What are the guideline sources, guidelines and references for Advanced maternal age pregnancy ?
Guideline sources The following summarized guidelines for the evaluation and management of advanced maternal age pregnancy are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2022) and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2017). 1 2 3 Guidelines 1. Diagnostic investigations Fertility evaluation: As per SOGC 2017 guidelines, refer females > 35 yeast of age for infertility work-up after 6 months of trying to conceive because of the decline in fertility and the increased time to conception that occur after age 35. B Show 4 more As per SOGC 2017 guidelines, obtain fertility evaluation after 6 months of unprotected intercourse without conception in females 35-37 years of age and earlier in females > 37 years of age. B Screening for multiple gestations: consider obtaining a first-trimester ultrasound to screen for multiple gestations in pregnant patients with anticipated delivery at age 35 years. C https://web.pathway.md/diseases/recMgU3hadUmKg8ET 1/3 6/23/23, 2:16 AM Advanced maternal age pregnancy Pathway Screening for genetic disorders: discuss and offer prenatal genetic screening (serum screening with or without nuchal translucency ultrasound or cell-free DNA screening) and diagnostic testing (chorionic villus sampling or amniocentesis) in all pregnant patients, regardless of age or risk of chromosomal abnormality. Recognize that every patient has the right to pursue or decline prenatal genetic screening and diagnostic testing after review and discussion. A Screening for congenital anomalies: As per ACOG 2022 guidelines, consider obtaining a detailed fetal anatomic ultrasound in pregnant patients with anticipated delivery at age 35 years because of the increased risk of aneuploidy and the potential increased risk of congenital anomalies. C As per SOGC 2017 guidelines, obtain screening for fetal aneuploidy and a detailed second- trimester ultrasound to look for significant fetal birth defects (particularly cardiac defects) in females 35 years of age. B Prenatal fetal monitoring: Consider obtaining an ultrasound for growth assessment in the third trimester in pregnant patients with anticipated delivery at age 40 years because of the increased risk of both large- for-gestational-age and small-for-gestational-age neonates. C Consider obtaining antenatal fetal surveillance in pregnant patients with anticipated delivery at age 40 years because of the increased risk of stillbirth. C 2. Medical management Prevention of preeclampsia: initiate daily low-dose aspirin for the reduction of preeclampsia in pregnant patients aged 35 years in the setting of at least one other moderate risk factor. B 3. Therapeutic procedures Indications for delivery: Initiate delivery in well-dated pregnancies at 39 0/7-39 6/7 weeks of gestation in patients with anticipated delivery at age 40 years because of the increasing rates of neonatal morbidity and stillbirth beyond this gestational age. B Consider counseling patients that vaginal delivery is safe and appropriate if there are no other maternal or fetal indications for Cesarean delivery. Include a discussion of the risks of Cesarean delivery, the patient's comorbidities, and the patient's preferences and goals. Recognize that advancing patient age alone is not an indication for Cesarean delivery. B 4. Patient education Maternal counseling: As per ACOG 2022 guidelines, consider viewing pregnancy with anticipated delivery at age 35 years as a risk factor for adverse maternal, fetal, and neonatal outcomes when counseling https://web.pathway.md/diseases/recMgU3hadUmKg8ET 2/3 6/23/23, 2:16 AM Advanced maternal age pregnancy Pathway patients and determining management plans. Provide nuanced counseling depending on specific age and comorbidities. C As per SOGC 2017 guidelines, recognize that females delaying childbearing are at increased risk of infertility. Inform prospective parents, especially females, that their fecundity and fertility begin to decline significantly after 32 years of age. Inform prospective parents that assisted reproductive technologies cannot guarantee a live birth or completely compensate for age- related decline in fertility. B Show 4 more As per SOGC 2017 guidelines, counsel females in their 20s and 30s about the age-related risk of infertility when other reproductive health issues, such as sexual health or contraception, are addressed as part of their primary well-woman care. Inform reproductive-age females that natural fertility and assisted reproductive technology success (except with egg donation) is significantly lower for females in their late 30s and 40s. B Show 2 more Paternal counseling: As per SOGC 2017 guidelines, counsel males > 40 years of age and their partners that advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions, autism spectrum disorders, and schizophrenia when they are seeking pregnancy, although the risks remain small. B As per SOGC 2017 guidelines, inform prospective parents that semen quality and male fertility deteriorate with advancing age and that the risk of genetic disorders in offspring increases. B References 1. Kimberly E Liu, Allison Case. No. 346 Advanced Reproductive Age and Fertility. J Obstet Gynaecol Can. 2017 Aug;39 8 685 695. Open 2. No authors listed. Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022 Aug 1;140 2 348 366. Open 3. Jo-Ann Johnson, Suzanne Tough. No-271 Delayed Child-Bearing. J Obstet Gynaecol Can. 2017 Nov;39 11):e500-e515. Open https://web.pathway.md/diseases/recMgU3hadUmKg8ET 3/3