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A. Trends and Patterns.
1. Lack of contraceptives (young adults: take the risk, older: don’t think they need them)
In comparison to young pregnant women, older women are notorious for contraceptive usage at a higher rate. On the other hand, the young adult crowd has sex without proper contraception, which leads to unplanned pregnancies. A multitude of factors are contributing to this pattern, such as a lack of knowledge about reproductive methods, misconceptions about pregnancy risks, and denial of reproductive health services due to social prejudices and access barriers. In contrast, advanced-aged women used more birth control, indicating a greater conscious awareness of reproductive health concerns and a more practical and strategic approach to family planning. The age-based disparity in the proportion of contraceptive users emphasizes the importance of customized education programs aimed at promoting contraceptive accessibility and education, particularly among young adults.
2. C-section and treatments/procedures used for advanced-age pregnancy
The risk of complications during advanced pregnancy increases when compared to normal pregnancy. Similarly, the risk of cesarean section delivery rises. Studies found that advanced-aged pregnant women had a higher number of C-sections due to age-related factors such as lower uterine tone, higher rates of medical comorbidity, and obstetric problems. In this case, advanced-age pregnancies usually require frequent monitoring and medications, such as induction of labor or assisted reproductive technologies, to reduce the risks associated with late pregnancies and promote the mother’s health. As a result, healthcare professionals tend to use a variety of techniques in managing an advanced maternal-age pregnancy, including close observation, early diagnosis of complications, and prompt intervention, including C-section deliveries, when necessary, to minimize adverse outcomes for the mother.
3. Age and risk factors associated
Gestational diabetes, hypertension, and preterm birth are all well-documented risk factors for advanced age at the time of pregnancy, as is an increase in the Down syndrome rate among fetal chromosomal defects. Pregnant women of advanced age may be the most vulnerable category due to age-related physiological losses that can affect outcomes, such as diminished ovarian reserve, a thoroughly functioning uterus, and a weakened placental bed. This trend of risk rises with maternal age, which in turn increases the risk of pregnancy complications like preeclampsia, gestational hypertension, and placental abruption, emphasizing the importance of proper risk assessment and how it can lead to specific management approaches for older pregnant women. As a result, healthcare practitioners must take a proactive approach to some older pregnant women while providing prenatal care, including early risk assessment, regular monitoring, and customized interventions to improve maternal and fetal health outcomes.
B. Themes
1. Longer hospitalization stays with advanced-age pregnancy
2. Mental health with advanced age pregnancy
3. Young adults’ perception of pregnancy and its risks
*The complications of advanced-age pregnancy result in more extended hospital stays. Geriatric pregnancies have a higher complication rate due to additional comorbidities that may play a role in family genetics. Pre-gestational and gestational diabetes mellitus, chromosomal abnormalities, and preterm delivery are a few examples. Pre-gestational and gestational diabetes mellitus plays a role because insulin resistance increases with age. Also, if they inherit diabetes risk factors such as genetics, family history, diet, obesity, poor sleeping habits, stress, and inflammation, chromosomal abnormalities could be caused by trisomy, an extra copy of chromosomes in the cell nuclei. Finally, preterm births can be caused by a lack of progesterone; they tend to decline with age.
Mental health, in general, is a critical issue. One’s emotional, psychological, and social well-being influences how one goes about one’s daily life. Because they are aware of the potential consequences of their pregnancy, these women’s hormones rise during advanced pregnancy. Many of them suffer from stress, depression, and suicidal thoughts. All of this occurs because they are aware of what can happen during the pregnancy, are attempting to avoid being judged by their age, or are potentially bringing a child into the world with various deficits.
In this generation, many young women who become pregnant are unaware of the consequences for their bodies due to the various risks and complications associated with their pregnancy. These young women may be suffering from uterine infections unknowingly because of recent trends in young-age pregnancies. These young adults’ lack of knowledge impair their decision-making. Because they are unaware of the risks associated with pregnancy, they proceed to have their own child. Whether it’s to alleviate pain or trauma or to find comfort in something, they can call their own. On the other hand, pregnancy-related issues that occur among older women include insufficient data on initial health concerns and challenges in managing the stigma associated with pregnancy timing.
