By: Jean Johnson for Uterus1
My neighbor across the street waited until she was in her late 30s to have a son and subsequently, a sweet little daughter named Fiona. Historically, though, healthcare providers have viewed women over 30 or 35 – especially those having their first child – as high risk and hence, not as desirable candidates for pregnancy as their younger counterparts.
|Weigh Your Options|
“Pregnancy complications may be increased in old women, so speak openly about your health history with your obstetrician,” writes Phillip E. Patton, M.D., professor of obstetrics & gynecology, and director of OHSU Fertility Consultants.
Before you get pregnant consider three questions:
Am I ready?
Babies demand attention and love. Parenting requires considerable energy and time commitment. Mothers and fathers of all ages can benefit by attending both childbirth and parenting classes.
Older women often have many advantages to give to a child:
Career goals in place
Increased confidence in child-raising abilities
But times change. These days, more and more women like my neighbor are waiting until their middle years to start their families.
“In the United States, birth rates for women in their 30s are at the highest levels in three decades,” according to a UAB Health System report. (UAB is one of the nation’s leading medical research and patient care centers located in Birmingham, Ala.)
Many factors are influencing this trend, a dynamic that is observable not just in the United States but throughout the developing world. The shift from the farm to urban areas has been one factor responsible in not only delaying the timing of children, but also in women having fewer babies. Accompanying this significant and sweeping demographic change has been women’s increased interest in obtaining higher education and meeting a wide variety of career goals before they start having children – or even get married.
Advanced maternal age also increases the chances that women are more secure financially and have cultivated marriages that are relatively stable. Additionally, mothers in this age bracket tend to have increased confidence in their ability to raise children well.
That said, a more mature age can bring disadvantages as well as advantages.
High Risk, but Not Necessarily Cause for Alarm
“Any pregnancy involves a leap of faith,” writes Sally Y. Segel, M.D., associate professor of obstetrics and gynecology at Oregon Health and Sciences University in Portland, Ore. (Like UAB, OHSU is a prominent teaching, research and patient care facility.) “But for pregnancies that begin or develop into those considered high-risk, that faith has to be supplemented by extra vigilance – and extra care, from specialists in maternal fetal medicine. The label high-risk needn’t be cause for alarm, however.”
Indeed, the consensus in the literature states that a number of factors including socioeconomic and educational status, family history, diet, activity and prenatal care influence the outcomes in mature pregnancies.
Women who eat nutritious diets and exercise, for example, increased their chances of carrying healthy infants to term without complications. Similarly, women decrease their risks if they are completely candid with their physicians about other physical problems they might have and are vigilant in seeking pre-natal care. Nonetheless, lifestyle factors only go so far in determining pregnancy outcomes in older women.
Major Medical Conditions
Women in their 30s and 40s who are considering pregnancy are well served if they realize that any major medical conditions they have such as diabetes, high blood pressure, or lupus increases their risk for normal pregnancy and delivery. These conditions, writes Segel, place women “at risk for poor placental function, and so they should contact a maternal fetal medicine physician for appropriate monitoring.”
OHSU’s director of Fertility Consultants, Phillip E. Patton, M.D. admonishes more mature women that “pregnancy complications may be increased in older women, so speak openly about your health history with your obstetrician.”
Phillips underscores that full disclosure is critical for all pregnant women who want the best the healthcare system can provide. Since older women often have more health problems than younger ones, confiding the details of one’s full health status portfolio can make the difference between a happy ending and one that is otherwise.
Down syndrome is most often associated with children born to older women, but the condition is only 1 of 400 known genetic defects that can affect newborns. Still, with many of the other conditions occurring rarely and Down syndrome at an almost 50 percent frequency (of newborns with genetic defects), the syndrome that has such sad implications rightly gets most of the attention.
Down syndrome, of course, causes mild to moderate mental retardation and some increased health risks such as cardiac valvular disease. Chances of a baby being born with the genetic defect run from 1 in 1,100 to 1 in 1,300 when women are in their early child bearing years.
After women reach 30, however, the odds dramatically shift. By the time women are 35, the odds are 1 in 350. By the time a woman reaches 40, chances are 1 in 100 that her child will have Down syndrome. At age 45, 1 in 25 women will have a baby with the serious condition.
