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Aims: To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery., Methods: This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006-2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding., Results: Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3-37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4-4.3 days., Conclusions: This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.

Objective: To investigate the association between advanced maternal age and stillbirth risks in first, second, third, and fourth births or more., Methods: A population-based registry study including all women aged 25 years and older with singleton pregnancies at 28 weeks of gestation and later gave birth in Sweden from 1990 to 2011; 1,804,442 pregnancies were analyzed. In each parity group, the risk of stillbirth at age 30-34 years, 35-39 years, and 40 years and older compared with age 25-29 years was investigated by logistic regression analyses adjusted for sociodemographic factors, smoking, body mass index, history of stillbirth, and interdelivery interval. Also, two low-risk groups were investigated: women with a high level of education and nonsmoking women of normal weight., Results: Stillbirth rates increased by maternal age: 25-29 years 0.27%; 30-34 years 0.31%; 35-39 years 0.40%; and 40 years or older 0.53%. Stillbirth risk increased by maternal age in first births. Compared with age 25-29 years, this increase was approximately 25% at 30-34 years and doubled at age 35 years. In second, third, and fourth birth or more, stillbirth risk increased with maternal age in women with a low and middle level of education, but not in women with high education. In nonsmokers of normal weight, the risk in second births increased from age 35 years or older and in third births or more from age 30 years or older., Conclusion: Advanced maternal age is an independent risk factor for stillbirth in nulliparous women. This age-related risk is reduced or eliminated in parous women, possibly as a result of physiologic adaptations during the first pregnancy., Level of Evidence: II.

Background: Delaying the first childbirth to an advanced age has increased significantly during the last decades, but little is known about older first time mothers' experience of childbirth. This study investigates the associations between advanced maternal age in primiparous women and the postnatal assessment of childbirth., Methods: The study was based on the National Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Data on 30 065 nulliparous women recruited in the second trimester 1999-2008 were used. Three questionnaires were completed: around gestational week 17 and 30, and at 6 months postpartum. Medical data were retrieved from the national Medical Birth Register. Advanced age was defined as ≥32 years and the reference group as 25-31 years. Descriptive and multiple logistic regression analyses were conducted., Results: Primiparous women aged 32 years and above expressed more worry about the upcoming birth than the younger women (adjusted OR 1.13; 95% CI 1.06-1.21), and 6 months after the birth they had a slightly higher risk of having experienced childbirth as 'worse than expected' (adjusted OR 1.09; 95% CI 1.02-1.16). The difference in birth experience was explained by mode of delivery. Comparisons within subgroups defined by the same mode of delivery showed that the risk of a more negative birth experience in the older women only applied to those with a spontaneous vaginal birth (adjusted OR 1.12; 95% CI 1.02-1.22). In women delivered by cesarean section, the older more often than younger women rated childbirth as 'better than expected' (elective cesarean delivery: adjusted OR 1.36; 95% CI 1.01-1.85, emergency cesarean delivery: adjusted OR 1.38; 95% CI 1.03-1.84)., Conclusion: Postponing childbirth to ≥32 years of age only marginally affected the experience of childbirth. Older women seemed to manage better than younger with having an operative delivery.

Objective: To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth., Design: National cohort study., Setting: Norway., Sample: A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units., Methods: Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as ≥ 32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to ≥ 40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress., Main Outcome Measures: Psychological distress measured by SCL-5., Results: Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months., Conclusion: Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years., (© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.)

Objective: To describe the background characteristics of women who gave birth to their first child at an advanced and very advanced maternal age, including their sociodemographic background, social relationships, health behavior, physical and mental health, and reproductive history., Design: Cross-sectional data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health., Setting: Norway. Sample. 41 236 Norwegian-speaking nulliparous women., Methods: Data were collected by the first questionnaire distributed in week 17 of pregnancy during the recruitment period 1999-2008. The distribution of descriptive variables in relation to age was investigated, by means of bivariate and multivariate logistic regression analyses., Main Outcome Measures: Advanced (33-37 years) and very advanced (≥38 years) maternal age., Results: Women who had their first baby at an advanced or very advanced age differed from the younger women with regard to a wide range of background characteristics, and this difference was most pronounced for the very advanced group. Problems related to physical aging were more common (infertility, physical health problems, sleep problems, depression and fatigue). Of the sociodemographic factors; high annual income and low level of education were most strongly correlated with high maternal age, followed by single status, unemployment, unsatisfactory relationship with partner and unplanned pregnancy., Conclusions: Besides having more age-related reproductive and physical health problems, women who had their first baby at an advanced or very advanced age constituted a heterogeneous group characterized by either socioeconomic prosperity or vulnerability., (© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: The aim of this study was to provide a comprehensive picture of the young to the old first time mother as she presents to the clinician in terms of background, expectations, experiences and outcome of labour., Methods: A longitudinal cohort study was conducted, including 1,302 primiparous women recruited at their first booking visit, at 593 antenatal clinics in Sweden (97% of all clinics), during three 1-week periods, evenly spread over 1 year in 1999 and 2000. Two questionnaires were posted and completed: in the second trimester and 2 months after the birth. Women were divided into 5 age groups, with women aged 26-29 as reference., Results: The very young women, aged 15-20 years, had the most negative expectations of the upcoming birth. During pregnancy they were more worried and a depressive mood was more common than in the reference group, as were social problems such as unemployment and lack of support. After the birth, they remembered being more afraid and experiencing more pain and lack of control during labour. In spite of this, their overall experience of childbirth did not differ from the reference group. In contrast, the oldest women, aged 35-43 years, did not have negative feelings about the upcoming birth during pregnancy, and did not remember being afraid or experiencing more pain than the reference group, but experienced childbirth overall as more difficult. Only 57% of the oldest women had a normal vaginal delivery compared with 77% of the youngest women. In addition, 7% of the newborns in the oldest group were transferred to the neonatal clinic after the birth, which was almost 3 times as often as in the reference group., Conclusion: This study showed that expectations and experiences of childbirth vary by maternal age. Whereas the youngest women were more exposed to social and psychological problems, which may have affected their expectations and experiences during labour, the oldest women may have suffered from the biological disadvantage of high maternal age, which is associated with a more complicated delivery. When looking back at labour and birth, the youngest women probably felt that the total experience was better than expected, whereas the opposite may have been the case for the oldest group.

Please cite this paper as: Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012;119:1108-1116. Objective To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth. Design National cohort study. Setting Norway. Sample A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units. Methods Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as ≥32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to ≥40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress. Main outcome measures Psychological distress measured by SCL-5. Results Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months. Conclusion Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years. [ABSTRACT FROM AUTHOR]