Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy

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Women’s Health (A Sarma, Section Editor)

Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy Anna C. OKelly, MD1 Nandita S. Scott, MD2,* Address 1 Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA *,2 Department of Medicine, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA Email: [email protected]

Published online: 13 November 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020

This article is part of the Topical Collection on Women’s Health Keywords Advanced maternal age I Cardiovascular complications of pregnancy I Cardio-obstetrics

Abstract Purpose of review Pregnancy in women of advanced maternal age (AMA) is increasingly common. Women of AMA have higher pregnancy risks, including higher risk of cardiovascular complications such as hypertensive disorders of pregnancy. This review highlights recent data comparing pregnancy risks in both younger women and women of AMA, as well as how these risks are influenced using assisted reproductive therapies (ART). It highlights long-term cardiovascular risks in women of AMA and suggestions on how to perform cardiovascular evaluations both preconception and during pregnancy in this group of women. It also highlights the importance of comprehensive cardio-obstetrics care in providing optimal preconception, pregnancy, and postpartum care for women of AMA. Recent findings Though data on evaluating pregnancy risk in women of AMA are limited, what data are available suggest higher rates of hypertensive disorders of pregnancy, gestational diabetes, and multiple other cardiovascular complications. The absolute risk however remains low. These risks are amplified by ART use. Increasing attention is being paid to optimizing preconception health, especially preconception obesity and hypertension. Summary More work is required to better characterize the risks of AMA in pregnancy and how to optimally care for these patients. What research is available emphasizes the importance of optimizing prepregnancy health. A multidisciplinary cardio-obstetrics may play an especially integral part in optimizing the safety of pregnancy in women of AMA.

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Curr Treat Options Cardio Med (2020) 22: 71

Introduction Pregnancy in women of advanced maternal age (AMA) is increasingly common. The average age of first-time mothers in the USA increased between 2000 and 2014, such that in 2014, 9.1% of births occurred in women over the age of 35 at time of delivery [1]. Advanced maternal age is considered a pregnancy in a woman 35 years of age or older [2–6], though the risks associated with advancing age increase over a continuum.

There are a number of fetal risks associated with AMA including greater rates of spontaneous abortion, ectopic pregnancy, chromosomal and placental abnormalities, small-for-gestational-age fetuses, and preterm delivery [7–9]. A full discussion of these risks falls outside the scope of this paper.