{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T14:19:52Z","timestamp":1783952392665,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology & Obste"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Birth rates among women aged 30 and above have climbed to record highs, influenced by evolving social and economic dynamics, including focus on professional advancement, prolonged education, and increased access to fertility treatments. This study aimed to assess whether nulliparity at advanced maternal age (AMA) is associated with increased long\u2010term morbidity in offspring.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A population\u2010based retrospective cohort study was conducted at a single tertiary medical center between 1991 and 2021. The cohort included all nulliparous women aged \u226530 who delivered a live singleton. Participants were stratified into three age groups: 30\u201335, 36\u201340, and >40. Offspring were followed until 18\u2009years of age for long\u2010term morbidity, defined as hospitalizations or outpatient diagnoses of cardiovascular, respiratory, endocrine, neurologic, gastrointestinal, or infectious conditions. Kaplan\u2013Meier survival analyses and Cox proportional hazards models were used to evaluate cumulative incidence and adjusted hazard ratios for each morbidity category.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study included 4951 women: 3729 (75.3%) aged 30\u201335, 946 (19.1%) aged 36\u201340, and 276 (5.6%) aged >40. Increasing maternal age was associated with higher rates of hypertensive disorders, gestational diabetes, preterm birth, and cesarean delivery (\n P<\/jats:italic>\n \u2009<\u20090.001). However, no significant differences were observed in the cumulative incidence of long\u2010term morbidity among offspring across age groups. In a Cox model, adjusting for fertility treatment, ethnicity, cesarean delivery, gestational age, gestational diabetes, and hypertensive disorders, AMA was not independently associated with long\u2010term morbidity in any category.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Although AMA is associated with adverse pregnancy outcomes, nulliparity at AMA is not associated with long\u2010term morbidity in offspring.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.71220","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:37:31Z","timestamp":1783949851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nulliparity at advanced maternal age and long\u2010term morbidity in offspring: A population\u2010based cohort study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6852-4670","authenticated-orcid":false,"given":"Shira","family":"Gat","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil","family":"Gutvirtz","sequence":"additional","affiliation":[{"name":"IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar","family":"Wainstock","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Services Evaluation Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyal","family":"Sheiner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gali","family":"Pariente","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences Ben\u2010Gurion University of the Negev Beer\u2010Sheva Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"B25","DOI":"10.1016\/j.ajog.2022.07.022","article-title":"Obstetric Care consensus #11, pregnancy at age 35\u2009years or older","volume":"228","author":"Gantt A","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ejogrb.2024.05.031","article-title":"Parents' age and total fertility rate in selected high\u2010income countries from Europe and North America, 1990\u20132020","volume":"299","author":"Esposito G","year":"2024","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","DOI":"10.1002\/ajhb.70037","article-title":"Delaying motherhood\u2014an increasingly common but risky trend in high\u2010income countries","volume":"37","author":"Kraus M","year":"2025","journal-title":"Am J Hum Biol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1007\/s00404-010-1459-4","article-title":"A significant linear association exists between advanced maternal age and adverse perinatal outcome","volume":"283","author":"Salem Yaniv S","year":"2011","journal-title":"Arch Gynecol Obstet"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/ijgo.14100","article-title":"Maternal and perinatal complications according to maternal age: a systematic review and meta\u2010analysis","volume":"159","author":"Saccone G","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0186287","article-title":"Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta\u2010analysis","volume":"12","author":"Lean SC","year":"2017","journal-title":"PLoS One"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1055\/s-0039-1700859","article-title":"Perinatal outcomes of women aged 50\u2009years and above","volume":"37","author":"Maoz\u2010Halevy E","year":"2020","journal-title":"Am J Perinatol"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/AOG.0000000000002504","article-title":"Risk of adverse pregnancy outcomes at advanced maternal age","volume":"131","author":"Frederiksen LE","year":"2018","journal-title":"Obstet Gynecol"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-072112","article-title":"Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co\u2010sibling study","volume":"380","author":"Crump C","year":"2023","journal-title":"BMJ"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1001\/jamainternmed.2024.0276","article-title":"Adverse pregnancy outcomes and long\u2010term mortality in women","volume":"184","author":"Crump C","year":"2024","journal-title":"JAMA Intern Med"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s10815-022-02533-w","article-title":"Effect of advanced parental age on pregnancy outcome