Characteristics of first-time fathers of advanced age: a Norwegian population-based study

Sociodemographic Trends and Perinatal Outcomes in Fathers 50 Years and Older

Importance

The age of fathers at childbirth is rising, with an increasing number of births attributed to older fathers. While the impact of advanced paternal age has been documented, sociodemographic data about fathers aged 50 years and older remain scarce.

Objectives

To explore sociodemographic and temporal trends among the oldest US fathers (age ≥50 years) and their associations with perinatal outcomes.

Design, Setting, and Participants

This retrospective cross-sectional study included data from all US births from 2011 to 2022 using the National Vital Statistics System. Data were analyzed from August 2023 and May 2024.

Exposures

Reported paternal age at childbirth.

Main Outcomes and Measures

Outcomes of interest were sociodemographic factors, temporal trends in older fatherhood, and perinatal outcomes, including preterm birth, low birth weight, gestational diabetes, gestational hypertension, assisted reproductive technology (ART), rates of maternal primiparity, and the infant sex ratio.

Results

From 2011 to 2022, the US recorded 46 195 453 births, with an overall mean (SD) paternal age of 31.5 (6.8) years and 484 507 (1.1%) involving fathers aged 50 years or older, 47 785 (0.1%) aged 60 years or older, and 3777 (0.008%) aged 70 years or older. Births to fathers aged 50 years or older increased from 1.1% in 2011 to 1.3% in 2022 (P for trend < .001). Fathers aged 50 years or older were more diverse, with variations in educational achievement and race and ethnicity. Marital status and maternal racial and ethnic and educational backgrounds also varied by paternal age and race. Despite controlling for maternal age and other sociodemographic and perinatal factors, every 10-year increase in paternal age was consistently associated with greater use of ART (eg, age 50-59 years: adjusted odds ratio [aOR], 2.23; 95% CI, 2.19-2.27), higher likelihood of first maternal birth (eg, age 50-59 years: aOR, 1.16; 95% CI, 1.15-1.17), and increased risks of preterm birth (eg, age 50-59 years: aOR, 1.16; 95% CI, 1.15-1.18) and low birth weight (eg, age 50-59 years: aOR, 1.14; 95% CI, 1.13-1.15) compared with fathers aged 30 to 39 years. No significant changes in the infant sex ratio were observed, except among fathers aged 70 years or older (aOR, 0.92; 95% CI, 0.86-0.99) and 75 years or older (aOR, 0.84; 95% CI, 0.73-0.97), who showed a decreased likelihood of having male offspring.

Conclusions and Relevance

In this cross-sectional study of all US births from 2011 to 2022, the percentage attributed to older fathers, while small, increased. Notable variations in paternal and maternal race and education were identified. Older fatherhood was associated with increased ART use, first-time maternal births, adverse perinatal outcomes, and altered sex ratio. Further research of this population is crucial for improving patient counseling and family planning.

Paternal age and perinatal outcomes: an observational study

OBJECTIVES

The study's primary aim was to examine the relationship between paternal age and perinatal outcomes.

METHODS

This study used data from two hospital birth registries to examine the association between paternal age and adverse perinatal outcomes. The sample included all live singleton births between 2010 and 2022. The primary exposure was paternal age, and the following perinatal outcomes were considered: mode of conception, mode of delivery, pregnancy complications, and neonatal outcomes.

RESULTS

A total of 15,232 pregnant women were considered. Maternal and paternal ages were 31.9 ± 5.3 and 36.5 ± 6.5 years, respectively. Independent of maternal, paternal age was associated with lower odds of spontaneous conceptions (OR 0.930, 95 % CI 0.968/0.993; p=0.003) and higher odds of intracytoplasmatic sperm injection (OR 1.054, 95 % CI 1.045/1.062; p=0.0001), respectively. In contrast to maternal age, paternal age decreased the odds of any (OR 0.922, 95 % CI 0.985/0.999; p=0.032) and urgent/emergent (OR 0.984, 95 % CI 0.975/0.993; p=0.0001) cesarean delivery. Paternal age did not affect the gestation length, placental or neonatal weight, blood loss during delivery, and neonatal 5th-minute Apgar score.

CONCLUSIONS

Paternal age is associated with perinatal outcomes. These findings suggest that advanced paternal age may have implications for reproductive counseling and prenatal care.

Comparison of Intratesticular Testosterone between Men Receiving Nasal, Intramuscular, and Subcutaneous Pellet Testosterone Therapy: Evaluation of Data from Two Single-Center Randomized Clinical Trials

PURPOSE

Testosterone replacement therapy (TRT) can potentially cause decreased spermatogenesis and subsequent infertility. Recent studies have suggested that 17-hydroxyprogesterone (17-OHP) is a reliable surrogate for intratesticular testosterone (ITT) that is essential for spermatogenesis. We evaluated data from two ongoing open-label, randomized, two-arm clinical trials amongst different treatment preparations (Trial I) subcutaneous testosterone pellets (TP) and (Trial II) intranasal testosterone (NT) or intramuscular testosterone cypionate (TC).

MATERIALS AND METHODS

Seventy-five symptomatic hypogonadal men (2 serum testosterone <300 ng/dL) were randomized into open label randomized clinical trials. Eligible subjects received 800 mg TP, 11 mg TID NT or 200 mg ×2 weeks TC. 17-OHP and Serum testosterone were evaluated at baseline and follow-up. The primary outcome was changes in 17-OHP. Secondary outcome was changes in serum testosterone. Data was analyzed by two-sample and single-sample t-tests, and determination of equal or unequal variances was computed using F-tests.

