Medicina e società
Il fattore di rischio “etŕ dei genitori” č un determinante non modificabile?
Is the “parental age” risk factor a non modifiable determinant?
Renata Bortolus1, Elena Cavaliere2, Sara Malizia2, Alice Dianin3, Francesca Filippini4, Francesca Rech Morassutti5
1IPF Promozione della Ricerca, Dipartimento Direzione Medica Ospedaliera, Azienda Ospedaliera Universitaria Integrata, Verona
2Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-Infantili, Universitŕ di Verona
3Centro Regionale per lo Screening, la Diagnosi e la Terapia delle Malattie Metaboliche Congenite ed Endocrinologiche, UOC Pediatria, Azienda Ospedaliera Universitaria Integrata, Verona
4Dipartimento di Medicina, Sezione Medicina Interna B, Universitŕ di Verona
5Clinica Pediatrica, Dipartimento di Medicina Clinica e Sperimentale, Ospedale Universitario di Udine
Marzo 2017 - pagg. 171 -176
Abstract
Age, together with sex and genetic characteristics, is traditionally classified as a non-modifiable
biological factor of health condition. The promotion of reproductive health finds
in parental age an important determinant that can affect fertility, pregnancy and child
health. In women age plays a key role on reproductive capacity, with a fertility rate that
is maximum between 20 and 30 years, decreases after 35 years and is close to zero
some years before menopause. As paternal age increases, the sperm count, motility and
quality decrease, enhancing the possibility of couple’s infertility. Moreover, also the probabilities
of miscarriage and pregnancy complications increase. Unlike maternal age,
the paternal one seems to play a significant but less marked role and its effects on infertility
and adverse productive outcomes become evident after 50 years of age. In 2015 in Italy,
considering only Italian citizens, women on average gave birth to 1.28 children, at an
average age of 32.2 years. An active offer of information by health care professionals
about the role played by age can help support a conscious choice of the couple also in
this context.
Parole chiave
Classificazione MeSH
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Bibliografia
1. Mastroiacovo P. La promozione della salute
riproduttiva. Prospettive in Pediatria 2012;42:
243-52.
2. EURO-PERISTAT Project’s. European Perinatal
Health Report: Health and Care of Pregnant
Women and Babies in Europe in 2010:
https://www.tno.nl/downloads/european_perinatal_
health_report_2010.pdf
3. Ministero della Salute. Dipartimento della
Qualitŕ. Direzione Generale del Sistema Informativo.
Ufficio di Direzione Statistica. Certificato
di assistenza al parto (CeDAP). Analisi
dell’evento nascita - Anno 2013.
4. http://ec.europa.eu/eurostat/statistics-explained/
index.php/Fertility_statistics
5. Marchetti F (a cura di). Natalitŕ e feconditŕ
della popolazione residente. Anno 2015. Medico
e Bambino 2016;35(10):627-9.
6. Kocourkova J, Burcin B, Kucera T. Demographic
relevancy of increased use of assisted
reproduction in European countries. Reproductive
Health 2014;11:37.
7. Gylfason JT, Kristjansson KA, Sverrisdottir
G, Jonsdottir K, Rafnsson V, Geirsson RT. Pelvic
endometriosis diagnosed in an entire nation
over 20 years. Am J Epidemiol 2010;172:
237-43.
8. Cook H, Ezzati M, Segars JH, McCarthy K.
The impact of uterine leiomyomas on reproductive
outcome. Minerva Ginecol 2010;62:
225-36.
9. Dreisler E, Stampe Sorensen S, Ibsen PH,
Lose G. Prevalence of endometrial polyps and
abnormal uterine bleeding in a Danish population
aged 20-74 years. Ultrasound Obstet Gynecol
2009:33:102-8.
10. Khoshnood B, Bouvier-Colle MH, Leridon
H, Blondel B. Impact of advanced maternal
age on fecundity and women’s and children’s
health. J Gynecol Obstet Biol Reprod (Paris)
2008;37:733-47.
11. Regione Emilia Romagna. Giunta Regionale
- Direzione Generale Sanitŕ e Politiche Sociali.
La nascita in Emilia-Romagna. 7° Rapporto sui
dati del Certificato di Assistenza al Parto (CedAP)
– Anno 2009. http://www.regione.emiliaromagna.
it/sas/cedap/pubblicazioni.htm.
12. Ministero della Salute. Dipartimento della
Qualitŕ. Direzione Generale del Sistema Informativo.
