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<span>Examples</span> </div> </a> <ul id="toc-Examples-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Possible_factors_that_influence_childbearing_age" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Possible_factors_that_influence_childbearing_age"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Possible factors that influence childbearing age</span> </div> </a> <ul id="toc-Possible_factors_that_influence_childbearing_age-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Effects" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Effects</span> </div> </a> <button aria-controls="toc-Effects-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Effects subsection</span> </button> <ul id="toc-Effects-sublist" class="vector-toc-list"> <li id="toc-Decreased_fertility" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Decreased_fertility"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Decreased fertility</span> </div> </a> <ul id="toc-Decreased_fertility-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Risk_of_birth_defects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_of_birth_defects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Risk of birth defects</span> </div> </a> <ul id="toc-Risk_of_birth_defects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Other effects</span> </div> </a> <ul id="toc-Other_effects-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Changes_in_interpregnancy_interval" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Changes_in_interpregnancy_interval"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Changes in interpregnancy interval</span> </div> </a> <ul id="toc-Changes_in_interpregnancy_interval-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ovarian_aging" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Ovarian_aging"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Ovarian aging</span> </div> </a> <ul id="toc-Ovarian_aging-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Citations" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Citations"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Citations</span> </div> </a> <ul id="toc-Citations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-General_and_cited_references" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#General_and_cited_references"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>General and cited references</span> </div> </a> <ul id="toc-General_and_cited_references-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" 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.ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Merge_from plainlinks metadata ambox ambox-move" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Mergefrom.svg/50px-Mergefrom.svg.png" decoding="async" width="50" height="20" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Mergefrom.svg/75px-Mergefrom.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0f/Mergefrom.svg/100px-Mergefrom.svg.png 2x" data-file-width="50" data-file-height="20" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">It has been suggested that <i><a href="/wiki/Pregnancy_over_age_50" title="Pregnancy over age 50">Pregnancy over age 50</a></i> be <a href="/wiki/Wikipedia:Merging" title="Wikipedia:Merging">merged</a> into this article. (<a href="/wiki/Talk:Advanced_maternal_age" title="Talk:Advanced maternal age">Discuss</a>)<small><i> Proposed since November 2024.</i></small></div></td></tr></tbody></table> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For effects associated with father's age, see <a href="/wiki/Paternal_age_effect" title="Paternal age effect">Paternal age effect</a>.</div> <p class="mw-empty-elt"> </p><p><b>Advanced maternal age</b>, in a broad sense, is the instance of a woman being of an older age at a stage of reproduction, although there are various definitions of specific age and stage of reproduction.<sup id="cite_ref-Fretts2012_1-0" class="reference"><a href="#cite_note-Fretts2012-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The variability in definitions is in part explained by the effects of increasing age occurring as a <a href="/wiki/Continuum_(measurement)" title="Continuum (measurement)">continuum</a> rather than as a threshold effect.<sup id="cite_ref-Fretts2012_1-1" class="reference"><a href="#cite_note-Fretts2012-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Average <b>age at first childbirth</b> has been increasing, especially in <a href="/wiki/OECD" title="OECD">OECD</a> countries, among which the highest average age is 32.6 years (<a href="/wiki/South_Korea" title="South Korea">South Korea</a>) followed by 32.1 years (<a href="/wiki/Ireland" title="Ireland">Ireland</a> and <a href="/wiki/Spain" title="Spain">Spain</a>).<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> In a number of European countries (Spain), the mean age of women at first childbirth has crossed the 30 year threshold.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> This process is not restricted to Europe. Asia, Japan and the United States are all seeing average age at first birth on the rise, and increasingly the process is spreading to countries in the <a href="/wiki/Developing_world" class="mw-redirect" title="Developing world">developing world</a> such as <a href="/wiki/China" title="China">China</a>, <a href="/wiki/Turkey" title="Turkey">Turkey</a> and <a href="/wiki/Iran" title="Iran">Iran</a>. In the U.S., the average age of first childbirth was 26.9 in 2018.