RESULTS

Median participant age was 45 years old, with overall baseline 17-OHP of 46 and serum testosterone of 223.5 ng/dL. 17-OHP significantly decreased in subjects prescribed long-acting TP or TC. The 4-month change in 17-OHP in the NT group (-33.3% from baseline) was less than the change seen in TC (-65.3% from baseline) or TP (-44% from baseline) (p=0.005). All testosterone formulations increased serum testosterone levels at follow-up, with the largest increase seen in TC (+157.6%), followed by NT (+114.3%) and TP (+79.6%) (p=0.005).

CONCLUSIONS

Short-acting nasal testosterone appear to have no impact on serum 17-OHP especially in comparison to long-acting testosterone formulations. All modalities saw significant increases in serum testosterone levels at follow-up. NT and other short acting testosterone formulations may better preserve ITT and be beneficial for hypogonadal men seeking to maintain fertility potential while on TRT.

Lived experiences and coping strategies of persons seeking infertility treatment in the Kumasi metropolis: a descriptive phenomenological study

BACKGROUND

Women seeking fertility treatment face myriad challenges that they must adapt and adjust to daily. This aimed at exploring the experiences and coping strategies of such persons in the Kumasi. Metropolis.

METHODS

A qualitative approach was employed and a purposive sampling technique was used to select 19 participants. A semi-structured interview was used to collect data. The data collected were analyzed using Colaizzi's method of data analysis.

RESULTS

Persons living with infertility had emotional experiences of anxiety, stress, and depression. Socially, participants experienced isolation, stigma, societal pressure, and marital problems due to their inability to conceive. The key coping strategies adopted were spiritual (faith-based) and social support. Though formal child adoption can be an option, no participant preferred it as a coping strategy. Some participants also reported using herbal medicine before going to the fertility centre upon realizing that the approach was not helping in achieving their desired outcome.

CONCLUSION

Infertility is a source of suffering for most women diagnosed with it, resulting in significant negative experiences in their matrimonial homes, families, friends, and the community at large. Most participants rely on spiritual and social support as their immediate and basic coping strategies. Future research could evaluate the treatment and coping strategies and also determine the outcomes of other forms of treatment for infertility.

Reprint of: Advanced paternal age and risk of schizophrenia in offspring - Review of epidemiological findings and potential mechanisms

A large number of studies have examined the association between advanced paternal age (APA) and risk of schizophrenia in offspring. Here we present an overview of epidemiological studies on this subject published since 2000, and systematically summarize their methodologies and results. Next, we discuss evidence to elucidate the potential mechanisms contributing to the association between APA and offspring schizophrenia, considering paternal psychiatric morbidity and genetic liability, maternal factors, and findings from family design studies. We propose that multiple mechanisms, including causal and non-causal pathways, contribute to the observed relationship between APA and schizophrenia in offspring, and conclude by highlighting the need for multi-disciplinary studies in disentangling these complex, non-mutually exclusive mechanisms.

A multifactorial model for the etiology of neuropsychiatric disorders: the role of advanced paternal age

Mental or neuropsychiatric disorders are widespread within our societies affecting one in every four people in the world. Very often the onset of a mental disorder (MD) occurs in early childhood and substantially reduces the quality of later life. Although the global burden of MDs is rising, mental health care is still suboptimal, partly due to insufficient understanding of the processes of disease development. New insights are needed to respond to this worldwide health problem. Next to the growing burden of MDs, there is a tendency to postpone pregnancy for various economic and practical reasons. In this review, we describe the current knowledge on the potential effect from advanced paternal age (APA) on development of autism spectrum disorder, schizophrenia, attention-deficit/hyperactivity disorder, bipolar disorder, obsessive-compulsive disorder, and Tourette syndrome. Although literature did not clearly define an age cut-off for APA, we here present a comprehensive multifactorial model for the development of MDs, including the role of aging, de novo mutations, epigenetic mechanisms, psychosocial environment, and selection into late fatherhood. Our model is part of the Paternal Origins of Health and Disease paradigm and may serve as a foundation for future epidemiological research designs. This blueprint will increase the understanding of the etiology of MDs and can be used as a practical guide for clinicians favoring early detection and developing a tailored treatment plan. Ultimately, this will help health policy practitioners to prevent the development of MDs and to inform health-care workers and the community about disease determinants. Better knowledge of the proportion of all risk factors, their interactions, and their role in the development of MDs will lead to an optimization of mental health care and management. IMPACT: We design a model of causation for MDs, integrating male aging, (epi)genetics, and environmental influences. It adds new insights into the current knowledge about associations between APA and MDs. In clinical practice, this comprehensive model may be helpful in early diagnosis and in treatment adopting a personal approach. It may help in identifying the proximate cause on an individual level or in a specific subpopulation. Besides the opportunity to measure the attributed proportions of risk factors, this model may be used as a blueprint to design prevention strategies for public health purposes.