Ufficio di Direzione Statistica. Certificato
di assistenza al parto (CeDAP). Analisi
dell’evento nascita - Anno 2009. www.salute.
gov.it
13. Senatore S, Donati S, Andreozzi S (Ed).
Studio delle cause di mortalitŕ e morbositŕ
materna e messa a punto di modelli di sorveglianza
della mortalitŕ materna. Roma: Istituto
Superiore di Sanitŕ, 2012 (Rapporti ISTISAN
12/6).
14. Hecht CA, Hook EB. Rates of Down syndrome
at livebirth by one-year maternal age
intervals in studies with apparent close to
complete ascertainment in populations of European
origin: a proposed revised rate schedule
for use in genetic and prenatal screening.
Am J Med Genet 1996;62:376-85.
15. www.pensiamociprima.net [Ultimo aggiornamento
01/05/2015].
16. Balasch J, Gratacos E. Delayed Childbearing:
Effects on Fertility and the Outcome of
Pregnancy. Fetal Diagn Ther 2011;29:263-73.
17. Gill SK, Broussard C, Devine O, Fisk
Green R, Rasmussen SA, Reefhuis J, and the
National Birth Defects Prevention Study. Association
between Maternal Age and Birth Defects
of Unknown Etiology - United States,
1997-2007. Birth Defects Res A Clin Mol Teratol
2012;94:1010-18.
18. Schmidt L, Sobotka T, Bentzen JG, Nyboe
Andersen A, on behalf of the ESHRE Reproduction
and Society Task Force. Demographic
and medical consequences of the postponement
of parenthood. Hum Reprod Update
2012;18:29-43.
19. Kenny LC, Lavender T, McNamee R, O’-
Neill S, Mills T, Khashan AS. Advanced Maternal
Age and Adverse Pregnancy Outcome:
Evidence from a Large Contemporary Cohort.
PLoS ONE 2013;8:1-9.
20. Sauer MV. Reproduction at an advanced
maternal age and maternal health. Fertil Steril
2015;103:1136-43.
21. Schimmel MS, Bromiker R, Hammerman
C, et al. The effects of maternal age and parity
on maternal and neonatal outcome. Arch Gynecol
Obstet 2015;291:793-8.
22. Lawn JE, Blencowe H, Waiswa P, et al, for
The Lancet Ending Preventable Stillbirths Series
study group with The Lancet Stillbirth
Epidemiology investigator group. Lancet
2016;387:587-603.
23. Malaspina D, Gilman C, Kranz TM. Paternal
age and mental health of offspring. Fertil
Steril 2015;103:1392-6.
24. Ramasamy R, Chiba K, Butler P, Lamb DJ.
Male biological clock: a critical analysis of advanced
paternal age. Fertil Steril 2015;103:
1402-6.
25. Sharma R, Agarwal A, Rohra VK, Assidi M,
Abu-Elmagd M, Turki RF. Effects of increased
paternal age on sperm quality, reproductive
outcome and associated epigenetic risks to
offspring. Reprod Biol Endocrinol 2015;13:35.
26. McGrath JJ, Petersen L, Agerbo E, Mors
O, Mortensen PB, Pedersen CB. A Comprehensive
Assessment of Parental Age and
Psychiatric Disorders. JAMA Psychiatry 2014;
71:301-9.
27. de Kluiver H, Buizer-Voskamp JE, Dolan
CV, Boomsma DI. Paternal Age and Psychiatric
Disorders: A Review. Am J Med Genet
Part B 2016;9999:1-12.
28. Wu S, Wu F, Ding Y, Hou J, Bi J, Zhang Z.
Advanced parental age and autism risk in children:
a systematic review and meta-analysis.
Acta Psychiatr Scand 2017;135:29-41.
29. Javaras KN, Rickert ME, Thornton LM, et
al. Paternal age at childbirth and eating disorders
in offspring. Psychol Med 2017;47:576-
84.
30. Bortolus R, Oprandi NC, Rech Morassutti
F, et al. Why women do not ask for information
on preconception health? A qualitative
study. BMC Pregnancy Childbirth 2017;17:5.
31. Consensus 2016 HELP - Human Early Life
Prevention. Prevenzione precoce delle malattie
non trasmissibili e promozione di un corretto
sviluppo neurocognitivo. Atti XXVIII
Congresso Nazionale SIPPS (www.sipps.it).
32. Revelli A, Razzano A, Delle Piane L, Casano
S, Benedetto C. Awareness of the effects of
postponing motherhood among hospital gynecologists:
is their knowledge sufficient to offer
appropriate help to patients? J Assist Reprod
Genet 2016;33:215-20.
Corrispondenza: renata.bortolus@aovr.veneto.it