Older maternal age at first delivery as a risk factor for pelvic organ prolapse: what we know
Authors:Â Hannah A. Zabriskie, MS; Micah J. Drummond, PhD; Ingrid E. Nygaard, MD, MS; Carolyn W. Swenson, MD
Summary
As the average maternal age at first birth rises in the United States and other high-income countries, concerns have grown about age-related risks for pelvic organ prolapse (POP). This review examines the evidence linking older maternal age at first vaginal delivery (VD) to an increased risk of POP, exploring mechanisms that may explain this association.
Key Points
1. Rising Maternal Age
The mean age of first-time mothers in the US reached 27.4 years in 2022.
Delaying childbirth has become more common in high-income countries.
2. BRisk of POP and Maternal Age
Both vaginal childbirth and increased chronological age are established risk factors for POP.
Studies show that women aged ≥30 at first VD have a higher incidence of POP and require POP surgery more frequently and sooner than younger mothers.
Each year of delay in first delivery increases the risk for self-reported POP symptoms by approximately 6%.
3. Mechanisms Linking Older Age to POP
Pelvic Floor Muscle (PFM) Dysfunction:Â Older age at first delivery is associated with weaker PFMs and less recovery postpartum.
Levator Ani Muscle (LAM) Defects:Â Increased maternal age is generally linked with a higher risk of LAM injury or defects, though some studies report conflicting findings.
Genital Hiatus (GH) Enlargement:Â Older women demonstrate more significant GH enlargement at 1 year postpartum, related to impaired tissue recovery.
Tissue and Cellular Changes:Â Aging contributes to muscle atrophy, decreased muscle quality, increased fibrosis, and cellular senescence, which may impair pelvic floor recovery.
4. Evidence Gaps and Research Challenges
Most current research focuses on end-stage (surgical) POP, potentially underestimating risk for milder POP stages.
Data on tissue and cellular mechanisms in living women are limited; most comes from cadaveric or indirect studies.
Parity, delivery mode, and study follow-up times contribute to inconsistent findings.
5. Recommendations and Future Directions
Future studies should stratify participants by age at first VD, report both subjective and objective POP outcomes, and better control for confounders.
More research is needed to understand the biological mechanisms at a cellular level and identify women at highest risk.
Prevention strategies and targeted interventions may be developed as understanding improves.
Delaying first childbirth increases the risk of pelvic organ prolapse, probably due to age-related decline in postpartum muscle and tissue recovery. As women increasingly postpone childbearing, awareness of this risk is crucial for prevention, counseling, and research.