Social, demographic and health characteristics of men fathering children at different ages

The aim of this study was to examine associations between selected sociodemographic, socioeconomic, and health characteristics and the rates of fatherhood in different age groups. We investigated rates between 2011 and 2015 in a population-based register study including all men born from 1945 to 1995 residing in Denmark in 2011. The study population consisted of 1,867,108 men who fathered 268,612 children during the follow-up. The associations were quantified as incidence rate ratios using Poisson regression. Young men had higher rates of fathering a child if they lived outside the Capital Region, had a relatively high income, were previously diagnosed with cardiovascular disease, psychoactive substance abuse, personality disorders, schizophrenia or behavioural and emotional disorders. Men of advanced age had higher rates of fathering a child when born outside Denmark, living in the Capital Region, were in the lower or upper 10th percentile income group, were self-employed or unemployed or previously diagnosed with depression. Men of advanced age had lower rates of fathering a child if previously diagnosed with somatic diseases, psychoactive substance abuse or mental retardation. The findings highlight the importance of consideration of various sociodemographic, socioeconomic, and health characteristics when studying associations between paternal age and offspring health.

Advanced paternal age and risk of schizophrenia in offspring - Review of epidemiological findings and potential mechanisms

A large number of studies have examined the association between advanced paternal age (APA) and risk of schizophrenia in offspring. Here we present an overview of epidemiological studies on this subject published since 2000, and systematically summarize their methodologies and results. Next, we discuss evidence to elucidate the potential mechanisms contributing to the association between APA and offspring schizophrenia, considering paternal psychiatric morbidity and genetic liability, maternal factors, and findings from family design studies. We propose that multiple mechanisms, including causal and non-causal pathways, contribute to the observed relationship between APA and schizophrenia in offspring, and conclude by highlighting the need for multi-disciplinary studies in disentangling these complex, non-mutually exclusive mechanisms.

DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples

STUDY QUESTION

What is the relationship between sperm DNA fragmentation and oxidative stress (OS) with increasing male age?

SUMMARY ANSWER

Sperm DNA fragmentation increases with age and is likely related to both defective spermatogenesis and increasing OS levels.

WHAT IS KNOWN ALREADY

Sperm quality declines with age. The presence of DNA damage in a high fraction of spermatozoa from a raw semen sample is associated with lower male fertility in natural conception and intrauterine insemination.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study of 16 945 semen samples analysed at a single reference laboratory between January 2010 and December 2018.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All males were undergoing an infertility evaluation. The cohort was divided into seven age categories: <30, 30-34, 35-39, 40-44, 45-49, 50 to <54 and ≥55 years. The mean age was 37.6 years (SD 6.8). Sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were calculated using flow cytometry. OS levels were measured using the oxidative stress adducts (OSA) test, by spectrophotometry. ANOVA with weighted polynomial contrast analysis was used to evaluate trends for DFI, OSA and HDS values across age categories.

MAIN RESULTS AND THE ROLE OF CHANCE

Mean DFI significantly increased across all age groups (Ptrend < 0.001). OSA was lowest in patients <30 years old (mean 3.6, SD 1.0) and also increased as age increased (Ptrend < 0.001). There was a statistically significant difference between age groups for each of the three parameters (P < 0.001). There was a significant linear trend for DFI, OSA and HDS across the seven age categories (P < 0.001). Among patients with high DFI, there was a decreasing age-dependent trend in the patients observed with high OSA (P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

This is a retrospective study. All males included in the study were undergoing a work-up for infertility and may not be representative of a fertile population. Additional patient demographics and clinical data were not available.

WIDER IMPLICATIONS OF THE FINDINGS

DNA and/or oxidative damage in sperm may be just as important to understand as the chromosomal aberrations that are carried in the oocyte. Further studies are needed to evaluate the effect of advancing paternal age on the male genome and, ultimately, on the health of the offspring.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was obtained for this study. V.D. is an employee of Reprosource/Quest Diagnostics. D.S. reports he was a Scientific Advisor to Cooper Surgical.

TRIAL REGISTRATION NUMBER

N/A.

The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects

BACKGROUND

There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.

OBJECTIVE AND RATIONALE

The present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA.

SEARCH METHODS

We used the scoping review methodology. Searches of interdisciplinary articles databases were performed with keywords pertaining to APA and its dimensions outside of biology and medicine. We included scientific articles, original research, essays, commentaries and editorials in the sample. The final sample of 177 documents was analysed with qualitative thematic analysis.

OUTCOMES

We identified six themes highlighting the interdisciplinary nature of APA research. The 'terminological aspects' highlight the lack of consensus on the definition of APA and the strategies developed to offer alternatives. The 'social aspects' focus on the postponement transition towards reproducing later in life and its cultural dimensions. The 'public health aspects' refer to attempts to analyse APA as a problem with wider health and economic implications. The 'psychological aspects' focus on the consequences of APA and older fatherhood on psychological characteristics of the child. The 'ethical aspects' reflect on issues of APA emerging at the intersection of parental autonomy, children's welfare and social responsibility. The 'regulatory aspects' group different suggestions to collectively approach the implications of APA. Our results show that the field of APA is still in the making and that evidence is lacking to fully address the issues of APA. The review suggests promising avenues of research such as introducing the voice of fathers of advanced age into the research agenda.

WIDER IMPLICATIONS

The results of this review will be useful for developing policies and preconception health interventions that consider and include prospective fathers of advanced age.

Association between paternal age and offspring's under-5 mortality: Data from 159 surveys in 67 low- to middle-income countries

AIM

To investigat the association between paternal age at birth and offspring's under-5 mortality in low- and middle-income countries (LIMCs).

METHODS

Data from 159 population-based surveys in 67 LIMCs between 2000 and 2018 were obtained from the Demographic and Health Surveys. Cox proportional hazard regression models in consideration of complex survey design were performed to examine the associations.

