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Advanced maternal age and the risk of perinatal death due to intrapartum anoxia at term
  1. Dharmintra Pasupathy1,
  2. Angela M Wood2,
  3. Jill P Pell3,
  4. Michael Fleming4,
  5. Gordon C S Smith1,5
  1. 1Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
  2. 2Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  3. 3Public Health Section, University of Glasgow, Glasgow, UK
  4. 4Information and Statistics Division, Common Services Agency, Edinburgh, UK
  5. 5Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK
  1. Correspondence to Gordon CS Smith, Obstetrics and Gynaecology, The Rosie Hospital, Addenbrookes NHS Trust, Cambridge CB2 2SW, UK; gcss2{at}


Background Advanced maternal age is associated with higher risks of intrapartum complications. However, the effect of maternal age on the risk of perinatal death due to these complications is unclear. The aim of the present study was to determine the association between maternal age and delivery-related perinatal death at term.

Methods In this retrospective cohort study, birth records of 1 043 002 singleton term infants with cephalic presentation were analysed excluding anomalous and antepartum losses in Scotland between 1985 and 2004. Linked Scottish national registries of pregnancy outcome data and perinatal death data were used. The event was delivery-related perinatal death (ie, intrauterine fetal death during labour or death of the infant in the first 4 weeks of life), plus a subgroup ascribed to intrapartum anoxia.

Results There were 803 delivery-related perinatal deaths, with 490 due to intrapartum anoxia (4.7 per 10 000 births) and 313 (3.0 per 10 000 births) due to non-anoxic causes. Compared to women aged 25–34, women aged 40 and above had a twofold risk of delivery-related perinatal death at term (adjusted OR 2.20, 95% CI 1.42 to 3.40). The excess was explained by increased risk of death due to intrapartum anoxia. Among women in labour at term, age greater than 40 was independently associated with risk of anoxic death among primiparous (adjusted OR 5.34, 95% CI 2.34 to 12.20) and multiparous women (adjusted OR 2.14, 95% CI 0.99 to 4.60).

Conclusions Advanced maternal age is associated with an increased risk of death due to intrapartum anoxia at term.

  • Infant mortality
  • labour
  • maternal age
  • perinatal epidemiology; perinatal mortality
  • term birth

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  • Funding DP was a recipient of a Clinical Research Training Fellowship awarded by the Medical Research Council and Royal College of Obstetricians and Gynaecologists (Florence & William-Blair Bell Memorial Fellowship Fund) when this study was performed. DP is currently a Clinical Lecturer in Maternal and Fetal Medicine at King's College London. The funding source had no involvement in the study design; in the collection, analysis and interpretation of the data; in writing the report; and in the decision to submit the paper for publication.

  • Competing interests None.

  • Ethics approval Approval for the record linkage was provided by the Privacy Advisory Committee of the Information and Statistics Division of the National Health Service Scotland. The Chair of the Scotland A Research Ethics Committee has stated that analysis of anonymised extracts of the linked data does not require separate ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.