Delayed First Childbirth Linked to Increased Risk of Pelvic Organ Prolapse, Review Finds

The findings were published online in the American Journal of Obstetrics and Gynecology in the June 2025 issue.

Pelvic organ prolapse—a condition in which pelvic organs such as the bladder, uterus, or rectum descend from their normal position—has long been associated with vaginal delivery and advancing chronological age. However, the specific contribution of maternal age at the time of first childbirth has received limited investigation until now.

The review emphasizes that aging naturally leads to deterioration in muscle function, including a decline in strength, flexibility, and healing capacity—factors that can compromise the pelvic floor muscles during childbirth. As a result, older first-time mothers may be more vulnerable to pelvic floor injuries during delivery and less able to recover effectively afterward.

Zabriskie and her team analyzed available literature to assess how delayed childbirth influences known mechanisms involved in POP, such as pelvic muscle weakening, levator ani muscle defects, and widening of the genital hiatus. They found consistent evidence that advancing maternal age at first delivery is linked to an increased risk of pelvic floor trauma and subsequent development of prolapse symptoms.

Importantly, the authors highlighted that current human studies are limited in number and scope, especially regarding the underlying cellular and molecular processes. There is a need for more comprehensive research that examines these biological mechanisms, specifically concerning maternal age at first delivery.

The review outlines several key recommendations for future investigations. These include ensuring clearly defined study populations with consistent parity and delivery methods, using appropriate statistical models, and accounting for confounding variables such as the duration of labor. Additionally, the authors noted that older mothers are often more likely to attend postpartum follow-ups, potentially skewing data and underrepresenting younger women. Therefore, greater efforts are needed to engage and retain younger postpartum women in future cohort studies.

Ultimately, the authors advocate for age-specific analyses in future POP research and stress the need to stratify findings based on maternal age at first birth. By better understanding how age affects pelvic floor outcomes, clinicians may be able to more effectively identify women at higher risk and develop targeted therapies to prevent or treat POP.

Reference:

Zabriskie HA, Drummond MJ, Nygaard IE, Swenson CW. Older maternal age at first delivery as a risk factor for pelvic organ prolapse: what we know. Am J Obstet Gynecol. 2025 Jun;232(6):499-505. doi: 10.1016/j.ajog.2025.03.006. Epub 2025 Mar 8. PMID: 40064413.