<sup id="cite_ref-cdc-natality_4-0" class="reference"><a href="#cite_note-cdc-natality-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Advanced maternal age is associated with adverse reproductive effects including increased risk of <a href="/wiki/Female_infertility" title="Female infertility">infertility</a>,<sup id="cite_ref-Leridon2004_5-0" class="reference"><a href="#cite_note-Leridon2004-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> and <a href="/wiki/Chromosomal_abnormalities" class="mw-redirect" title="Chromosomal abnormalities">chromosomal abnormalities</a> in children.<sup id="cite_ref-morris_6-0" class="reference"><a href="#cite_note-morris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The corresponding <a href="/wiki/Paternal_age_effect" title="Paternal age effect">paternal age effect</a> is less pronounced.<sup id="cite_ref-Tournaye-2009_7-0" class="reference"><a href="#cite_note-Tournaye-2009-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Kidd-2001_8-0" class="reference"><a href="#cite_note-Kidd-2001-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=1" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Having children later was not exceptional in the past, when families were larger and women often continued bearing children until the end of their reproductive age. What is so radical about this recent transformation is that it is the age at which women give birth to their first child, which is becoming comparatively high, leaving an ever more constricted window of biological opportunity for second and subsequent children, should they be desired. Unsurprisingly, high first-birth ages and high rates of birth postponement are associated with the arrival of low, and lowest-low fertility.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p><p>This association has now become especially clear, since the postponement of first births in a number of countries has now continued unabated for more than three decades and has become one of the most prominent characteristics of <a href="/wiki/Fertility_factor_(demography)" title="Fertility factor (demography)">fertility patterns</a> in developed societies. A variety of authors (in particular, <a href="/w/index.php?title=Lesthaeghe&action=edit&redlink=1" class="new" title="Lesthaeghe (page does not exist)">Lesthaeghe</a>) have argued that fertility postponement constitutes the "hallmark" of what has become known as the "second demographic transition". <sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2024)">citation needed</span></a></i>]</sup> </p><p>Others have proposed that the postponement process itself constitutes a separate "third transition".<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> On this latter view, modern developed societies exhibit a kind of dual fertility pattern, with the majority of <a href="/wiki/Births" class="mw-redirect" title="Births">births</a> being concentrated either among very young or increasingly older mothers. This is sometimes known as the "rectangularisation" of <a href="/wiki/Fertility_factor_(demography)" title="Fertility factor (demography)">fertility patterns</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Examples">Examples</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=2" title="Edit section: Examples"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the US, the average age at which women bore their first child advanced from 21.4 years old in 1970<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> to 26.9 in 2018.<sup id="cite_ref-cdc-natality_4-1" class="reference"><a href="#cite_note-cdc-natality-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>The German <a href="/wiki/Federal_Institute_for_Population_Research" title="Federal Institute for Population Research">Federal Institute for Population Research</a> claimed in 2015 the percentage for women with an age of at least 35 giving birth to a child was 25.9%. This figure rose from 7.6% in 1981.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Possible_factors_that_influence_childbearing_age">Possible factors that influence childbearing age</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=3" title="Edit section: Possible factors that influence childbearing age"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are many factors that may influence childbearing age in women, although they are mostly <a href="/wiki/Correlation_does_not_imply_causation" title="Correlation does not imply causation">correlations without certain causations</a>. For instance, older maternal age at first childbirth is associated with higher educational attainment and income.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Two studies show that generous parental leave allowances in Britain encourage young motherhood and that parental-leave allowance reduces postponement in Sweden.<sup id="cite_ref-balbo2013_14-0" class="reference"><a href="#cite_note-balbo2013-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Effects">Effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=4" title="Edit section: Effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Decreased_fertility">Decreased fertility</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=5" title="Edit section: Decreased fertility"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Age_and_female_fertility.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/57/Age_and_female_fertility.png/270px-Age_and_female_fertility.png" decoding="async" width="270" height="184" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/57/Age_and_female_fertility.png/405px-Age_and_female_fertility.