RESULTS

In the pooled analysis, compared with children born to fathers aged 25-29 years, those born to younger fathers aged 20-24, 16-19 and 12-15 years, respectively, were at increased risk of under-5 mortality (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.06-1.13; HR = 1.48, 95% CI = 1.42-1.55; HR = 1.70, 95% CI = 1.56-1.84, respectively). In addition, children born to older fathers aged 40-44 and ≥ 45 years, also had increased risk of under-5 mortality (HR = 1.08, 95% CI = 1.03-1.15; HR = 1.12, 95% CI = 1.07-1.18, respectively).

CONCLUSIONS

Our findings show that children born to both younger and older fathers are at higher risk of offspring's under-5 mortality in LIMCs.

Men's age at first birth and alcohol-related morbidity and mortality among siblings

BACKGROUND

Men's age at first birth may negatively or positively affect alcohol-related morbidity and mortality, although little evidence is available.

METHODS

We used register data of over 22,000 brothers to analyze the associations between age at first birth and alcohol-related morbidity and mortality from the age of 35 until the age of 60 or 72. We employed conventional Cox models and inter-sibling models, which allowed adjustment for unobserved social and genetic characteristics shared by brothers.

RESULTS

The findings show that men's age at first birth was inversely associated with alcohol-related morbidity and mortality, independent of unobserved characteristics shared by brothers and of observed demographic confounders. Men who had their first child late at 35-45 years experienced lower alcohol-related morbidity and mortality (hazard ratio (HR) = 0.57, 95 % confidence interval (CI) = 0.43, 0.75) than men who had their first child at 25-29. Men who had their first child before age 20 had the highest morbidity and mortality among all fathers (HR = 1.36, 95 % CI = 1.09, 1.69), followed by men who had their child at 20-24 (HR = 1.12, 95 % CI = 1.00, 1.25).

CONCLUSIONS

The results imply that the inverse association between men's age at first birth and alcohol-related morbidity and mortality is not driven by familial characteristics.

When Fathers Begin to Falter: A Comprehensive Review on Paternal Perinatal Depression

The transition to parenthood is considered to be a major life transition that can increase the vulnerability to parental depressive disorders, including paternal perinatal depression (PPND). Although it is known that many fathers experience anxiety and depression during the perinatal period, PPND is a recent diagnostic entity and there are not enough published studies on it. Accordingly, its prevalence and epidemiology are still not well defined, although the majority of studies agree that PPND is less frequent than maternal perinatal depression and postpartum depression. Nevertheless, PPND is different from maternal perinatal mental health disorders, usually, fathers have less severe symptoms, and mood alterations are often in comorbidity with other affective disorders. Despite the absence of DSM-5 diagnostic criteria and the fluctuation of prevalence rates, clinical symptoms have been defined. The main symptoms are mood alterations and anxiety, followed by behavioral disturbances and concerns about the progress of pregnancy and the child’s health. Moreover, PPND negatively impacts on family functioning, on couples’ relationships, and on family members’ well-being. The aim of this paper is to present an overview of the current understandings on PPND and the potential screening, prevention, and treatment options.

Understanding the association between advanced paternal age and schizophrenia and bipolar disorder

BACKGROUND

Previous studies reported an association between advanced paternal age at birth and increased risk for schizophrenia and bipolar disorder. While some hypothesize that this association is caused by de-novo mutations in paternal spermatozoa, others cite factors associated with psycho-social characteristics of fathers who have children at a late age. This study aims to test these hypotheses.

METHODS

A historical-prospective, population-based cohort study, performed by linking the Israeli Draft Board Registry and the Israeli National Psychiatric Hospitalization Registry (N = 916 439; 4488 with schizophrenia, 883 with bipolar disorder). Odds ratios (OR) and two-sided 95% confidence intervals (CI) were calculated by logistic regression models, using paternal age as predictor and risk for later hospitalizations for schizophrenia or bipolar disorder as outcome measure. Models were first fitted unadjusted, then adjusted for paternal age at birth of the first child.

RESULTS

In the unadjusted model, offspring of fathers aged 45 and above at birth had increased risk of schizophrenia (OR = 1.71, 95% CI 1.49-1.99) and bipolar disorder (OR = 1.63, 95% CI 1.16-2.24). However, taking into account paternal age at birth of first child, advanced paternal age was no longer associated with increased risk of schizophrenia (OR = 0.60, 95% CI 0.48-0.79) or bipolar disorder (OR = 1.03, 95% CI 0.56-1.90).

CONCLUSIONS

Controlling for paternal age at birth of the first offspring, advanced paternal age does not predict increased risk for schizophrenia or bipolar disorder. These data indicate that the association between advanced paternal age and having an offspring with schizophrenia and bipolar disorder is likely due to psychos-social factors, or common genetic variation associated with delayed initial fatherhood.

The correlation between marital satisfaction and childbearing characteristics in women in Tehran

BACKGROUND

Pregnancy and childbearing can change the relationship between a couple and their degree of marital satisfaction.

OBJECTIVES

The present study was conducted to determine the effect of women's childbearing characteristics, including age at marriage, childbearing age, the interval between marriage and the birth of the first child, the number of children, age differences between children and children's gender composition (only sons, only daughters or both sons and daughters) on marital satisfaction in women of childbearing age in Tehran.

MATERIALS AND METHODS

This descriptive correlational study was conducted on 213 married females aged 15-45 years presenting to health centers in Tehran in 2016. The demographic questionnaire, the Enrich Marital Satisfaction Scale and a devised questionnaire on childbearing were used for data collection. The data collected were analyzed with SPSS-17 using descriptive statistics (mean and standard deviation) and Pearson's correlation test, the analysis of variance (ANOVA) and the stepwise regression test.

