INCREASED MATERNAL AGE AND THE RISK OF FETAL DEATH

Background. Although the fetal death rate has declined over the past 3 0 years among women of all ages, ii is unknown whether particular char acteristics of the mother, such as age, still affect the risk of fetal death. We undertook a study to determine whether older age, having a first child (nulliparity), or other characteristics of the mother are risk factors for fetal death. Methods. We used data from the McGill Ob stetrical Neonatal Database to evaluate risk factors for fetal death a mong all deliveries at the Royal Victoria Hospital in Montreal (n=94,3 46) from 1961 through 1993, Data were available for two time periods ( 1961 through 1974 and 1978 through 1993); data for 1975 through 1977 h ave not been entered into the data base and were therefore not include d. Using logistic regression, we estimated the effect of specific mate rnal characteristics and complications of pregnancy on the risk of fet al death. Results. The fetal death rate decreased significantly from 1 1.5 per 1000 total births (including live births and stillbirths) in t he 1960s to 3.2 per 1000 in 1990 through 1993 (P<0,001), Between these periods, the average maternal age at delivery increased from 27 to 30 years (P<0.001), and the frequency of the diagnosis of diabetes and h ypertension during pregnancy increased fivefold (P<0.001), Nevertheles s, after we controlled for these and other maternal characteristics, w omen 35 years of age or older continued to have a significantly higher rate of fetal death than their younger counterparts (odds ratio for w omen 35 to 39 years of age as compared with women <30 years of age, 1. 9; 95 percent confidence interval, 1.3 to 2.7; for those 40 or older, 2.4; 95 percent confidence interval, 1.3 to 4.5). Conclusions. Changes in maternal health and obstetrical practice have resulted in a 70 per cent decline in the rate of fetal death among pregnant women of all ag es since the 1960s. Advancing maternal age, however, continues to be a risk factor for fetal death.