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/57/Age_and_female_fertility.png/540px-Age_and_female_fertility.png 2x" data-file-width="1616" data-file-height="1099" /></a><figcaption>Cumulative percentage and average age for women reaching <a href="/wiki/Subfertility" class="mw-redirect" title="Subfertility">subfertility</a>, <a href="/wiki/Infertility" title="Infertility">sterility</a>, <a href="/wiki/Irregular_menstruation" title="Irregular menstruation">irregular menstruation</a> and <a href="/wiki/Menopause" title="Menopause">menopause</a><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></figcaption></figure> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Age_and_female_fertility" title="Age and female fertility">Age and female fertility</a></div> <p>A woman's fertility peaks lasts during the twenties and first half of thirties, after which it starts to decline, with advanced maternal age causing an increased risk of <a href="/wiki/Female_infertility" title="Female infertility">female infertility</a>. </p><p>According to Henri Leridon, PhD, an epidemiologist with the French Institute of Health and Medical Research, of women trying to get pregnant, without using fertility drugs or in vitro fertilization:<sup id="cite_ref-Leridon2004_5-1" class="reference"><a href="#cite_note-Leridon2004-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p> <ul><li>At age 30, 75% will have a conception ending in a live birth within one year, and 91% will have a conception ending in a live birth within four years.</li> <li>At age 35, 66% will have a conception ending in a live birth within one year, and 84% will have a conception ending in a live birth within four years.</li> <li>At age 40, 44% will have a conception ending in a live birth within one year, and 64% will have a conception ending in a live birth within four years.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Risk_of_birth_defects">Risk of birth defects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=6" title="Edit section: Risk of birth defects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A woman's risk of having a baby with <a href="/wiki/Chromosomal_abnormalities" class="mw-redirect" title="Chromosomal abnormalities">chromosomal abnormalities</a> increases with her age. <a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a> is the most common chromosomal <a href="/wiki/Congenital_disorder" class="mw-redirect" title="Congenital disorder">birth defect</a>, and a woman's risk of having a baby with Down syndrome is:<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-morris_6-1" class="reference"><a href="#cite_note-morris-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <dl><dd><dl><dt>Risk of having a baby with Down syndrome</dt></dl></dd></dl> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 8em;"> <dl><dd><table style="text-align:center;"> <tbody><tr> <th>Age</th> <th>Risk </th></tr> <tr> <td>20</td> <td><style data-mw-deduplicate="TemplateStyles:r1214402035">.mw-parser-output .sfrac{white-space:nowrap}.mw-parser-output .sfrac.tion,.mw-parser-output .sfrac .tion{display:inline-block;vertical-align:-0.5em;font-size:85%;text-align:center}.mw-parser-output .sfrac .num{display:block;line-height:1em;margin:0.0em 0.1em;border-bottom:1px solid}.mw-parser-output .sfrac .den{display:block;line-height:1em;margin:0.1em 0.1em}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);clip-path:polygon(0px 0px,0px 0px,0px 0px);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}</style><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 2 000 </span></span>⁠</span> </td></tr> <tr> <td>24</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 1 300 </span></span>⁠</span> </td></tr> <tr> <td>25</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 1 200 </span></span>⁠</span> </td></tr> <tr> <td>29</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 950 </span></span>⁠</span> </td></tr> <tr> <td>30</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 900 </span></span>⁠</span> </td></tr></tbody></table></dd></dl> <dl><dd><table style="text-align:center;"> <tbody><tr> <th>Age</th> <th>Risk </th></tr> <tr> <td>34</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 450 </span></span>⁠</span> </td></tr> <tr> <td>35</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 350 </span></span>⁠</span> </td></tr> <tr> <td>39</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den">150</span></span>⁠</span> </td></tr> <tr> <td>40</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 100 </span></span>⁠</span> </td></tr></tbody></table></dd></dl> <dl><dd><table style="text-align:center;"> <tbody><tr> <th>Age</th> <th>Risk </th></tr> <tr> <td>44</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 40 </span></span>⁠</span> </td></tr> <tr> <td>45</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 30 </span></span>⁠</span> </td></tr> <tr> <td>49</td> <td><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1214402035"><span class="sfrac">⁠<span class="tion"><span class="num">1</span><span class="sr-only">/</span><span class="den"> 10 </span></span>⁠</span> </td></tr></tbody></table></dd></dl> </div> <div class="mw-heading mw-heading3"><h3 id="Other_effects">Other effects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=7" title="Edit section: Other effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Advanced maternal age is associated with adverse outcomes in the <a href="/wiki/Perinatal_period" class="mw-redirect" title="Perinatal period">perinatal period</a>, which may be caused by detrimental effects on <a href="/wiki/Decidua" title="Decidua">decidual</a> and <a href="/wiki/Placenta" title="Placenta">placental</a> development.