Trend in Delayed Childbearing and Its Potential Consequences on Pregnancy Outcomes: a Single Centre 9-years Retrospective Cohort Study in Hubei, China

Background: Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes. Objective: To determine trend in delayed childbearing and its negative impact on pregnancy outcomes. Material and Methods: A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011-2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes. Results: Between 2011 and 2019, the trend in advanced maternal age (AMA) increased by 75% [AAPC 7.5% (95% CI: -10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.6; 95% CI: 1.2, 2.2), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.5; 95% CI: 1.3, 1.8), gestational diabetes mellitus (aOR 2.6; 95% CI: 2.3, 2.9), preterm births (aOR 1.4; 95% CI: 1.3, 1.5), perinatal mortality (aOR 1.5; 95% CI: 1.2, 2.2), and low birth weight (aOR 1.2; 95% CI: 1.1, 1.3) compared with women aged <30 years. Conclusion: Our findings show a marked increase in delayed childbearing and its negative association with pregnancy outcomes.

Association between maternal age and adverse perinatal outcomes in Arba Minch zuria, and Gacho Baba district, southern Ethiopia: a prospective cohort study

Background Globally, delayed childbearing to the advanced age is a growing option. It is an emerging public health issue in developing countries. Currently, adverse perinatal outcomes significantly increased. A few studies showed the effect of advanced maternal age on adverse perinatal outcomes. However, most used secondary data or chart reviews, and this increases the risk of biases. Besides, there are limited studies in-country Ethiopia as advanced maternal age steadily increased. Therefore, this study aimed to assess the status of advanced maternal age and its effect on perinatal outcomes in the study setting. Methods A community-based prospective cohort study was conducted among 709 study participants from October 15, 2018, to September 30, 2019, in Arba Minch zuria, and Gacho Baba district, southern Ethiopia. The data were collected by a pretested interviewer-administered structured Open Data Kit survey tool and analyzed by SPSS version 25. The log-linear regression model was used to compare perinatal outcomes among women aged 20–34 years and ≥ 35 years. The log-likelihood ratio tested for the goodness of fit. In this study, P-value < 0.05 was considered to declare a result as a statistically significant association. Results In this study, 209(29.5%) of the women were age group ≥35 years old, and 500(70.5%) were age group from20–34 years old. Stillbirth (β = 0.29, 95%CI: 0.05, 0.52), and neonatal mortality (β = 0.11, 95%CI: 0.01, 0.21) were significantly associated with the advanced maternal age. Conclusions Perinatal outcomes such as stillbirth and neonatal mortality were independently associated with advanced maternal age after controlling for possible cofounders. Therefore, different strategies should design for the women who planned to bear child, and information should provide for women who are advanced age or delayed childbearing to alert them.

First-Birth Timing and the Motherhood Wage Gap in 140 Occupations

Is delayed fertility associated with a reduced motherhood wage gap in all occupations? Using multilevel models and data from the 2011–2015 American Community Survey, O*NET, and the Current Population Survey, I examine whether delayed fertility is associated with a reduced motherhood wage gap in 140 occupations. Delayed childbearing is one strategy women use to mitigate the motherhood wage penalty. Findings indicate that mothers in high-earning professional occupations experienced the largest wage penalties with early motherhood but also the largest premiums with delayed childbearing. Although delaying a first birth mitigated the motherhood wage penalty in high-wage occupations requiring extensive career preparation, the majority of women who worked in lower wage occupations with more limited human capital requirements experienced no economic benefit from older motherhood. These results challenge the broader narrative that most women can improve their long-term earnings and partly overcome the structural motherhood wage gap by delaying fertility.