C. Debates/Contradictions
1. Planned vs. unplanned advanced-age pregnancy.
2. Certain risk factors can be subjective based on people’s opinions/perceptions of age.
3. Perception of providers/doctors
*The articles presented some debates and contraindications, such as people’s opinions/perceptions of age and how this can place a subjective view on certain risk factors, the perception of providers/doctors, and pregnancy preparedness (planned vs unplanned). Sangin and Phonkusol (2021) explain that older adults have an altered perception of risk relating to pregnancy. Firstly, older adults tend not to use contraceptives because they believe they will not need them as they age. Second, they believe that their pregnancy risks are low and that if they become pregnant, there will be few or no complications. They also state that nulliparous women (women who have never given birth to a child) have an increased perception of risk than multiparous (those who have given birth before). Multiparous older women have a decreased view because they have had experience, so they think their other pregnancies/birthing process will go just as smoothly. Another point was the perception of doctors/providers. Older adults have a skewed perception as there are more complications for them, and doctors are unable or unwilling to provide the necessary extra attention. Lastly, there is a debate about advanced-age planned versus unplanned pregnancies. They explain that unplanned pregnancies have an increased risk for alcohol consumption and smoking during the pregnancy, as well as the delay or failure to receive necessary prenatal vitamins due to not knowing they were pregnant. Planned advanced-age pregnancy has a lower risk because women are prepared to take the required essential vitamins and follow the recommended instructions. However, this does not reduce the other risk factors associated with advanced-age pregnancy.
D. Gaps
1. Lack of reporting (perception/fear of judgment)
On the other hand, pregnancy-related issues that occur among older women include insufficient data on initial health concerns and challenges in managing the stigma associated with pregnancy timing.
2. Health literacy
Literacy education has become an important field that prevents unplanned pregnancies and assures the overall reproductive health of women. Inadequate health literacy can be a stumbling block for most individuals in understanding contraceptive methods, how they work, and the importance of visiting reproductive health clinics, among others. Filling this gap could be through inclusive curricula that ensure the public is literate about health, has correct contraception use choices, and has more knowledge on reproductive health.
3. Access to Healthcare
Pregnant women often lack access to affordable and comprehensive healthcare services, including contraception, reproductive health checkups, and prenatal care. It is important to address this gap because the lack of access to reproductive health treatments creates an uneven playing field by primarily impacting low-income and excluded populations, thereby worsening reproductive healthcare disparities. The goal is to close this gap by improving reproductive care access in underserved areas through community clinics, telemedicine initiatives, and targeted outreach activities. Furthermore, actions to reduce the financial barriers to health care would ensure that everyone had equal access to necessary reproductive health resources.
References
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Bommarito, K., Madden, T., Olsen, M. A., Subramaniam, H., Peipert, J. F., & Bierut, L. J. (2015). Maternal age and risk of labor and delivery complications. Maternal and child health journal, 19(6), 1202–1211. https://doi.org/10.1007/s10995-014-1624-7
Glick, I., Kadish, E., & Rottenstreich, M. (2021). Management of Pregnancy in Women of Advanced Maternal Age: Improving Outcomes for Mother and Baby. International journal of women’s health, 13, 751–759. https://doi.org/10.2147/IJWH.S283216
Correa‐de‐Araujo, R., & Yoon, S. S. (2021, February 1). Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. Journal of Womens Health. https://doi.org/10.1089/jwh.2020.8860
Sriprasert, I., Chaovisitsaree, C., Sribanditmongkhol, N., Sunthornlimsiri, N., & Kietpeerakool, C. (2015). Unintended pregnancy and associated risk factors among young pregnant women. International Journal of Gynaecology and Obstetrics, 128(3), 228–231. https://doi.org/10.1016/j.ijgo.2014.09.004
Mehari, M. A., Maeruf, H., Robles, C. C., Woldemariam, S., Adhena, T., Mulugeta, M., Haftu, A., Hagose, H., & Kumsa, H. (2020, January 30). Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-2740-6
Siriwan Sangin, & Chotip Phonkusol. (2021). Perception of Pregnancy Risk and Related Obstetric Factors amoung Women of Advanced Maternal Age. Pacific Rim International Journal of Nursing Research, 25(3), 494-504 (CAN” T SEEM TO FIND WEBSITE so please complete this reference)
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