RESULTS

According to the stepwise regression test, of all the factors associated with marital satisfaction, the number of children showed the highest correlation with marital satisfaction (p < 0.001, r = -0.22). In those with three children, the age difference between the second and third children had the highest correlation with marital satisfaction (p < 0.001, r = -0.5). The variables of age at first childbirth (r = 0.18) and children's gender composition were also significantly related to marital satisfaction (p < 0.005).

CONCLUSION

The findings suggest that of all the factors associated with marital satisfaction, the number and spacing of children affect marital satisfaction.

Is the relationship between men's age at first birth and midlife health changing? Evidence from two British cohorts

Becoming a father, particularly for the first time, is a central transition in men's lives, and whether this transition takes place early or later in life may have important ramifications on the whole later life course. Previous research has shown that men who father their first child early in life have poorer later-life health than men who postpone having children. However, it is not known how selection by cognitive ability and other childhood characteristics confound the association between the timing of fatherhood and later-life health, or how the association is changing over time as parenthood is postponed to an older age. We investigate the association between men's age at the birth of their first child and midlife self-rated health in two British cohorts born in 1958 and 1970. The study employs logit models. Relative to men who had their first child when they were between 25 and 29 years old, men who had their first child before the age of 20 have the poorest health, followed by men who had a child when they were 20–24 years old. This result was observed in both cohorts. Childhood cognitive ability, which previous research has not analyzed, strongly contributed to this association, and to a greater extent than other childhood characteristics. For the 1970 cohort, those who became fathers at age 35 or older had the best health. This advantage was not found for the 1958 cohort. These findings suggest that the relationship between young age at fatherhood and midlife health is strongly confounded by cognitive ability, and that in recent cohorts a new pattern of advantage among older fathers has emerged.

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Early fatherhood shows associations with poorer self-rated health in midlife.

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Childhood cognitive ability strongly confounds this association.

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First-time fathers aged 35 years or older have the best health in the 1970 cohort.

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A similar health advantage in older fathers is not found in the 1958 cohort.

The effect of paternal factors on perinatal and paediatric outcomes: a systematic review and meta-analysis

BACKGROUND

Maternal factors, including increasing childbearing age and various life-style factors, are associated with poorer short- and long-term outcomes for children, whereas knowledge of paternal parameters is limited. Recently, increasing paternal age has been associated with adverse obstetric outcomes, birth defects, autism spectrum disorders and schizophrenia in children.

OBJECTIVE AND RATIONALE

The aim of this systematic review is to describe the influence of paternal factors on adverse short- and long-term child outcomes.

SEARCH METHODS

PubMed, Embase and Cochrane databases up to January 2017 were searched. Paternal factors examined included paternal age and life-style factors such as body mass index (BMI), adiposity and cigarette smoking. The outcome variables assessed were short-term outcomes such as preterm birth, low birth weight, small for gestational age (SGA), stillbirth, birth defects and chromosomal anomalies. Long-term outcome variables included mortality, cancers, psychiatric diseases/disorders and metabolic diseases. The systematic review follows PRISMA guidelines. Relevant meta-analyses were performed.

OUTCOMES

The search included 14 371 articles out of which 238 met the inclusion criteria, and 81 were included in quantitative synthesis (meta-analyses). Paternal age and paternal life-style factors have an association with adverse outcome in offspring. This is particularly evident for psychiatric disorders such as autism, autism spectrum disorders and schizophrenia, but an association is also found with stillbirth, any birth defects, orofacial clefts and trisomy 21. Paternal height, but not BMI, is associated with birth weight in offspring while paternal BMI is associated with BMI, weight and/or body fat in childhood. Paternal smoking is found to be associated with an increase in SGA, birth defects such as congenital heart defects, and orofacial clefts, cancers, brain tumours and acute lymphoblastic leukaemia. These associations are significant although moderate in size, with most pooled estimates between 1.05 and 1.5, and none exceeding 2.0.

WIDER IMPLICATIONS

Although the increased risks of adverse outcome in offspring associated with paternal factors and identified in this report represent serious health effects, the magnitude of these effects seems modest.

Fertility History and Physical and Mental Health Changes in European Older Adults

Previous studies have shown that aspects of reproductive history, such as earlier parenthood and high parity, are associated with poorer health in mid and later life. However, it is unclear which dimensions of health are most affected by reproductive history, and whether the pattern of associations varies for measures of physical, psychological and cognitive health. Such variation might provide more insight into possible underlying mechanisms. We use longitudinal data for men and women aged 50–79 years in ten European countries from the Survey of Health, Ageing and Retirement in Europe to analyse associations between completed fertility history and self-reported and observed health indicators measured 2–3 years apart (functional limitations, chronic diseases, grip strength, depression and cognition), adjusting for socio-demographic, and health factors at baseline. Using multiple imputation and pattern mixture modelling, we tested the robustness of estimates to missing data mechanisms. The results are partly consistent with previous studies and show that women who became mothers before age 20 had worse functional health at baseline and were more likely to suffer functional health declines. Parents of 4 or more children had worse physical, psychological and cognitive health at baseline and were more likely to develop circulatory disease over the follow-up period. Men who delayed fatherhood until age 35 or later had better health at baseline but did not experience significantly different health declines. This study improves our understanding of linkages between fertility histories and later life health and possible implications of changes in fertility patterns for population health. However, research ideally using prospective life course data is needed to further elucidate possible mechanisms, considering interactions with partnership histories, health behaviour patterns and socio-economic trajectories.

