis A, Remes H, Barclay K, et al (2017). Advanced maternal age and the risk of low birth weight and preterm delivery: a within-family analysis using Finnish population registers. Am J Epidemiol, 186 (11):1219-1226.
4. Martin JA, Hamilton BE, Ventura SJ, et al (2002) Births: final data for 2001. Natl Vital Stat Rep, 51(2):1-102.
5. Shan D, Qiu PY, Wu YX, et al (2018). Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Sci Rep, 8 (1): 12239.
6. Mathews TJ, Hamilton BE (2016). Mean age of mothers is on the rise: United States, 2000-2014. NCHS Data Brief, (232):1-8.
7. Bornstein E, Eliner Y, Chervenak FA, et al (2020). Concerning trends in maternal risk factors in the United States: 1989–2018. EClinicalMedicine, 29-30:100657.
8. Claramonte NM, Meler BE, Garcia MS, et al (2019). Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy and Childbirth, 19(1):342.
9. Martínez GJM (2016). La maternidad en madres de 40 años. Rev Cubana Salud Pública, 42:451-458.
10. Kim Y-N, Choi DW, Kim DS, et al (2021). Maternal age and risk of early neonatal mortality: a national cohort study. Sci Rep, 11(1):814.
11. Rosenberg E, Lev B, Bin NG, et al (2008). Healthy Israel 2020: a visionary national health targeting initiative. Public Health, 122 (11):1217-1225.
12. Hugo G (2007). Recent trends in Australian fertility. Climate Change, 9 (2):11-13.
13. Leader A (2006). Pregnancy and motherhood: the biological clock. Sex Reprod Menopause, 4 (1):3-6.
14. Ministry of Health, Labor and Welfare, Summary Report of Vital Statistics of Japan. 2013. https://www.mhlw.go.jp/english/database/db-hw/vs01.html
15. Bianco A, Stone J, Lynch L, et al (1996). Pregnancy outcome at age 40 and older. Obstet Gynecol, 87 (6):917-922.
16. Berkowitz GS, Skovron ML, Lapinski RH, et al (1990). Delayed childbearing and the outcome of pregnancy. N Engl J Med, 322 (10):659-664.
17. Kessler L, Lancet M, Borenstein R, et al (1980). The problem of the older primipara. Obstet Gynecol, 56 (2):165-169.
18. Londero AP, Rossetti E, Pittini C, et al (2019). Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth, 19 (1):261.
19. Zsembik B, Gui T (2016). Delayed childbearing.The Wiley Blackwell Encyclopedia of Family Studies, First Edition. Edited by Constance L. Shehan.
20. Loghi M, Crialesi R (2017). La salute riproduttiva della donna. Roma: Istituto Nazionale di Statistica.
21. Kearney AL, White KM (2016). Examining the psychosocial determinants of women's decisions to delay childbearing. Hum Reprod, 31 (8):1776-1787.
22. Éva B, Laurent T (2021). European countries with delayed childbearing are not those with lower fertility. Genus, 77:2.
23. Beaujouan É, Sobotka T (2017). Late Motherhood in Low-Fertility Countries: Reproductive Intentions, Trends and Consequences, Vienna Institute of Demography Working Papers, No. 02/2017, Austrian Academy of Sciences (ÖAW), Vienna Institute of Demography (VID), Vienna,
24. Özerdoğan N, Yilmaz B (2018). Turkish University seniors’ knowledge of and opinions on fertility and expectations of having children. Afr Health Sci, 18 (1):172-179.
25. Ranjbar F, Shirzad M, Kamali K, et al (2015). Fertility behaviour of Iranian women: a community-based, cross-sectional study. Arch Iran Med, 18 (1):2-5.
26. Vollset SE, Ababneh HS, Abate YH, et al (2024). Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet, 403 (10440):2204-2256.
27. Mills M, Rindfuss RR, McDonald P, et al (2011). Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update, 17 (6):848-860.
28. Martin SP (2000). Diverging fertility among US women who delay childbearing past age 30. Demography, 37 (4):523-533.
29. Bongaarts J, Mensch BS, Blanc AK (2017). Trends in the age at reproductive transitions in the developing world: The role of education. Popul Stud, 71 (2):139-154.
