Literature Review

Peer-Reviewed Research We Have Reviewed

References for Further Reading are Included Below the Summaries

Research on affects of AMA on offspring: (Quantitative studies)

  • Research done by Myrskyla & Fenelon found that only children born to mothers under 25 and over 45 are associated with negative offspring health outcomes.
    • “The results suggest that children born to young parents might have been better off if the parents had waited a few years”.
    • “The public health concern regarding maternal age should focus on young, not old mothers”. [1]

Research on affects of AMA on mothers: (Quantitative studies)

  • One study found that “increased maternal age was significantly associated with several specific…adverse outcomes”.
    • Study also found that these outcomes increase with age.
    • These outcomes include: a threefold increase in cesareans, risk factors for perinatal mortality, and increased frequency of diabetes and hypertension.[2]
    • A study of over 5 million gestations found that women of advanced maternal age “are at higher risk of stillbirth throughout gestation” with the peak period to be at 37-41 weeks.
      • The study found that the risk of stillbirth is only “marginally elevated” than younger women.  The risk of stillbirth for women aged 35 to 39 years old was 1 in 382 and the risk of stillbirth for women older than 40 was 1 in 267.[3]
  • In Norway, a study of women 32 and older found that they had a slightly increased risk of psychological distress during pregnancy and motherhood compared with 25-31 year olds.
    • A history of depression increased the risk in all women regardless of age.  Age alone does not increase the risk for depression.
    • Depressive triggers are: timing of childbirth, cesarean delivery, prematurity, and a baby needing neonatal care
    • Because the age of first time mothers has changed, new groups of women are exposed to psychological distress.[4]
    • Using data from The National Survey of Family Growth found there is a perception that if a woman has children and decides to work outside of the home, then she will sacrifice career success.
      • However, the results found that delaying childbirth does not by itself guarantee career success, therefore the “conventional notion of the “mommy track” in which career success and motherhood are incompatible” is not supported.
      • Mothers of advanced maternal age that have career success often have higher levels of education, and therefore have higher wages.  So, if a woman has career success, becoming a mother does not have an effect on wages.[5]

Research on women’s experiences and views: (Qualitative studies)

  • A study done in the UK found that women have many factors that combine to influence their choice to delay motherhood.[6]
  • Another study from the UK correlated. Avoiding medical risk is not the only factor women consider.[7]
    • The factors the participants experienced were:
    • Being in a relationship, financial stability, physical health, and fertility.
    • Without all of these factors being aligned, women may perceive an element of risk greater than health alone to having a baby.
    • In an American study in 2008, 79 couples were interviewed about how they negotiated any kind of social stigma they experienced being older parents
      • “Both women and men experienced being older parents as important personal identities”.
      • Fathers “almost exclusively discussed older fatherhood as a personal identity”.
      • Mothers discussed all the ways age, gender and socioeconomic status intersected and became a public identity assigned by culture.
      • Women often tried to normalize older motherhood as a way of managing interactions that were stigmatizing.
        • They would openly discuss how older motherhood is becoming more common in society.
        • Others would assert that they were not different, but “extraordinary” and saw their older motherhood as something exceptional.
  • Women also expressed that they are better mothers now than they would have been if they gave birth in their 20’s.
    • They describe themselves as stable, confident, experienced and more patient.
  • The author noted that older mothers “by refusing to let the potential of stigma dictate their actions” enables social change and “stereotypes will be dismantled”.[8]
  • A study about how the media frames the narratives of older mothers found that even while there are risks associated with older fatherhood, they are often congratulated while older mothers criticized for their “risky behavior”.[9]

Research on birth methods:

  • One study found that there has been an increase of cesarean deliveries performed for women who have no medical need.
    • Cesareans increase the risk for respiratory problems in infants, greater complications in subsequent pregnancies, and longer hospital stays.[10]
    • In a study that combined findings from 21 research papers, it was found that “perceptions of safety shaped women’s preferences” in birthplace choices.
      • In cultures that medicalize childbirth, women believe giving birth is only safe in a hospital.
      • Women reported that felt the hospital gave them physical safety, but not emotional safety.
      • Women that used a midwife found that the medicalised culture made it difficult for them to “provide all the options available to women”.
      • Women felt that without being informed of all of their birthplace choices, they had no autonomy and therefore could not make an informed decision.
      • However, women who used a midwife reported that they felt more in control and more satisfied with their birth experience.
      • Women that used a midwife reported an increased feeling of autonomy and “experienced greater personal attention”.[11]