Get good prenatal care as soon as you realize you are pregnant.
Communicate all of your past health history and any new signs or symptoms to your doctor. Your doctor can’t catch warning signs if you keep them to yourself.
Avoid alcohol and tobacco.
Eat a healthy diet. Take a look at the Harvard School of Public Health’s Nutrition Source for nutritional guidelines.
Keep a healthy weight – this will reduce complications during pregnancy right up through the delivery. According to the Mayo Clinic, if you are at a normal weight before pregnancy you should expect to gain 25 to 35 pounds, less weight if you are already overweight and a little more if you are underweight when you get pregnant.
Consult with your doctor about any over-the-counter medications and herbal supplements before you take them.
Various tests are available to determine whether or not a fetus in utero has chromosomal abnormalities. Blood tests and ultrasound can help to some degree, but more commonly, chorionic villus sampling (CVS) or amniocentesis is preferred. These tests are only done with the complete understanding and consent of the pregnant woman since the tests themselves carry a less than 1 percent risk of miscarriage.
The CVS, which tests tissue around the fetus, can be performed as early as nine weeks and the results can be available within a few days. On the other hand, an amniocentesis – in which a sample of amniotic fluid is drawn – is generally not taken until the 14th to 16th week, with results unavailable for another week to two weeks.
If women carry fetuses with a genetic syndrome or a chromosomal abnormality to term, Segal notes that “the pregnancy is at increased risk, and the appropriate pediatric specialties will be required upon delivery.”
Preeclampsia/High Blood Pressure
Preeclampsia, also called toxemia, affects about “5 percent of pregnant women, most of whom are having their first baby,” according to the March of Dimes Pregnancy and Newborn Health Education Center. “Preeclampsia is a pregnancy-induced condition that includes hypertension (high blood pressure). It can be serious for both mother and baby.” More, women over 35 “are more likely to get high blood pressure (and diabetes) for the first time during pregnancy.”
Along with high blood pressure – that is often only detected during a routine prenatal care appointment – women with preeclampsia can have protein in their urine, swelling in the hands and feet, sudden weight gain as in a pound a day or more, blurred vision, headaches, dizziness and intense stomach pain. “Rarely,” states the March of Dimes, “preeclampsia progresses to a life-threatening condition called eclampsia, which includes convulsions and sometimes leads to coma and death of the mother and baby.”
Most commonly when preeclampsia is detected, women are put on bed rest at home and monitored while the baby matures inside the womb. “In some cases, a woman’s blood pressure continues to rise despite treatment, and her baby must be delivered to prevent serious health problems in the mother such as severe stroke, liver damage and convulsions.”
Healthy Habits Help Reduce Risks during Pregnancy
March of Dimes pundits champion healthy habits for older women planning on having children. “A study at the University of Washington in Seattle found that women who exercised regularly before pregnancy may be less likely to develop preeclampsia. That study also found that women with certain risk factors for preeclampsia (such as obesity) may be less likely to develop that disorder if they exercised regularly during pregnancy (always check with your provider before starting or continuing an exercise program in pregnancy to make sure it is safe for you.)”
Along with exercise come tips on diet, of course. The March of Dimes puts it in a nutshell: “Eat healthy foods.” In other words, shop the outer aisles of the grocery store for fresh foods, avoiding packaged, processed fare. Watch for ways to increase intake of fresh vegetables and whole grains.
The venerable organization also encourages older women to watch their weight gain and keep it within healthy boundaries. Then there are the usual strictures on staying away from all alcohol, tobacco and illegal drugs. Added to this list is also a caution on over-the-counter medications including herbal supplements, with the rule of thumb being: Don’t take anything without first checking with your doctor.
In sum, as OHSU’s Dr. Segel observed, high risk doesn’t necessarily mean cause for alarm. Rather it’s a prudent warning, a red flag for the over 30 crowd. If you’re planning a pregnancy, the high-risk status means take care of yourself and work with your health providers. Be prudent. Be forewarned. Know that the odds are clearly in your favor if you tow the line, and soon you’ll have a wee one in the bassinette.
If you enjoyed this article, you might also be interested in the following:
Birth Rates on the Rise in Older Women