Pregnancy After Age 35

Predictors of perception of pregnancy risk among nulliparous women

OBJECTIVE

To determine factors associated with perception of pregnancy risk using a conceptual framework based on a review of the relevant literature and the psychometric model of risk perception.

DESIGN

A correlational study.

SETTING

Ambulatory care and antepartum units of two tertiary hospitals and selected obstetricians' offices and prenatal classes in Winnipeg, Canada.

PARTICIPANTS

A convenience sample of nulliparous women in their third trimester with a singleton pregnancy.

METHODS

Between December 2009 and January 2011, the following questionnaires were completed by 159 nulliparous women: the Perception of Pregnancy Risk Questionnaire, the Pregnancy-related Anxiety scale, Knowledge of Maternal Age-related Risks of Childbearing Questionnaire, the SF-12v2 Health Status Survey, the Multidimensional Health Locus of Control, and the Prenatal Scoring Form. Pearson's r correlations and stepwise multivariable linear regression analyses were conducted to achieve the research objectives.

RESULTS

Of the eight proposed factors in the conceptual framework, five factors were significant predictors of perception of pregnancy risk, including pregnancy-related anxiety, maternal age, medical risk, perceived internal control, and gestational age, accounting for 47% to 49% of the variance in risk perception. An interaction between the pregnancy-related anxiety score and maternal age was found.

CONCLUSIONS

These results contribute to the literature on perception of pregnancy risk by identifying a new predictor (gestational age), supporting the role of previously known factors in the state of pregnancy, and proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. This knowledge may have implications for developing more effective risk communication models.

Tailoring peripartum nursing care for women of advanced maternal age

Births to women of advanced maternal age have increased dramatically over the last decade in both the United States. The majority of women who deliver their first baby after age 35 are healthy and experience positive birth outcomes. According to current research, primigravidas over 35 tend to be educated consumers. Their physical and psychosocial needs differ from those of the mother in her 20s, due to advanced age and factors related to difficulty conceiving and life circumstances. This paper presents (a) an overview of the possible risks to outcomes of childbearing for women over the age of 35; (b) a discussion of how women of advanced maternal age may differ from younger women related to developmental stage, stress or anxiety or both, decision making, and support systems; and (c) an exploration of tailoring nursing care strategies during the peripartum period specifically for this age cohort.

First Mothering Over 35 Years: Questioning the Association of Maternal Age and Pregnancy Risk

Women having a first baby at 35+ years are commonly considered to be "at risk" for pregnancy complications. This understanding appears to be based primarily on age, and curerntly many healthy women are included in this category. There is clear evidence to suggest that, for these women, being considered "at risk" is anxiety provoking. In this Australian qualitative study of first mothering over 35 years, we found four risk-related themes, "realizing I was at risk," "hoping for reassurance," "dealing with uncertainty," and "getting through it/negotiating risk." We concluded that successful adjustment to motherhood related principally to participants negotiating risk and also to the infant growing and becoming more responsive. Attitudes of health professionals were found to contribute to rather than ameliorate participant dilemmas. Understanding how healthy women over 35 years engage with and negotiate notions of risk may assist health professionals in the provision of more meaningful maternal support for this growing group of women.