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p><p>The risk of the mother dying before the child becomes an adult increases by more advanced maternal age, such as can be demonstrated by the following data from France in 2007:<sup id="cite_ref-Schmidt2011_18-0" class="reference"><a href="#cite_note-Schmidt2011-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable" style="text-align:center;"> <tbody><tr> <th>Maternal age at childbirth (years) </th> <td>20</td> <td>25</td> <td>30</td> <td>35</td> <td>40</td> <td>45 </td></tr> <tr> <th>Risk of mother not surviving to the child's 18th birthday (in <a href="/wiki/Percent" class="mw-redirect" title="Percent">%</a>)<sup id="cite_ref-Schmidt2011_18-1" class="reference"><a href="#cite_note-Schmidt2011-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </th> <td>0.6%</td> <td>1.0%</td> <td>1.6%</td> <td>2.6%</td> <td>3.8%</td> <td>5.5% </td></tr></tbody></table> <p>The above table is not to be confused with <a href="/wiki/Maternal_mortality" class="mw-redirect" title="Maternal mortality">maternal mortality</a>. </p><p>Advanced maternal age continues to be associated with a range of adverse pregnancy outcomes including low birth weight, pre-term birth, stillbirth, unexplained fetal death, and increased rates of Caesarean section. However, over time, improvements in (and improvements in access to) medical services and social resources have decreased the negative association between older maternal age and low birth weight.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>According to a meta analysis from 2017 of 63 cohort studies and 12 case control studies, advanced maternal age(≥35 years) increased the risk of stillbirth (<a href="/wiki/Odds_ratio" title="Odds ratio">OR</a> 1.75, 95%CI 1.62 to 1.89). It also increased the risk for FGR (fetal growth restriction) (OR 1.23; 95%CI 1.01–1.52). It is suggested that the rise in the risk could be due to conditions related to placental pathology/dysfunction.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>On the other hand, advanced maternal age is associated with a more stable family environment, higher socio-economic position, higher income and better living conditions, as well as better parenting practices<sup id="cite_ref-Schmidt2011_18-2" class="reference"><a href="#cite_note-Schmidt2011-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> (including better disciplinary methods<sup id="cite_ref-Trilgsgrd-Sommer-2018_21-0" class="reference"><a href="#cite_note-Trilgsgrd-Sommer-2018-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup>). A qualitative study on couples in the United States who used in-vitro fertilization to conceive their first child when the woman was aged 40 or older at the time of delivery found that 72% of the women and 57% of the men believed that they had enhanced emotional preparedness for parenting which benefitted both their children and themselves.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> In quantitative studies, mother's older age at first birth has been associated with increases in children's psychiatric health,<sup id="cite_ref-Goisis-2015_23-0" class="reference"><a href="#cite_note-Goisis-2015-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> language skills,<sup id="cite_ref-Goisis-2015_23-1" class="reference"><a href="#cite_note-Goisis-2015-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> cognitive ability,<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> and fewer social and emotional difficulties.<sup id="cite_ref-Trilgsgrd-Sommer-2018_21-1" class="reference"><a href="#cite_note-Trilgsgrd-Sommer-2018-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Further, a study in the United Kingdom showed that older maternal age at first birth was associated with fewer hospital admissions and fewer unintentional injuries for children up to age 5 and a greater likelihood of having had all of their immunizations by 9 months of age – all outcomes used as indicators of child wellbeing in reports from the World Health Organisation.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Changes_in_interpregnancy_interval">Changes in interpregnancy interval</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=8" title="Edit section: Changes in interpregnancy interval"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Kalberer <i>et al</i>.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> have shown that despite the older maternal age at birth of the first child, the time span between the birth of the first and the second child (the interpregnancy interval) decreased over the last decades. If purely biological factors were at work, it could be argued that interpregnancy interval should have increased, as fertility declines with age, which would make it harder for the woman to get a second child after postponed birth of the first one. This not being the case shows that sociologic factors (see above) prime over biological factors in determining interpregnancy interval. </p><p>With technology developments cases of <a href="/wiki/Post-menopausal" class="mw-redirect" title="Post-menopausal">post-menopausal</a> pregnancies have occurred, and there are several known cases of <a href="/wiki/Pregnancy_over_age_50" title="Pregnancy over age 50">older women</a> carrying a pregnancy to term, usually with <a href="/wiki/In_vitro_fertilization" class="mw-redirect" title="In vitro fertilization">in vitro fertilization</a> of a donor egg. A 61-year-old Brazilian woman, aided by the implantation of a donor egg, gave birth to twins in October 2012.