Archive for November 19th, 2018

On October 5, 2018 the FDA approved the use of the 9-valent HPV vaccine in women and men aged 27 through 45 years1. Although this approval opens the possibility for expanded protection against HPV disease in women and men, further review of the available data, including cost-effectiveness, is needed. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is reviewing the available data, and ACOG is working closely with the CDC to determine if changes in clinical guidance and recommendations are appropriate.

In the meantime, members are advised that Committee Opinion 704, Human Papillomavirus Vaccination, remains in effect2. As outlined in the guidance, obstetrician-gynecologists and other health care providers are encouraged to welcome conversations with women older than 26 years who are interested in receiving the HPV vaccine2. In patients aged 27 to 45 years, their decision to be vaccinated should be individually based using shared decision making and clinical judgment based on those patients’ circumstances, preferences, and concerns. The vaccine is safe and is effective in preventing new infections with HPV in women aged 27-45 years3.

This Practice Advisory was developed by the American College of Obstetricians and Gynecologists’ Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group with Linda O’Neal Eckert, MD, and Kevin Ault, MD.


  1. Food and Drug Administration. FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old [press release]. Silver Spring (MD): FDA; 2018. Available at: Retrieved October 18, 2018.
  2. Human Papillomavirus Vaccination. Committee Opinion No. 704. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e173-8. Available at: Retrieved October 18, 2018.
  3. Luna J, Plata M, Gonzalez M, Correa A, Maldonado I, Nossa C, et al. Long-term follow-up observation of the safety, immunogenicity, and effectiveness of Gardasil in adult women. PLoS One 2013;8:e83431. Available at: Retrieved October 18, 2018.



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Premature birth, low birth weight and seizures are among the problems reported.

Babies of older fathers are at greater risk of premature birth, low birth weight and other neonatal problems, a new study reports.

Mothers may also be affected: Those with older partners were more likely to have gestational diabetes, probably because older paternity is associated with changes in the placenta.

The study, published in BMJ, used data gathered by the Centers for Disease Control and Prevention on more than 40 million live births between 2007 and 2016.

Compared with babies of fathers 25 to 34, those whose fathers were 45 to 54 had a 15 percent increased risk for premature birth, and an 18 percent increased risk for seizure. They were 14 percent more likely to be admitted to a neonatal intensive care unit, and 9 percent more likely to need antibiotics. Babies of fathers older than 55, although there were few in the study, were at even greater risk. The study controlled for maternal age and other factors.

The lead author, Dr. Michael L. Eisenberg, director of male reproductive medicine and surgery at Stanford, said that for the individual couple the effect is modest, and he would never tell a man he is too old to be a father.

Still, he said, “Men should no longer think their runway is unlimited. Now we know there are some risks that you should take into account when starting a family.”

A version of this article appears in print on , on Page D5 of the New York edition with the headline: Family: Woes for Babies of Older Fathers.

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