and offspring health","volume":"39","author":"Zhang C","year":"2022","journal-title":"J Assist Reprod Genet"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1136\/bmj.321.7258.420","article-title":"Influence of maternal age at delivery and birth order on risk of type 1 diabetes in childhood: prospective population based family study","volume":"321","author":"Bingley PJ","year":"2000","journal-title":"BMJ"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"380","DOI":"10.5468\/ogs.24005","article-title":"The influence of advanced maternal age on congenital malformations, short\u2010 and long\u2010term outcomes in offspring of nulligravida: a Korean National Cohort Study over 15\u2009years","volume":"67","author":"You SJ","year":"2024","journal-title":"Obstet Gynecol Sci"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000493191","article-title":"Advanced maternal age and the future health of the offspring","volume":"46","author":"Pariente G","year":"2019","journal-title":"Fetal Diagn Ther"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1186\/s12884-021-03718-4","article-title":"Parity and the risks of adverse birth outcomes: a retrospective study among Chinese","volume":"21","author":"Lin L","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00404-019-05386-4","article-title":"Does parity affect pregnancy outcomes in the elderly gravida?","volume":"301","author":"Shechter\u2010Maor G","year":"2020","journal-title":"Arch Gynecol Obstet"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00404-014-3469-0","article-title":"The effects of maternal age and parity on maternal and neonatal outcome","volume":"291","author":"Schimmel MS","year":"2015","journal-title":"Arch Gynecol Obstet"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1056064","article-title":"The interaction between age and parity on adverse pregnancy and neonatal outcomes","volume":"10","author":"Dai J","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"e_1_2_10_20_1","volume-title":"Israel in Figures: Selected Data from the Statistical Abstract of Israel 2023","author":"Central Bureau of Statistics","year":"2024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0174770","article-title":"Maternal age and child morbidity: a Danish national cohort study","volume":"12","author":"Hviid MM","year":"2017","journal-title":"PLoS One"},{"key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00431-018-3136-8","article-title":"Advanced maternal age during pregnancy and the risk for malignant morbidity in the childhood","volume":"177","author":"Imterat M","year":"2018","journal-title":"Eur J Pediatr"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jpeds.2003.10.064","article-title":"Maternal age and other predictors of newborn blood pressure","volume":"144","author":"Gillman MW","year":"2004","journal-title":"J Pediatr"},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"5807","DOI":"10.1113\/JP275472","article-title":"Increased susceptibility to cardiovascular disease in offspring born from dams of advanced maternal age","volume":"596","author":"Cooke CLM","year":"2018","journal-title":"J Physiol"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1161\/HYPERTENSIONAHA.114.03492","article-title":"Maternal parity, fetal and childhood growth, and cardiometabolic risk factors","volume":"64","author":"Gaillard R","year":"2014","journal-title":"Hypertension"},{"key":"e_1_2_10_26_1","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1210\/jc.2012-3531","article-title":"First\u2010born children have reduced insulin sensitivity and higher daytime blood pressure compared to later\u2010born children","volume":"98","author":"Ayyavoo A","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_2_10_27_1","doi-asserted-by":"crossref","DOI":"10.1186\/s40168-021-01089-8","article-title":"Remodeling of the maternal gut microbiome during pregnancy is shaped by parity","volume":"9","author":"Berry AS","year":"2021","journal-title":"Microbiome"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1093\/humrep\/dead177","article-title":"Human ovarian aging is characterized by oxidative damage and mitochondrial dysfunction","volume":"38","author":"Smits MA","year":"2023","journal-title":"Hum Reprod"},{"key":"e_1_2_10_29_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.placenta.2021.01.024","article-title":"The impact of advanced maternal age on pregnancy and offspring health: a mechanistic role for placental angiogenic growth mediators","volume":"106","author":"Biagioni EM","year":"2021","journal-title":"Placenta"},{"key":"e_1_2_10_30_1","first-page":"H1","article-title":"Advanced maternal age and the impact on maternal and offspring cardiovascular health","volume":"317","author":"Cooke CLM","year":"2019","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"e_1_2_10_31_1","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1038\/ajh.2012.57","article-title":"Hemodynamic adaptations in different trimesters among nulliparous and multiparous pregnant women; the generation R study","volume":"25","author":"Rurangirwa AA","year":"2012","journal-title":"Am J Hypertens"}],"container-title":["International Journal of Gynecology & Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71220","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.71220","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.71220","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T13:37:35Z","timestamp":1783949855000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.71220"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":30,"alternative-id":["10.1002\/ijgo.71220"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.71220","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"assertion":[{"value":"2025-09-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ijgo.71220"}}