Advanced maternal age and the risk for long-term malignant morbidity in the offspring

Objective
Advanced maternal age has been associated with several short and long-term adverse maternal and perinatal outcomes. We sought to determine whether advanced maternal age is independently associated with an increased risk of childhood cancers in the offspring.

Study Design
A retrospective cohort study of all women who delivered at the Soroka University Medical Center (SUMC) between the years 1991 and 2014 was conducted. Elderly parturients (≥35 years) were divided into: 1) 35-39 years and 2) 40-50 years, and compared to parturients aged 20-34 years. Outcome included all hospitalizations of the offspring up to the age of 18 years involving malignant morbidity, according to a set of predefined oncological ICD-9 codes. A Kaplan-Meier Survival curve was used to compare cumulative malignant morbidity incidence of the offspring in all maternal age groups. A Cox hazards regression model was used to control for confounders.

Results
During the study period 202 709 deliveries met the inclusion criteria. Most of the elderly parturient were 35-39 years old (n= 26287; 79.7%) and a smaller fraction were aged 40-50 years (n= 6718; 20.3%). No significant differences were noted between the groups in the different malignancies evaluated, except for childhood leukemia which was more common in the 35-39 years old group (Table, Figure). In the Cox regression model, while controlling for multiple confounders, advanced maternal age exhibited no association with general malignant morbidity in the offspring up to 18 years of age (mothers aged 35-39: adjusted HR 1.03, 95%CI 0.76-1.04, p=0.86, mothers aged 40-50: adjusted HR 0.67, 95%CI 0.34-1.3, p=0.24).

Conclusion
Advanced maternal age does not appear to raise the risk for future malignancy in the offspring up to the age 18 years. The specific nature of the association between childhood leukemia and maternal age necessitates further investigation.