Lack of association between receiving ART treatment and parental psychological distress during pregnancy: Preliminary findings of the Japan Environment and Children's Study

In a nationwide population-based birth cohort study in Japan, pregnant women and their partners were evaluated for psychological distress as part of the first and second/third trimester health checks. Participants were divided into three groups: an infertility group receiving assisted reproductive technology (ART) treatment (239 mothers and 151 fathers); an infertility group receiving non-ART treatment (350 mothers and 215 fathers); and a spontaneous pregnancy group (8514 mothers and 5110 fathers). Data on maternal and child health as well as basic characteristics were collected via medical records and self-administered questionnaires. The Kessler Six-item Psychological Distress Scale was employed for eligible women and their partners. Multivariate logistic regression analysis was used to evaluate the association between psychological distress experienced during pregnancy and ART treatment, with adjustment for potential confounders such as basic health status and socio-economic status. The mothers who received ART treatment suffered less psychological distress than the mothers in the other two groups. In multivariate analysis adjusted for background characteristics, no significant association was observed between persistent maternal distress and ART treatment (adjusted odds ratio 0.79, 95% confidence interval 0.49-1.26). Higher socio-economic status among couples receiving ART treatment may explain, in part, the lack of association between ART treatment and parental distress during pregnancy.

Paternal age and psychiatric disorders: A review

We review the hypotheses concerning the association between the paternal age at childbearing and childhood psychiatric disorders (autism spectrum- and attention deficit/hyperactive disorder) and adult disorders (schizophrenia, bipolar-, obsessive-compulsive-, and major depressive disorder) based on epidemiological studies. Several hypotheses have been proposed to explain the paternal age effect. We discuss the four main-not mutually exclusive-hypotheses. These are the de novo mutation hypothesis, the hypothesis concerning epigenetic alterations, the selection into late fatherhood hypothesis, and the environmental resource hypothesis. Advanced paternal age in relation to autism spectrum disorders and schizophrenia provided the most robust epidemiological evidence for an association, with some studies reporting a monotonic risk increase over age, and others reporting a marked increase at a given age threshold. Although there is evidence for the de novo mutation hypothesis and the selection into late fatherhood hypothesis, the mechanism(s) underlying the association between advanced paternal age and psychiatric illness in offspring remains to be further clarified. © 2016 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

Advanced paternal age effects in neurodevelopmental disorders-review of potential underlying mechanisms

Multiple epidemiological studies suggest a relationship between advanced paternal age (APA) at conception and adverse neurodevelopmental outcomes in offspring, particularly with regard to increased risk for autism and schizophrenia. Conclusive evidence about how age-related changes in paternal gametes, or age-independent behavioral traits affect neural development is still lacking. Recent evidence suggests that the origins of APA effects are likely to be multidimensional, involving both inherited predisposition and de novo events. Here we provide a review of the epidemiological and molecular findings to date. Focusing on the latter, we present the evidence for genetic and epigenetic mechanisms underpinning the association between late fatherhood and disorder in offspring. We also discuss the limitations of the APA literature. We propose that different hypotheses relating to the origins of the APA effects are not mutually exclusive. Instead, multiple mechanisms likely contribute, reflecting the etiological complexity of neurodevelopmental disorders.

Perinatal mental health: Fathers - the (mostly) forgotten parent

INTRODUCTION

The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarize existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development.

METHOD

An electronic literature search was conducted using MEDLINE and PubMed databases. Key texts were used to cross-check for any further articles of interest.

RESULTS

Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child's emotional and behavioral development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited.

CONCLUSIONS

A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders, to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.

Postponing parenthood to advanced age

The aim of the Postponing Parenthood project was to investigate several aspects of the delaying of childbearing phenomenon in Sweden and Norway, such as medical risks and parental experiences. Data were retrieved from the Swedish and Norwegian Medical Birth Registers and three different cohorts: the Swedish Young Adult Panel Study, the Norwegian Mother and Child Cohort, and the Swedish Women's Experiences of Childbirth cohort. Postponing childbirth to age 35 years and later increased the risk of rare but serious pregnancy outcomes, such as stillbirth and very preterm birth. Older first-time parents were slightly more anxious during pregnancy, and childbirth overall was experienced as more difficult, compared with younger age groups. First-time mothers' satisfaction with life decreased from about age 28 years, both when measured during pregnancy and early parenthood. Delaying parenthood to mid-30 or later was more related to lifestyle than socioeconomic factors, suggesting that much could be done in terms of informing young persons about the limitations of fertility and assisted reproductive techniques, and the risks associated with advanced parental age.

Factors influencing first childbearing timing decisions among men: Path analysis

BACKGROUND

Factors that influence men's childbearing intentions have been relatively unexplored in the literature.

OBJECTIVE

This study aimed to determine the influencing factors about the first childbearing timing decisions of men.

MATERIALS AND METHODS

In this cross-sectional study, 300 men who were referred to private and governmental healthcare centers in Shahrood, Iran were randomly recruited from April to September 2014. Data were collected using a demographic questionnaire, the Quality of Life Questionnaire; ENRICH Marital Satisfaction Questionnaire, Synder's Hope Scale, and the Multidimensional Scale of Perceived Social Support.