30. Amin V, Behrman JR (2014). Do more-schooled women have fewer children and delay childbearing? Evidence from a sample of US twins. J Popul Econ, 27 (1):1-31.
31. Amuedo DC, Kimmel J (2005). The motherhood wage gap for women in the United States: The importance of college and fertility delay. Rev Econ Household, 3 (1):17-48.
32. Tough S, Benzies K, Fraser LN, et al (2007). Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women. Matern Child Health J, 11 (2):189-198.
33. Steinberg S, Kruckman L, Steinberg S (2000). Reinventing fatherhood in Japan and Canada. Soc Sci Med, 50 (9):1257-1272.
34. Budig MJ (2003). Are women’s employment and fertility histories interdependent? An examination of causal order using event history analysis. Soc Sci Res, 32 (3):376-401.
35. Miller AR (2011). The effects of motherhood timing on career path. J Popul Econ, 24 (3):1071-1100.
36. Tower LE, Alkadry MG (2008). The social costs of career success for women. Rev Public Pers Adm, 28 (2):144-165.
37. O'Donoghue C, Meredith D, O'Shea E (2011). Postponing maternity in Ireland. Camb J Econ, 35 (1):59-84.
38. Scime NV, Chaput KH, Faris PD, et al (2020). Pregnancy complications and risk of preterm birth according to maternal age: A population‐based study of delivery hospitalizations in Alberta. Acta Obstet Gynecol Scand, 99 (4):459-468.
39. Fuchs F, Monet B, Ducruet T, et al (2018). Effect of maternal age on the risk of preterm birth: A large cohort study. PLoS One, 13 (1):e0191002.
40. Deshmukh J, Motghare D, Zodpey S, et al (1998). Low birth weight and associated maternal factors in an urban area. Indian Pediatr, 35:33-36.
41. De Bernabé JV, Soriano T, Albaladejo R, et al (2004). Risk factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol, 116 (1):3-15.
42. Kyozuka H, Fujimori K, Hosoya M, et al (2019). The effect of maternal age at the first childbirth on gestational age and birth weight: The Japan Environment and Children’s Study (JECS). J Epidemiol, 29(5):187-191.
43. Khoshnood B, Wall S, Lee K (2005). Risk of low birth weight associated with advanced maternal age among four ethnic groups in the United States. Matern Child Health J, 9 (1):3-9.
44. Restrepo MMC, Lawlor DA, Horta BL, et al (2015). The association of maternal age with birthweight and gestational age: a cross‐cohort comparison. Paediatr Perinat Epidemiol, 29 (1):31-40.
45. Cartlidge PH, Stewart JH (1995). Effect of changing the stillbirth definition on evaluation of perinatal mortality rates. Lancet, 346 (8973):486-488.
46. Fretts RC, Schmittdiel J, McLean FH, et al (1995). Increased maternal age and the risk of fetal death. N Engl J Med, 333 (15):953-957.
47. Dulitzki M, Soriano D, Schiff E, et al (1998). Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstet Gynecol, 92 (6):935-939.
48. Mutz DI, Scheier M, Jerabek KS, et al (2014). Perinatal mortality and advanced maternal age. Gynecol Obstet Invest, 77 (1):50-57.
49. Dhaded SM, Somannavar MS, Vernekar SS, et al (2015). Neonatal mortality and coverage of essential newborn interventions 2010-2013: a prospective, population-based study from low-middle income countries. Reprod Health, 12 Suppl 2(Suppl 2):S6.
50. O'Leary CM, Bower C, Knuiman M, et al (2007). Changing risks of stillbirth and neonatal mortality associated with maternal age in Western Australia 1984–2003. Paediatr Perinat Epidemiol, 21 (6):541-549.
51. Yaniv SS, Levy A, Wiznitzer A, et al (2011). A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet, 283 (4):755-759.
52. Huang L, Sauve R, Birkett N, et al (2008). Maternal age and risk of stillbirth: a systematic review. CMAJ, 178 (2):165-172.
53. Naeye RL (1983). Maternal age, obstetric complications, and the outcome of pregnancy. Obstet Gynecol, 61 (2):210-216.
