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. 2018 Oct 31:363:k4372.
doi: 10.1136/bmj.k4372.

Association of paternal age with perinatal outcomes between 2007 and 2016 in the United States: population based cohort study

Yash S Khandwala  1 , Valerie L Baker  2 , Gary M Shaw  3 , David K Stevenson  3 , Ying Lu  4 , Michael L Eisenberg  5   2
Affiliations

Association of paternal age with perinatal outcomes between 2007 and 2016 in the United States: population based cohort study

Yash S Khandwala et al. BMJ. .

Abstract

Objective: To evaluate the impact of advanced paternal age on maternal and perinatal outcomes in the United States.

Design: Retrospective, population based cohort study.

Setting: US.

Population: 40 529 905 documented live births between 2007 and 2016.

Main outcome measures: Primary perinatal outcomes were gestational age, birth weight, Apgar score at five minutes, admission to a neonatal intensive care unit, need for postpartum antibiotics, and seizures. Primary maternal outcomes were gestational diabetes and pre-eclampsia. Secondary outcome was the number of preventable perinatal events.

Results: Higher paternal age was associated with an increased risk of premature birth, low birth weight, and low Apgar score. After adjustment for maternal age, infants born to fathers aged 45 years or older had 14% higher odds of premature birth (odds ratio 1.14, 95% confidence interval 1.13 to 1.15), independent of gestational age, and 18% higher odds of seizures (1.18, 0.97 to 1.44) compared with infants of fathers aged 25 to 34 years. The odds of gestational diabetes was 34% higher (1.34, 1.29 to 1.38) in mothers with the oldest partners. 13.2% (95% confidence interval 12.5% to 13.9%) of premature births and 18.2% (17.5% to 18.9%) of gestational diabetes in births associated with older fathers were estimated to be attributable to advanced paternal age.

Conclusions: Advanced paternal age is associated with negative effects on both mothers and offspring. Given the relatively low prevalence of advanced paternal age in the US, population level impacts are currently modest. Nevertheless, as advanced paternal age has doubled in the US over the past generation, further investigation is warranted of the impact on birth outcomes and public health.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Scatter plots of odds of an adverse birth event by paternal age stratified by maternal age group. Error bars indicate 99% confidence intervals based on distribution of births within each paternal age group
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