RESULTS

After removing the statistically insignificant paths, men's age at marriage had the highest direct effect (β=0.86) on their first childbearing decision. Marital satisfaction (β=-0.09), social support (β=0.06), economic status (β=0.06), and quality of life (β=-0.08) were other effective factors on men's first childbearing decisions. Moreover, marital satisfaction and social support had significant indirect effects on men's childbearing decisions (β=-0.04 and -0.01, respectively).

CONCLUSION

Many factors, including personal factors (age at marriage and quality of life), family factors (marital satisfaction), and social factors (social support), can affect men's decision to have a child. Policymakers are hence required to develop strategies to promote the socioeconomic and family conditions of the couples and to encourage them to have as many children as they desire at an appropriate time.

Alcohol consumption among partners of pregnant women in Sweden: a cross sectional study

Background

Antenatal care in Sweden involves a visit in pregnancy week 6–7 for counseling about lifestyle issues, including alcohol. The aim of this study was to investigate alcohol consumption among partners of pregnant women, their motives for changing drinking patterns when becoming a parent and their perceptions of the midwife’s counseling about alcohol.

Method

The study was conducted at 30 antenatal care centers across Sweden in 2009–2010. All partners who accompanied a pregnant women in pregnancy week >17 were asked to participate. The questionnaire included questions on alcohol consumption.

Results

Questionnaires from 444 partners were analyzed. Most, 95 %, of the partners reported alcohol consumption before pregnancy; 18 % were binge drinking (6 standard drinks or more per occasion, each drink containing 12 grams of pure alcohol) at least once every month during the last year. More than half, 58 %, of all partners had decreased their alcohol consumption following pregnancy recognition and a higher proportion of binge drinkers decreased their consumption compared to non-frequent binge drinkers (p = 0.025). Their motives varied; the pregnancy itself, fewer social gatherings (potentially involving alcohol consumption) and a sense of responsibility for the pregnant partner were reported. Of the partners, 37 % reported support for decreased drinking from others (pregnant partner, parents, friend or workmates). Further, most partners appreciated the midwife’s counseling on alcohol.

Conclusion

A majority of partners decreased their alcohol consumption in transition to parenthood, which also appears to be a crucial time for changing alcohol-drinking patterns. The partners with higher AUDIT-C scores reported more support for decreased drinking. Most partners appreciated the midwife’s talk about alcohol and pregnancy and those who filled out AUDIT in early pregnancy reported that the counseling was more engaging. During pregnancy it is possible to detect partners with high alcohol consumption, and promote interventions for decreased drinking, also for the partners. Written information addressing alcohol use and directed to partners is needed.

Investigating paternal preconception risk factors for adverse pregnancy outcomes in a population of internet users

BACKGROUND

Paternal preconception risk factors such as smoking, exposure to environmental substances, medication use, overweight and advanced age correlate with the occurrence of malformations and birth defects in the offspring. Nonetheless, the prevalence of risk factors for adverse pregnancy outcomes in the male population has been scarcely investigated and no report on preconception interventions targeting prospective fathers is available. We conducted a web-based survey to measure the prevalence of paternal preconception risk factors for adverse pregnancy outcomes in an Italian population of Internet users.

METHODS

Prospective or expectant fathers were enrolled during a four-week period through two of the main Italian web-sites dedicated to preconception, pregnancy, childhood and family care. Participants filled in a web questionnaire regarding preconception risk factors for adverse pregnancy outcomes. Logistic regression analysis was used to explore the predictors of paternal preconception risk factors.

RESULTS

We enrolled 131 prospective and 205 expectant fathers. More than half of the total participants used medications during the preconception period, 35% were smokers and 8% were obese. Exposure to environmental substances was declared by almost 20% of the participants, with the group including pesticides/herbicides/professional paints being the most prevalent. More than a half of the study sample included men aged over 35 years. According to the multivariate analysis, smoking and exposure to environmental toxics were less frequent among individuals with a university degree (respectively: OR = 0.52; 95% CI 0.32-0.84; OR = 0.52; 95% CI 0.29-0.93). Paternal obesity and medication use in the preconception period were not associated with any of the independent variables.

CONCLUSIONS

The prevalence of preconception risk factors among male population should not be neglected when planning preconception interventions, confirming that preconception health must be focused on the couple, rather than on women only.

Aging fatherhood in Finland – first-time fathers in Finland from 1987 to 2009

Aim: The increase in maternal age has been well documented in Western societies, but information on paternal age trends is scarce. The aim of this study was to investigate changes in age and other background characteristics of first-time fathers in Finland in the period 1987–2009. Materials and methods: A random 60% sample of first-time fathers in each year from 1987 to 2009 was obtained from Statistics Finland ( n=344,529). Five-year intervals were used (three years in 1987–1989). Sociodemographic characteristics of older first-time fathers (⩾40 years) were compared over time using logistic regression. In the logistic regression, immigrants were excluded from the study population as they may have had children before migrating to Finland. Results: The mean age of first-time fathers increased from 28.7 to 30.4 years in 1987–2009. The change was greatest in the Capital Region and smallest in Northern and Eastern Finland. Fatherhood at the age of ⩾40 years doubled from 3.1% to 6.8%. From 2005 to 2009, men who lived in rural areas and the Capital Region, had a long education, were divorced or widowed, had been born in a rural area and were native Finnish speakers, were more likely than other men to be old when they became fathers. Conclusions: During the study period, the average age of first-time fathers increased by two years. Further studies are needed to examine whether delays in first-time fatherhood affect fertility, child health and the use of social and health services.

