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Researchers at Columbia Presbyterian Medical Center report that women who delay childbearing increase their likelihood that their male babies will have hypospadias, a congenital anomaly that occurs when the penile urethra develops abnormally, leaving the urethral opening on the bottom side of the penis.

The study, reported in the March issue of the Journal of Urology, highlights the risk involved in delaying childbearing until a woman's older years.

The lead author of the new study, Dr. Harry Fisch, Associate Clinical Professor of Urology at Columbia University College of Physicians & Surgeons and Director of the Department of Urology's Male Reproductive Center at Columbia Presbyterian Medical Center, says that hypospadias can lead to infections and infertility. Although hypospadias can be repaired surgically, it would be best if the defect could be prevented.

Dr. Fisch's co-authors include Drs. Gary L. Libersen, Grace S. Hyun, and Terry W. Hensle at Columbia Presbyterian Medical Center; Dr. Maria I. New at New York Weill Cornell Medical Center; Dr. Robert J. Golden, of Toxlogic, Potomac, Maryland; and Ms. Pamela Madsen of the American Infertility Association.

The researchers analyzed data on maternal age and birth defects in New York and California from 1983 to 1996. Currently, the New York State Congenital Malformation Registry and the California Birth Defects Monitoring Program combined provide data from approximately 500,000 births annually, or approximately 16 percent of all United States births.

The researchers found that advanced maternal age is significantly associated with hypospadias. In California, mothers 35 and older have a 50 percent greater risk of giving birth to this defect compared to mothers less than 20 years old.

"It's commonly known that older women have greater problems getting pregnant, run a higher risk of miscarriages and multiple fetuses, and have a greater chance of such congenital abnormalities as heart defects and Down's syndrome," Dr. Fisch says. "Now it is necessary to add to the list the danger of a urological defect, hypospadias."

Dr. Fisch points out that the trend for American women to delay childbearing is remarkable. In New York State in 1983, women aged 35 and older having children accounted for only 7 percent of all births; by 1996, women of that age group were responsible for 17 percent of all births—one out of six.

One question is whether the greater incidence of hypospadias among older mothers may be caused by environmental factors. Dr. Fisch says there are no scientific data to show such a cause.

Another question discussed in the article is whether fertility treatments may account for an increased incidence of hypospadias. A cursory look at the evidence might indicate this possibility, but when the data are controlled for maternal age, it appears that the defect arises because of increasing age, not increasing use of fertility treatments.

"The consequences of delaying childbearing are a matter that society has still not fully faced up to," says Dr. Fisch, calling for more research and public education.