Over-the-hill childbearing.

Childbearing is possible for some women aged 50 and older, but it is associated with risks for both the mother and her infant that exceed those of younger women. (1) Analyses of data on all U.S. births from 1997 to 1999 show that rates of several maternal complications--cardiac disease, diabetes, chronic hypertension, eclampsia and placental problems--rise steadily with age. The likelihood that a singleton infant will be low-birth-weight, preterm, very preterm or small for gestational age is significantly higher if the mother is 50 or older than if she is 20-29 years old (odds ratios from analyses controlling for risk-related factors, 1.7-3.0); the odds of fetal death also are elevated if a woman is 50 or older when she conceives (2.2). For all of these outcomes except fetal death, the risks are raised in multiple births, but the differentials are smaller (odds ratios, 1.5-1.6). Notably, the risks of poor outcomes for infants and, to a lesser extent, of maternal complications are markedly higher if the pregnancy occurs at age 50 or later than if a woman conceives in her 40s. Thus, the analysts conclude that pregnancy among older women may entail a distinct pattern of risks that calls for "special counseling both before and after conception."

(1.) Salihu HM et al., Childbearing beyond maternal age 50 and fetal outcomes in the United States, Obstetrics & Gynecology, 2003, 102(5, part 1): 1006-1014.