Advancing parental age and autism: multifactorial pathways

Converging evidence from epidemiological, genetic, and animal studies supports the hypothesis that advancing parental age, both of the father and mother, increases the risk of autism spectrum disorders (ASD) in offspring. Paternal age has received considerable attention, with whole-genome sequencing studies linking older fathers to higher rates of de novo mutations and increased risk of ASD. The current evidence suggests that the increased risk of ASD in the offspring of older mothers may be related to mechanisms different from those operating in older fathers. Causal pathways probably involve the interaction of multiple risk factors. Although the etiology of ASD is still poorly understood, studies of parental age provide clues into the genetic and environ-mental mechanisms that mediate the risk of ASD.

Delayed fatherhood

Birth data from developed countries indicates that the average paternal age is increasing. As the trend to older fatherhood has become established, concerns have been raised that this may be linked to adverse outcomes, such as pregnancy complications, congenital anomalies, and long-term health implications for the child. Since the sperm of older fathers may be impaired due to the general effects of ageing, their offspring may be at risk due to defects in sperm quality at conception. A literature search was performed to identify pregnancy complications, fetal anomalies and health issues for the child when the father is in an older age bracket. Evidence for impairment in the sperm and genetic material of older fathers was reviewed. With an older father, there is evidence of an increase in stillbirths and a slightly increased risk of autism, bipolar disorder and schizophrenia in the offspring later in life. The increased risk of achondroplasia has long been recognised. For the mother, there is an increased rate of Caesarean section. Investigations of other possible adverse outcomes have produced mixed findings. Further robust and longitudinal studies are needed to clarify these issues.

Still childless at the age of 28 to 40 years: a cross-sectional study of Swedish women's and men's reproductive intentions

BACKGROUND

Delayed childbearing is associated with adverse reproductive outcomes. Our aim was to investigate Swedish women's and men's childbearing intentions at the age of 28, 32, 36 and 40 years, in terms of: (1) time point for a first child, (2) number of children, and (3) reasons for not yet having children.

METHODS

Cross-sectional data from the Swedish Young Adult Panel Study, including 365 childless women and 356 childless men aged 28, 32, 36 and 40 years who responded to a questionnaire in 2009. Descriptive and multivariate logistic regression analyses were conducted.

RESULTS

Most 28- and 32-year-olds intended to have children, but only 32% of women and 37% of men aged 36/40 years (merged), many of whom still postponed childbearing. Reasons for remaining childless differed by age. Most prominent in the 36/40-year-olds were: lack of a partner (women 60%, men 59%), no desire for children (women 44%, men 44%), not mature enough (women 29%, men 35%), and wanting to do other things before starting a family (women 26%, men 33%). The 36/40-year-olds had the highest odds for infertility problems (OR 3.8; CI 95% 1.8-7.9) and lacking a suitable partner (OR 1.8 CI 95% 1.1-3.0), and lower odds for reasons related to work and financial situation.

CONCLUSIONS

Many childless 36- and 40-year-olds intended to have children but seemed to overestimate their fecundity. The most prominent reasons for being childless were: not having wanted children up to now, lack of a partner, infertility problems, and prioritising an independent life.

Paternal age, placental weight and placental to birthweight ratio: a population-based study of 590,835 pregnancies

STUDY QUESTION

Is the age of the father associated with placental weight or the ratio of placental weight to birthweight?

SUMMARY ANSWER

Placental weight and placental to birthweight ratio increased according to increasing paternal age, also after adjustment for maternal age.

WHAT IS KNOWN ALREADY

High paternal age and also high placental to birthweight ratio have been associated with adverse pregnancy outcome.

STUDY DESIGN, SIZE AND DURATION

We performed a population-based study and included all singleton births after 22 weeks of gestation in the Medical Birth Registry of Norway (n = 590,835) during the years 1999-2009.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We compared mean placental weight and placental to birthweight ratio between paternal age groups. The association of paternal age with placental weight was estimated by linear regression analyses, and adjustments were made for maternal age, birthweight, parity, offspring sex, gestational age at birth, maternal smoking, pre-eclampsia, maternal diabetes mellitus and pregnancy after assisted reproductive technology (ART).

MAIN RESULTS AND THE ROLE OF CHANCE

In pregnancies with fathers aged 20-24 years old, the mean placental weight was 656.2 g [standard deviation (SD) 142.8], whereas it was 677.8 g (SD 160.0) in pregnancies with fathers aged 50 years or older (P < 0.001). The mean offspring birthweight in pregnancies with fathers aged 20-24 year old was 3465.0 g (SD 583.8), and it was 3498.9 g (SD 621.8) when the father was 50 years or older (P < 0.001). The placental to birthweight ratio in the corresponding paternal age groups were 0.191 (SD 0.039) and 0.196 (SD 0.044) (P < 0.001). In multivariable linear regression analysis the placentas in pregnancies fathered by a man of 50 years or older were estimated to weigh 13.99 g [95% confidence interval (CI) 10.88-17.10] more than in pregnancies with a 20-24-year-old father (P < 0.001) after adjustment for maternal age, birthweight, parity, offspring sex, gestational age at birth, maternal smoking, pre-eclampsia, maternal diabetes mellitus and pregnancy after ART.

LIMITATIONS, REASONS FOR CAUTION

Paternal age explains only a small proportion of the total variation in placental weight.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings may increase the understanding of the father's role in human pregnancy.

STUDY FUNDING/ COMPETING INTEREST(S)

Norwegian Resource Centre for Women's Health, Norway. No conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.