What Took You So Long? A Public Health Approach to Mitigate the Delayed Childbearing

Background: The delayed childbearing has doubled in prevalence during the last decade. It affects reproductive health, population distribution and economy. We use the public health approach to survey among women aged at least 35 years seeking fertility treatment. Methods: A self-administered questionnaire-based survey was conducted in women aged at least 35 years attending an infertility clinic in a university hospital. The questionnaire consisted of background information and three domains: (1) reasons for delayed childbearing, (2) required social policy incentives, and (3) acceptability toward infertility treatment. Each domain was scored from ‘5 — most important’ to ‘1 — least important’. Results: A total of 590 women (median age 38.0 years) were recruited; 86.4% of them held at least a bachelor degree and 93.2% had higher income than Thailand’s GDP per capita. They thought that the most appropriate age to have the first child was 28.7 years. The top three reasons for delayed childbearing were “I need more financial security”, “no spouse”, and “I need progress on my career”. The participants thought that “paid paternity leave”, “increase paid maternity leave”, and “good quality childcare” were essential for them to make an earlier fertility decision. The most acceptable infertility treatments were IUI, IVF/ICSI, and social oocyte banking. Conclusions: Women who delayed childbearing focus on financial and career security or finding the proper partner before fertility decision making. However, they have greater concerns over family welfare than money when it comes to domestic issues. The social policy and the related fertility treatment should adapt to serve the needs of the people and promote national fertility rate.

Childbearing and maternity leave in residency: determinants and well-being outcomes

PurposeTo characterise determinants of resident maternity leave and their effect on maternal and infant well-being. Among non-parents, to identify factors that influence the decision to delay childbearingStudy designIn 2016, a survey was sent to female residents at a large academic medical centre on their experiences with maternity leave, the impact of personal and programme factors on length of leave, reasons for delaying childbearing and measures of well-being.ResultsForty-four percent (214/481) of residents responded. Fifty (23%) residents were parents, and 25 (12%) took maternity leave during training. The average maternity leave length was 8.4 weeks and did not differ across programme type, size or programme director gender but was longer for programmes with fewer women than men. The most common self-reported determinant of leave was financial. Residents with >8 weeks of leave were less likely to have postpartum depression or burnout and more likely to breastfeed longer, perceive support from colleagues and programme directors, and be satisfied with resident parenthood. Among 104 non-parents who were married or partnered, 84 (81%) were delaying childbearing, citing busy work schedules, concern for burdening colleagues and finances.ConclusionsThis study suggests that multiple aspects of resident wellbeing are associated with longer maternity leaves, yet finances and professional relationships hinder length of leave and lead to delayed childbearing. These issues could be addressed at a programme level with clear policies describing how work is redistributed during parental leave and at an institutional and state level through provision of paid family leave.

Development and Psychometric Properties of The Delayed Childbearing Questionnaire (DCBQ-55)

The comprehensive assessment of delayed childbearing needs a valid and reliable instrument. Therefore, the aim of the present study was to develop an instrument to evaluate factors influencing delayed childbearing among women and to assess its psychometric properties. The current methodological study was performed in two phases of (i) qualitative instrument development, and (ii) quantitative psychometric assessment of the developed instrument. Face and content validity of the instrument was assessed by eligible women and a panel of experts. Construct validity was assessed using the exploratory factor analysis (EFA). For reliability, internal consistency reliability and intra-rater reliability analysis were used. The initial instrument developed from the qualitative phase consisted of 60 items, which were reduced to 55 items after the face and content validity processes. EFA (n = 300) using the Kaiser criteria (Eigenvalues > 1) and the scree plot led to a six-factor solution accounting for 61.24% of the observed variance. The Cronbach’s alpha coefficient, Spearman’s correlation, test–retest and intra-class correlation coefficients for the whole instrument were reported as 0.83, 0.86 and 0.81, respectively. The final instrument entitled the delayed childbearing questionnaire (DCBQ-55) included 50 items with six domains of ‘readiness for childbearing’, ‘stability in the partner relationship’, ‘awareness about the adverse outcomes of pregnancy in advanced maternal age’, ‘attitude toward delayed childbearing’, ‘family support’, and ‘social support’ on a five-point Likert scale. The DCBQ-55 as a simple, valid and reliable instrument can assess factors influencing delayed childbearing. It can be used by reproductive healthcare providers and policy makers to understand factors influencing delayed childbearing and devise appropriate strategies.