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Ovarian_aging">Ovarian aging</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=9" title="Edit section: Ovarian aging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As women age, they experience a decline in reproductive performance leading to <a href="/wiki/Menopause" title="Menopause">menopause</a>.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> This decline is tied to a decline in the number of <a href="/wiki/Ovarian_follicle" title="Ovarian follicle">ovarian follicles</a>. Although about 1 million <a href="/wiki/Oocyte" title="Oocyte">oocytes</a> are present at birth in the human <a href="/wiki/Ovary" title="Ovary">ovary</a>, only about 500 of them (about 0.05%) <a href="/wiki/Ovulation" title="Ovulation">ovulate</a>, and the rest do not (<a href="/wiki/Ovarian_follicle_atresia" class="mw-redirect" title="Ovarian follicle atresia">ovarian follicle atresia</a>). The decline in <a href="/wiki/Ovarian_reserve" title="Ovarian reserve">ovarian reserve</a> appears to occur at a constantly increasing rate with age,<sup id="cite_ref-pmid18192670_30-0" class="reference"><a href="#cite_note-pmid18192670-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> and leads to nearly complete exhaustion of the reserve by about age 51. As ovarian reserve and <a href="/wiki/Fertility" title="Fertility">fertility</a> decline with age, there is also a parallel increase in pregnancy failure and <a href="/wiki/Meiosis" title="Meiosis">meiotic</a> errors resulting in chromosomally abnormal <a href="/wiki/Fertilisation" title="Fertilisation">conceptions</a>. </p><p>Titus <i>et al</i>.<sup id="cite_ref-Titus_31-0" class="reference"><a href="#cite_note-Titus-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> have proposed an explanation for the decline in ovarian reserve with age. They showed that as women age, double-strand breaks accumulate in the DNA of their primordial follicles. Primordial follicles are immature primary oocytes surrounded by a single layer of <a href="/wiki/Granulosa_cell" title="Granulosa cell">granulosa cells</a>. An enzyme system is present in oocytes that normally accurately repairs DNA double-strand breaks. This repair system is referred to as <a href="/wiki/Homologous_recombination" title="Homologous recombination">homologous recombinational</a> repair, and it is especially active during <a href="/wiki/Meiosis" title="Meiosis">meiosis</a>. Meiosis is the general process by which <a href="/wiki/Germ_cell" title="Germ cell">germ cells</a> are formed in <a href="/wiki/Eukaryote" title="Eukaryote">eukaryotes</a>, and it appears to be an adaptation for efficiently removing damages in germ line DNA by homologous recombinational repair (see <a href="/wiki/Origin_and_function_of_meiosis" title="Origin and function of meiosis">Origin and function of meiosis</a>). Human primary oocytes are present at an intermediate stage of meiosis, that is prophase I (see <a href="/wiki/Oogenesis" title="Oogenesis">Oogenesis</a>). Titus <i>et al</i>.<sup id="cite_ref-Titus_31-1" class="reference"><a href="#cite_note-Titus-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> also showed that expression of four key <a href="/wiki/DNA_repair" title="DNA repair">DNA repair</a> genes that are necessary for homologous recombinational repair (<i><a href="/wiki/BRCA1" title="BRCA1">BRCA1</a></i>, <i><a href="/wiki/MRE11A" title="MRE11A">MRE11</a></i>, <i><a href="/wiki/Rad51" class="mw-redirect" title="Rad51">Rad51</a></i> and <i><a href="/wiki/Ataxia_telangiectasia_mutated" class="mw-redirect" title="Ataxia telangiectasia mutated">ATM</a></i>) decline in oocytes with age. This age-related decline in ability to repair double-strand damages can account for the accumulation of these damages, which then likely contributes to the decline in ovarian reserve. </p><p>Women with an inherited mutation in the DNA repair gene <i>BRCA1</i> undergo menopause prematurely,<sup id="cite_ref-pmid16773440_32-0" class="reference"><a href="#cite_note-pmid16773440-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> suggesting that naturally occurring DNA damages in oocytes are repaired less efficiently in these women, and this inefficiency leads to early reproductive failure. <a href="/wiki/Exome_sequencing" title="Exome sequencing">Genomic</a> data from about 70,000 women were analyzed to identify protein-coding variation associated with age at natural menopause.<sup id="cite_ref-pmid26414677_33-0" class="reference"><a href="#cite_note-pmid26414677-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Pathway analyses identified a major association with DNA damage response genes, particularly those expressed during meiosis and including a common <a href="/wiki/Coding_region" title="Coding region">coding</a> variant in the <i>BRCA1</i> gene. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=10" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Age_and_female_fertility" title="Age and female fertility">Age and female fertility</a></li> <li><a href="/wiki/Childlessness" title="Childlessness">Childlessness</a></li> <li><a href="/wiki/Fertility_factor_(demography)" title="Fertility factor (demography)">Fertility factor (demography)</a></li> <li><a href="/wiki/List_of_countries_by_age_at_first_marriage" title="List of countries by age at first marriage">List of countries by age at first marriage</a></li> <li><a href="/wiki/Pregnancy_over_age_50" title="Pregnancy over age 50">Pregnancy over age 50</a></li> <li><a href="/wiki/Teenage_pregnancy" title="Teenage pregnancy">Teenage pregnancy</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Citations">Citations</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=11" title="Edit section: Citations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 25em;"> <ol class="references"> <li id="cite_note-Fretts2012-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Fretts2012_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Fretts2012_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFFretts,_Ruth_C.2012" class="citation web cs1">Fretts, Ruth C. (3 December 2012). Wilkins-Haug, Louise; Barss, Vanessa A. (eds.). