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Abstract
Objective: To determine the magnitude of risk for fetal death among singleton pregnancies in relation to maternal age, and to compare the risks with other common indications for fetal testing.Study design: We performed a retrospective cohort analysis of singleton births delivered between 1995 and 2000 using the US linked birth/infant death data. Gestational age at <24 weeks and fetuses with anomalies were excluded. Fetal death rates at ≥24 and ≥32 weeks were calculated among women aged 15–19, 20–24, 25–29, 30–34, 35–39, 40–44 and 45–49 years, as well as for other common indications for testing: chronic and pregnancy-induced hypertension, diabetes and smallfor-gestational age (SGA). The association between maternal age and fetal deaths was derived after adjusting for potential confounders through multivariable logistic regression models. Relative risks (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for the effects of gravidity, race, marital status, prenatal care, education, smoking and placental abruption.Results: Among the 21 610 873 singleton births delivered at ≥24 weeks, fetal deaths occurred in 58 580 (2.7 per 1000). Births to young (15–19 years) and older (≥35 years) women comprised 12.6% and 11.4%, respectively. Compared with women aged 20–24 years, young women did not experience an increased risk of fetal death. However, increasing rates of fetal death at ≥24 and at ≥32 weeks were seen with increasing maternal age. The RR for fetal death at ≥24 and at ≥32 weeks among women 35–39 years were 1.21 and 1.31, respectively, while the RRs were 1.62 and 1.67 among women aged 40–44 years. Women 45–49 years were 2.40-fold (95% CI 1.77, 3.27) and 2.38-fold (95% CI 1.64, 3.46) as likely to deliver a stillborn fetus at ≥24 weeks and ≥32 weeks, respectively. RRs for fetal death at ≥24 and ≥32 weeks for hypertensive disease, diabetes, and SGA ranged between 1.46 and 4.95.Conclusion: Fetal deaths are increased among older women (≥35 years). Fetal testing in women of advanced maternal age may be beneficial.