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Fatherhood later in life brings risks to offspring, father
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Nine percent of all U.S. births between 2007 and 2016 were to men aged 40 years and older, according to a study in BMJ.
Some well-publicized examples of this higher paternal age have been lauded and criticized, but ultimately are misleading, according to Aaron McColpin, DNP, a family medicine practitioner and assistant professor of nursing at California State University Channel Islands.
“Men may see Mick Jagger and Tony Randall becoming fathers and think that everything about having a child later in life is the same as it is younger in life. And in most instances, it is. But there is a risk,” he told Healio Primary Care Today.
There is no clear-cut answer on the age when fathering a child increases the risk to the father and children has been established, according to researchers.
"When trying to weigh the possible risks and benefits of delaying childbearing, there is no set age at which advancing paternal age suddenly becomes problematic,” Brian M. D’Onofrio, PhD, of Indiana University, and Paul Lichtenstein, PhD, of the Karolinska Instituet in Sweden, wrote in a 2014 Cerebrum study that included a sample size of 5.6 million potential births.
Compounding the uncertainty is that research into the risks for this cohort and their offspring is in its nascency, Cristiano Jodicke, MD, a maternal fetal medicine physician with Orlando Health Winnie Palmer Hospital for Women & Babies said in an interview.
“In the past, all of the research was dedicated to discovering complications in older women and their offspring. It was previously only thought that a man in his late thirties and trying to conceive may have reduced fertility and man man in his early forties had reduced fecundity. Thus, if this interview about risks to older fathers and their offspring occurred about 10 to 15 years ago, I would not have much to say on the topic,” he told Healio Primary Care Today. “Though the risk for complication is still greater in women, we are starting to see ways that paternal age can have impacts.”
Research has found a higher risk for genetic disorders, birth defects, developmental illnesses, skeletal dysplasia (bone developmental abnormalities), hemophilia, Klinefelter and Down Syndrome and childhood cancers such as leukemia in some higher paternal age births, Jodicke said. In some cases, the increased risk can even skip a generation.
“There are instances where the genetic problem is passed onto the grandson, from the daughter who was conceived at an older age,” Jodicke said. “These mutations would be transmitted from carrier daughters to affected grandsons and have thus been called the ‘grandfather effect’. Examples of such diseases include hemophilia A and Duchenne muscular dystrophy.
McColpin encouraged PCPs to keep the lines of discussion open and honest in their older patients who become fathers.
“Some of the discussions surrounding the risks of older fatherhood involve tough conversations about changing long standing habits or adopting a healthier lifestyle, but it is a conversation that needs to happen,” he said.
Jodicke recommended that primary care physicians refer older patients who are considering a first-time pregnancy and are older than 40 years, to genetic counselors as an early step before pregnancy.
“The genetic counselor can go over these risks and offer suggestions on what the best way forward may be,” Jodicke noted.
The risks to these offspring also extend to some behavioral and mental health disorders, McColpin added.
“These babies are at greater risk for autism and schizophrenia, though this last condition typically does not show its symptoms until the child is older,” he said, adding that in some medical problems in the offspring of older fathers can even skip a generation, Jodicke said.
The potential complications are tied to normal aging processes that cannot be alleviated by behavioral controls, Yash S. Khandwala, a urology resident at the Stanford University School of Medicine and the lead author on the BMJ study, and colleagues wrote.
“It has become increasingly clear that male aging influences germline integrity through other mechanisms as well, such as DNA fragmentation, telomere lengthening, mutations, and overall genomic instability,” Khandwala and colleagues wrote.
Consequently, nothing can be done to avoid the risks, McColpin said.
“This is not a risk that can be alleviated by a man consuming 1,000 mg of vitamin D a day for 6 months prior to impregnating women,” he said. “All our systems break down as we get older, and sperm is no exception.”
According to Jodicke, once a child is conceived, The American College of Medical Genetics recommends obstetric ultrasonography at 18 to 20 weeks gestation in cases of advanced paternal age to evaluate fetal development. This society also cautions this procedure "is unlikely to detect many of the conditions of interest,” Jodicke added.
The man is also at risk for some health issues when he fathers a child later in his life, McColpin said.
“Having a child is such a major life change: the father is likely getting less sleep, engaging in bad eating habits, changing his exercise regime for the worse and participating in binge drinking and is feeling anxious and depressed,” he said.
“For that reason, these men should be monitored more frequently for high BP and cholesterol levels, rapid weight gains, and signs of postpartum depression and suicide,” McColpin continued.
Jodicke said the child should be mentioned in post-birth visits to reverse these negative behaviors.
“As men, we try not to think of ourselves as having medical problems. Explaining that another person is now dependent on them to engage in positive behavior, such as eating healthy, stopping smoking, exercising regularly, drinking less often, often helps the father change his habits,” Jodicke said.
He and the Cerebrum study authors emphasized that the risks described should not deter an older man from fatherhood.
“It is important to remember that these risks are very small, and that the father should not be discouraged from having a baby because of them,” Jodicke said.
“There are many personal circumstances and values that go into making the decision of when to have a child or children. Yes, we think that research can help inform personal decision-making. But no study, set of studies, or science in general should unduly influence the decision of when someone should have children,” D’Onofrio and Lichtenstein wrote. – by Janel Miller
References:
D'Onoforio BM and Lichenstein PhD. Cerebrum. 2014:Jul-Aug.9.
Khandwala YS, et al. BMJ. 2018;doi:/10.1136/bmj.k4372.
Disclosures: Neither McColpin nor Jodicke report any relevant financial disclosures.