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160619172839/http://www.uptodate.com/contents/effect-of-advanced-age-on-fertility-and-pregnancy-in-women">"Effect of advanced age on fertility and pregnancy in women"</a>. <i><a href="/wiki/UpToDate" title="UpToDate">UpToDate</a></i>. Archived from <a rel="nofollow" class="external text" href="http://www.uptodate.com/contents/effect-of-advanced-age-on-fertility-and-pregnancy-in-women">the original</a> on 19 June 2016.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=UpToDate&rft.atitle=Effect+of+advanced+age+on+fertility+and+pregnancy+in+women&rft.date=2012-12-03&rft.au=Fretts%2C+Ruth+C.&rft_id=http%3A%2F%2Fwww.uptodate.com%2Fcontents%2Feffect-of-advanced-age-on-fertility-and-pregnancy-in-women&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1 cs1-prop-foreign-lang-source"><a rel="nofollow" class="external text" href="https://elordenmundial.com/mapas-y-graficos/edad-madres-primer-hijo/">"¿A qué edad tienen las madres su primer hijo?"</a> [At what age do mothers have their first child?]. <i><a href="/w/index.php?title=El_Orden_Mundial&action=edit&redlink=1" class="new" title="El Orden Mundial (page does not exist)">El Orden Mundial</a> (elordenmundial.com)</i> (in Spanish). 12 August 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=El+Orden+Mundial+%28elordenmundial.com%29&rft.atitle=%C2%BFA+qu%C3%A9+edad+tienen+las+madres+su+primer+hijo%3F&rft.date=2020-08-12&rft_id=https%3A%2F%2Felordenmundial.com%2Fmapas-y-graficos%2Fedad-madres-primer-hijo%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation report cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20141222133841/http://www.oecd.org/els/soc/SF2.3%20Mean%20age%20of%20mother%20at%20first%20childbirth%20-%20updated%20240212.pdf">Mean age of mothers at first childbirth</a> <span class="cs1-format">(PDF)</span>. <i>oecd.org</i> (Report). Paris, FR: Organisation for Economic Co-operation and Development. SF2.3. Archived from <a rel="nofollow" class="external text" href="http://www.oecd.org/els/soc/SF2.3%20Mean%20age%20of%20mother%20at%20first%20childbirth%20-%20updated%20240212.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 22 December 2014<span class="reference-accessdate">. Retrieved <span class="nowrap">27 May</span> 2014</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=report&rft.btitle=Mean+age+of+mothers+at+first+childbirth&rft.place=Paris%2C+FR&rft.pub=Organisation+for+Economic+Co-operation+and+Development&rft_id=http%3A%2F%2Fwww.oecd.org%2Fels%2Fsoc%2FSF2.3%2520Mean%2520age%2520of%2520mother%2520at%2520first%2520childbirth%2520-%2520updated%2520240212.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></span> </li> <li id="cite_note-cdc-natality-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-cdc-natality_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-cdc-natality_4-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation report cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/nchs/fastats/births.htm">Births and natality</a>. <i>cdc.org</i> (Report). 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Genet</i>. <b>47</b> (11): 1294–303. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fng.3412">10.1038/ng.3412</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661791">4661791</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26414677">26414677</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nat.+Genet.&rft.atitle=Large-scale+genomic+analyses+link+reproductive+aging+to+hypothalamic+signaling%2C+breast+cancer+susceptibility+and+BRCA1-mediated+DNA+repair&rft.volume=47&rft.issue=11&rft.pages=1294-303&rft.date=2015&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4661791%23id-name%3DPMC&rft_id=info%3Apmid%2F26414677&rft_id=info%3Adoi%2F10.1038%2Fng.3412&rft.aulast=Day&rft.aufirst=FR&rft.au=Ruth%2C+KS&rft.au=Thompson%2C+DJ&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4661791&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="General_and_cited_references">General and cited references</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=12" title="Edit section: General and cited references"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin refbegin-columns references-column-width" style="column-width: 25em"> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJabcossonLadfordsMilsom2004" class="citation journal cs1">Jabcosson, B.; Ladfords, L.; Milsom, I. (2004). "Advanced maternal age and adverse perinatal outcome". <i><a href="/wiki/Obstetrics_%26_Gynecology" class="mw-redirect" title="Obstetrics & Gynecology">Obstetrics & Gynecology</a></i>. <b>104</b> (4): 727–733. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F01.aog.0000140682.63746.be">10.1097/01.aog.0000140682.63746.be</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15458893">15458893</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:8652247">8652247</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Obstetrics+%26+Gynecology&rft.atitle=Advanced+maternal+age+and+adverse+perinatal+outcome&rft.volume=104&rft.issue=4&rft.pages=727-733&rft.date=2004&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A8652247%23id-name%3DS2CID&rft_id=info%3Apmid%2F15458893&rft_id=info%3Adoi%2F10.1097%2F01.aog.0000140682.63746.be&rft.aulast=Jabcosson&rft.aufirst=B.