54. Gill SK, Broussard C, Devine O, et al (2012). Association between maternal age and birth defects of unknown etiology―United States, 1997–2007. Birth Defects Res A Clin Mol Teratol, 94 (12):1010-1018.
55. Hollier LM, Leveno KJ, Kelly MA, et al (2000). Maternal age and malformations in singleton births. Obstet Gynecol, 96 (5 Pt 1):701-706.
56. Hagen A, Entezami M, Gasiorek WA, et al (2011). The impact of first trimester screening and early fetal anomaly scan on invasive testing rates in women with advanced maternal age. Ultraschall Med, 32 (3):302-306.
57. Albizua I, Rambo MB, Allen E, et al (2015). Association between telomere length and chromosome 21 nondisjunction in the oocyte. Hum Genet, 134 (11-12):1263-1270.
58. Loane M, Dolk H, Morris J, et al (2009). Maternal age‐specific risk of non‐chromosomal anomalies. BJOG, 116 (8):1111-9.
59. Cantwell R, Clutton BT, Cooper G, et al (2011). Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG, 118 Suppl 1:1-203.
60. Ananth CV, Keyes KM, Wapner RJ (2013). Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ, 347:f6564.
61. Ben DA, Glasser S, Schiff E, et al (2016). Pregnancy and birth outcomes among primiparae at very advanced maternal age: at what price? Matern Child Health J, 20 (4):833-842.
62. Timofeev J, Reddy UM, Huang CC, et al (2013). Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol, 122 (6):1184-95.
63. Poon L, Kametas N, Chelemen T, et al (2010). Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach. J Hum Hypertens, 24 (2):104-110.
64. Ye C, Ruan Y, Zou L, et al (2014). The 2011 survey on hypertensive disorders of pregnancy in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One, 9 (6):e100180.
65. Ma R, Liu JM, Li S, et al (2005). Study on the descriptive epidemiology of pregnancy-induced hypertension from 1995-2000 in Jiaxing of Zhejiang province, China. Zhonghua Liu Xing Bing Xue Za Zhi, 26(12):960-3.
66. Yogev Y, Melamed N, Bardin R, et al (2010). Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol, 203 (6):558.e1-7.
67. Desplanches T, Bouit C, Cottenet J, et al (2019). Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age. Pregnancy Hypertens, 18:112-116.
68. Jacobs DJ, Vreeburg SA, Dekker GA, et al (2003). Risk factors for hypertension during pregnancy in South Australia. Aust N Z J Obstet Gynaecol, 43 (6):421-428.
69. Sheen JJ, Huang Y, Andrikopoulou M, et al (2020). Maternal age and preeclampsia outcomes during delivery hospitalizations. Am J Perinatol, 37 (1):44-52.
70. Conde‐Agudelo A, Belizán JM (2000). Risk factors for pre‐eclampsia in a large cohort of Latin American and Caribbean women. BJOG, 107 (1):75-83.
71. Lee CJ, Hsieh TT, Chiu TH, et al (2000). Risk factors for pre‐eclampsia in an Asian population. Int J Gynaecol Obstet, 70 (3):327-333.
72. Zhang J, Savitz DA (1993). Maternal age and placenta previa: a population-based, case-control study. Am J Obstet Gynecol, 168 (2):641-645.
73. Faiz A, Ananth C (2003). Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med, 13 (3):175-190.
74. Adere A, Mulu A, Temesgen F (2020). Neonatal and Maternal Complications of Placenta Praevia and Its Risk Factors in Tikur Anbessa Specialized and Gandhi Memorial Hospitals: Unmatched Case-Control Study. J Pregnancy, 2020:5630296.
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| Files | ||
| Issue | Vol 54 No 1 (2025) | |
| Section | Review Article(s) | |
| Keywords | ||
| Delayed childbearing age Fertility rate Education Occupation Pregnancy outcomes | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ding X, Li H, Yang Q, . N. The Trend in Delayed Childbearing Age and Its Potential Impact on Adverse Maternal-Perinatal Outcomes in Developed and Developing Countries: A Narrative Review. Iran J Public Health. 2025;54(1):1-12.