Research on fertility/infertility:

  • The number of births per 1000 women 35-39 years of age has increased 36% between 1992 and 2002.[12]
  • The rate among women 40-44 has increased by 70%.[13]
  • The average age for women to cryopreserve their eggs is 38, as a reactive not a proactive measure.
    • Women aged 30-35 are the ideal age to cryopreserve their eggs as a proactive measure to prevent future infertility.
    • At the average age of 38, a woman’s amount of oocytes has declined and can produce a lower number of oocytes.
    • Cryobanks and gynecologists should inform women about cryopreservation to expand their options.
    • “This would expand a woman’s reproductive options and allows them to overcome the gap between optimal age to reproduce from a gynecological point of view and the optimal age to reproduce from a socioeconomic point of view”.[14]

[1] Myrskylä, M.,, & Fenelon, A. (2012). Maternal Age and Offspring Adult Health: Evidence From the Health and Retirement Study. Demography, 49(4), 1231–1257. doi:10.1007/s13524-012-0132-x

[2] Salem Yaniv, S., Levy, A., Wiznitzer, A., Holcberg, G., Mazor, M., & Sheiner, E. (2011). A significant linear association exists between advanced maternal age and adverse perinatal outcome. Archives Of Gynecology And Obstetrics, 283(4), 755–759. doi:10.1007/s00404-010-1459-4

[3] Reddy, U. M., Ko, C.-W., & Willinger, M. (2006). Maternal age and the risk of stillbirth throughout pregnancy in the United States. American Journal of Obstetrics and Gynecology, 195(3), 764–770. doi:10.1016/j.ajog.2006.06.019

[4] Aasheim, V., Waldenström, U., Hjelmstedt, A., Rasmussen, S., Pettersson, H., & Schytt, E. (2012). Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG: An International Journal Of Obstetrics And Gynaecology, 119(9), 1108–1116. doi:10.1111/j.1471-0528.2012.03411.x

[5] Meyer, C. S. (1999). Family focus or career focus: controlling for infertility. Social Science & Medicine, 49(12), 1615–1622. doi:10.1016/S0277-9536(99)00210-5

[6] Cooke, A., Mills, T. A., & Lavender, T. (2010). “Informed and uninformed decision making”—Women’s reasoning, experiences and perceptions with regard to advanced maternal age and delayed childbearing: A meta-synthesis. International Journal of Nursing Studies, 47(10), 1317–1329. doi:10.1016/j.ijnurstu.2010.06.001

[7] Cooke, Alison, Tracey A. Mills, & Tina Lavender. (n.d.). Advanced maternal age: Delayed childbearing is rarely a conscious choice. A qualitative study of women’s views and experiences. International Journal of Nursing Studies, 49, 30–39. doi:10.1016/j.ijnurstu.2011.07.013

[8] Friese, C., Becker, G., & Nachtigall, R. D. (2008). Older motherhood and the changing life course in the era of assisted reproductive technologies. Journal of Aging Studies, 22(1), 65–73. doi:10.1016/j.jaging.2007.05.009

[9] Campbell, P. (2011). Boundaries and risk: Media framing of assisted reproductive technologies and older mothers. Social Science & Medicine, 72(2), 265–272. doi:10.1016/j.socscimed.2010.10.028

[10] MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: epidemiology, trends, and outcomes. Clinics in Perinatology, 35(2), 293–307, v. doi:10.1016/j.clp.2008.03.007

[11] Hadjigeorgiou, E., Kouta, C., Papastavrou, E., Papadopoulos, I., & Mårtensson, L. B. (2012). Women’s perceptions of their right to choose the place of childbirth: an integrative review. Midwifery, 28(3), 380–390. doi:10.1016/j.midw.2011.05.006

[12] Lester, S. (1999).  An introduction to phenomenological research. Stan Lester Developments.  Retrieved from

[13] Smajdor, A. (2011). The ethics of IVF over 40. Maturitas, 69(1), 37–40. doi:10.1016/j.maturitas.2011.02.012

[14] Mertes, H., & Pennings, G. (2011). Social egg freezing: for better, not for worse. Reproductive Biomedicine Online, 23(7), 824–829. doi:10.1016/j.rbmo.2011.09.010