&rft.au=Ladfords%2C+L.&rft.au=Milsom%2C+I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKhashan2013" class="citation journal cs1">Khashan, Ali S.; et al. (2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577849">"Advanced maternal age and adverse pregnancy outcome: Evidence from a large contemporary cohort"</a>. <i>PLOS ONE</i>. <b>8</b> (2): 1–9. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2013PLoSO...856583K">2013PLoSO...856583K</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.pone.0056583">10.1371/journal.pone.0056583</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577849">3577849</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23437176">23437176</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+ONE&rft.atitle=Advanced+maternal+age+and+adverse+pregnancy+outcome%3A+Evidence+from+a+large+contemporary+cohort&rft.volume=8&rft.issue=2&rft.pages=1-9&rft.date=2013&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3577849%23id-name%3DPMC&rft_id=info%3Apmid%2F23437176&rft_id=info%3Adoi%2F10.1371%2Fjournal.pone.0056583&rft_id=info%3Abibcode%2F2013PLoSO...856583K&rft.aulast=Khashan&rft.aufirst=Ali+S.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3577849&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLorentzon2012" class="citation journal cs1">Lorentzon, M.; et al. (2012). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261413">"Advancing maternal age is associated with lower bone mineral density in young adult male offspring"</a>. <i>Osteoporosis International</i>. <b>23</b> (2): 475–482. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs00198-011-1558-5">10.1007/s00198-011-1558-5</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261413">3261413</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21350896">21350896</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Osteoporosis+International&rft.atitle=Advancing+maternal+age+is+associated+with+lower+bone+mineral+density+in+young+adult+male+offspring&rft.volume=23&rft.issue=2&rft.pages=475-482&rft.date=2012&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3261413%23id-name%3DPMC&rft_id=info%3Apmid%2F21350896&rft_id=info%3Adoi%2F10.1007%2Fs00198-011-1558-5&rft.aulast=Lorentzon&rft.aufirst=M.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3261413&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNilsen2012" class="citation journal cs1">Nilsen, A.B.; et al. (2012). <a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1600-0412.2011.01335.x">"Characteristics of women who are pregnant with their first baby at an advanced age"</a>. <i>Acta Obstetricia et Gynecologica Scandinavica</i>. <b>91</b> (3): 353–362. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1600-0412.2011.01335.x">10.1111/j.1600-0412.2011.01335.x</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22150020">22150020</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:38149716">38149716</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Acta+Obstetricia+et+Gynecologica+Scandinavica&rft.atitle=Characteristics+of+women+who+are+pregnant+with+their+first+baby+at+an+advanced+age&rft.volume=91&rft.issue=3&rft.pages=353-362&rft.date=2012&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A38149716%23id-name%3DS2CID&rft_id=info%3Apmid%2F22150020&rft_id=info%3Adoi%2F10.1111%2Fj.1600-0412.2011.01335.x&rft.aulast=Nilsen&rft.aufirst=A.B.&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fj.1600-0412.2011.01335.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=13" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCharlemagne2006" class="citation magazine cs1">Charlemagne (9 February 2006). <span class="id-lock-subscription" title="Paid subscription required"><a rel="nofollow" class="external text" href="http://www.economist.com/world/europe/displaystory.cfm?story_id=5494593">"The Fertility Bust"</a></span>. Europe. <i><a href="/wiki/The_Economist" title="The Economist">The Economist</a></i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Economist&rft.atitle=The+Fertility+Bust&rft.date=2006-02-09&rft.au=Charlemagne&rft_id=http%3A%2F%2Fwww.economist.com%2Fworld%2Feurope%2Fdisplaystory.cfm%3Fstory_id%3D5494593&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGavrilovGavrilova1997" class="citation journal cs1">Gavrilov, L.A.; Gavrilova, N.S. (1997). "Parental Age at Conception and Offspring Longevity". <i><a href="/wiki/Reviews_in_Clinical_Gerontology" title="Reviews in Clinical Gerontology">Reviews in Clinical Gerontology</a></i>. <b>7</b>: 5–12. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1017%2FS0959259897000026">10.1017/S0959259897000026</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Reviews+in+Clinical+Gerontology&rft.atitle=Parental+Age+at+Conception+and+Offspring+Longevity&rft.volume=7&rft.pages=5-12&rft.date=1997&rft_id=info%3Adoi%2F10.1017%2FS0959259897000026&rft.aulast=Gavrilov&rft.aufirst=L.A.&rft.au=Gavrilova%2C+N.S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGavrilovGavrilova2000" class="citation book cs1">Gavrilov, L.A.; Gavrilova, N.S. (2000). "Human Longevity and Parental Age at Conception". In Robine, J.-M.; Kirkwood, T.B.L.; Allard, M. (eds.). <i>Sex and Longevity: Sexuality, Gender, Reproduction, Parenthood</i>. Berlin / Heidelberg, DE: Springer-Verlag. pp. 7–31. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/3-540-67740-2" title="Special:BookSources/3-540-67740-2"><bdi>3-540-67740-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Human+Longevity+and+Parental+Age+at+Conception&rft.btitle=Sex+and+Longevity%3A+Sexuality%2C+Gender%2C+Reproduction%2C+Parenthood&rft.place=Berlin+%2F+Heidelberg%2C+DE&rft.pages=7-31&rft.pub=Springer-Verlag&rft.date=2000&rft.isbn=3-540-67740-2&rft.aulast=Gavrilov&rft.aufirst=L.A.&rft.au=Gavrilova%2C+N.S.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHofmeisterMillsBlossfeld2006" class="citation book cs1">Hofmeister, Heather; Mills, Melinda; Blossfeld, Hans-Peter (2006). <a rel="nofollow" class="external text" href="https://fis.uni-bamberg.de/handle/uniba/13816">"Globalization, Uncertainty and Women's, Mid-Career Life Courses: A Theoretical Framework"</a>. In Blossfeld, Hans-Peter; Hofmeister, Heather (eds.). <i>Globalization, Uncertainty, and Women's Careers : An international comparison</i>. Cheltenham: Edward Elgar Publishing. pp. 3–31. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/1-84542-664-9" title="Special:BookSources/1-84542-664-9"><bdi>1-84542-664-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Globalization%2C+Uncertainty+and+Women%27s%2C+Mid-Career+Life+Courses%3A+A+Theoretical+Framework&rft.btitle=Globalization%2C+Uncertainty%2C+and+Women%27s+Careers+%3A+An+international+comparison&rft.place=Cheltenham&rft.pages=3-31&rft.pub=Edward+Elgar+Publishing&rft.date=2006&rft.isbn=1-84542-664-9&rft.aulast=Hofmeister&rft.aufirst=Heather&rft.au=Mills%2C+Melinda&rft.au=Blossfeld%2C+Hans-Peter&rft_id=https%3A%2F%2Ffis.uni-bamberg.de%2Fhandle%2Funiba%2F13816&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKohlerBillariOrtega2006" class="citation book cs1">Kohler, Hans-Peter; Billari, Francesco C.; Ortega, José Antonio (2006). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=75alsu8U9QAC&pg=PA48">"Low Fertility in Europe: Causes, Implications and Policy Options"</a>. In Harris, Fred R. (ed.). <i>The Baby Bust: Who will do the work? Who will pay the taxes?</i>. Rowman & Littlefield. pp. 48–109. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7425-3855-9" title="Special:BookSources/978-0-7425-3855-9"><bdi>978-0-7425-3855-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Low+Fertility+in+Europe%3A+Causes%2C+Implications+and+Policy+Options&rft.btitle=The+Baby+Bust%3A+Who+will+do+the+work%3F+Who+will+pay+the+taxes%3F&rft.pages=48-109&rft.pub=Rowman+%26+Littlefield&rft.date=2006&rft.isbn=978-0-7425-3855-9&rft.aulast=Kohler&rft.aufirst=Hans-Peter&rft.au=Billari%2C+Francesco+C.&rft.au=Ortega%2C+Jos%C3%A9+Antonio&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D75alsu8U9QAC%26pg%3DPA48&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLesthaeghe,_R.Neels,_K.2002" class="citation journal cs1">Lesthaeghe, R.; Neels, K. (2002). "From the First to the Second Demographic Transition: An Interpretation of the Spatial Continuity of Demographic Innovation in France, Belgium and Switzerland". <i>European Journal of Population</i>. <b>18</b> (4): 325–360. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1023%2FA%3A1021125800070">10.1023/A:1021125800070</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:878879">878879</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Population&rft.atitle=From+the+First+to+the+Second+Demographic+Transition%3A+An+Interpretation+of+the+Spatial+Continuity+of+Demographic+Innovation+in+France%2C+Belgium+and+Switzerland&rft.volume=18&rft.issue=4&rft.pages=325-360&rft.date=2002&rft_id=info%3Adoi%2F10.1023%2FA%3A1021125800070&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A878879%23id-name%3DS2CID&rft.au=Lesthaeghe%2C+R.&rft.au=Neels%2C+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSobotka2004" class="citation thesis cs1">Sobotka, Tomás (25 November 2004). <i>Postponement of Childbearing and Low Fertility in Europe</i>. Faculty of Spatial Sciences (Ph.D. thesis). Groningen, DE: University of Groningen. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<a rel="nofollow" class="external text" href="https://hdl.handle.net/11370%2F7fe0743c-9766-4ae9-befe-3edae1006c6e">11370/7fe0743c-9766-4ae9-befe-3edae1006c6e</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9036191025" title="Special:BookSources/9036191025"><bdi>9036191025</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adissertation&rft.title=Postponement+of+Childbearing+and+Low+Fertility+in+Europe&rft.degree=Ph.D.&rft.inst=University+of+Groningen&rft.date=2004-11-25&rft_id=info%3Ahdl%2F11370%2F7fe0743c-9766-4ae9-befe-3edae1006c6e&rft.isbn=9036191025&rft.aulast=Sobotka&rft.aufirst=Tom%C3%A1s&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Advanced_maternal_age&action=edit&section=14" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSobotka" class="citation audio-visual cs1">Sobotka, Tomás. <a rel="nofollow" class="external text" href="http://www.ilcuk.org.uk/downloads/2%20Tomas%20Sobotka.ppt"><i>Postponement of childbearing and low fertility in Europe</i></a> (Power Point presentation).</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Postponement+of+childbearing+and+low+fertility+in+Europe&rft.aulast=Sobotka&rft.aufirst=Tom%C3%A1s&rft_id=http%3A%2F%2Fwww.ilcuk.org.uk%2Fdownloads%2F2%2520Tomas%2520Sobotka.ppt&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAdvanced+maternal+age" class="Z3988"></span></li> <li><a rel="nofollow" class="external text" href="http://www.inciid.org/">InterNational Council on Infertility Information Dissemination</a> (inciid.org)</li></ul>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; 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