1. Delayed Childbearing: Effect of Maternal Age at 1 st Childbirth on Pregnancy Outcome and Postpartum Incontinence H Li, P Osterweil, M Mori and JM Guise Oregon Health Science University Funded by the National Institute of Child Health & Human Development R01 HD41139-04

2. Background Delayed Childbearing Continuously rising in US since early 70s National Vital Statistics, 2002 1 st livebirths per 1000 women

3. Impact of Advanced Maternal Age Infertility and spontaneous abortion Chromosomal abnormalities Cesarean delivery Gestational diabetes and hypertension Risks of Pelvic Dysfunction after 1 st Vaginal Delivery Prolonged 2 nd stage labor Device assisted labor and laceration Large baby and maternal overweight Constipation Standing long time and yoga/jogging during pregnancy Background Advanced Maternal Age- Stein 1980, Kessler 1980, Hook 1981, Kim 1985, Peipert 1993 Risk of Pelvic Disorder- Guise (Submitted), Zetterstrom 1999, Murphy 2001, Farrel 2001, Fenner 2003, Dahl 2006

4.  To examine characteristics and pregnancy outcomes in women who had their 1 st childbirth before or after 30 years of age  To determine whether advanced maternal age increases the risk of having postpartum urinary or fecal incontinence Objective

5. The Fecal Incontinence Postpartum Research Initiative A population-based study of all women who delivered a live-born infant in the state of Oregon Guise et al Am J OB Gyn, 2003 Guise et al OB Gyn, 2007 Guise et al (Submitted) Funded by NICHD #R01 HD41139-04 Methods

6. Study  Phase II Subject  Surveys mailed to all women delivering a live-born infant  October 2002-September 2003  Exclusions: abortions, adoptions, or out of state residents  The response rate was 37.2% 5,946 primiparous women (mean age 27.4, range 18–46 yrs were included in this analysis. Methods

7. Survey Period 3 to 6 months after delivery Information Collected Women’s characteristics Childbirth experience Fecal incontinence after delivery up to the time of survey -Involuntarily loss flatus or stool -Difficulty distinguishing flatus from stool -Fecal urgency Urinary incontinence after delivery up to the time of survey FI Definition- NIH Conference for Researchers in Female Pelvic Floor Disorders, 1998 Validation of Tool-Osterberg 1996, Guise 2003 Methods

8. Statistical Analysis T test Chi square Logistic regression Generalized additive model Methods

9. * There is a higher proportion of low birth weight babies among maternal age  35 group vs. maternal age < 35 group (6.2% vs. 4.4%, p=0.04) Characteristics Of Primiparous Women

10. Characteristics Of Primiparous Women

11. * Laceration Delivery Characteristics By Route Of Delivery

12. Risk Of Postpartum Incontinence After Vaginal Delivery

13. a: P = 0.005; b: P < 0.0001 * Adjusted for women’s characteristics, baby weight, push time, device and laceration (for vaginal delivery) Postpartum Incontinence

14.  1 st childbirth at advanced age was associated with prolonged 2 nd stage labor, device assistant, laceration, and characteristics such as constipation that are shown to be risk factors of pelvic dysfunction  The risk of urinary incontinence is potentially significant after 30 and fecal incontinence after age 33 among vaginal delivery  Maternal age may be independently associated with urinary incontinence, while its association with fecal incontinence depended upon obstetric risks and women’s characteristics Summary

15. Implication  Public awareness of risk factors and obstetric risks associated with postpartum incontinence among women having their 1 st childbirth at advanced age  Public policy implications regarding improving women’s health and their quality of life in both short- term and long-term

16.  Natural history  Quality of life  Clinical predictors Follow-Up Study

17.  FIPP Initiative is a joint effort of many investigators and staff members, whose contributions are greatly acknowledged  We especially thank these new moms who participated in this study in first few months after childbirth and with many responsibilities in their life Acknowledgements For more information and our survey tool please visit us under OB Health at: www.storc.orgwww.storc.org