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According to the American College of Obstetricians and Gynecologists (ACOG) there is no set age that is unsafe for women to become pregnant. Even for women 35 and older the chances of having a normal pregnancy and a healthy baby are good provided they get good preconception counseling and prenatal care. However, despite the favorable prognosis, there are issues that the older prenatal patient has to consider that do not apply to a younger woman. Pregnancy puts great demands on a woman’s body and complications are higher for older women. According to ACOG they will probably need to see their physician more often, require special testing and require more care during labor and delivery. The risk of genetic disorders, in particular, chromosomal disorders, is higher in the older patient. These disorders occur when parts of the chromosome are either missing or damaged or there is an extra chromosome. The effect on the child born with a chromosomal disorder can be physical and/ or mental. In Down’s syndrome or Trisomy 21 the child has an extra copy of chromosome 21. This is an example of a chromosomal disorder that has both physical and mental effects on the child. At age 40 the risk of having a baby with a chromosomal disorder is 1/66 and that risk increases dramatically at 45 to 1/21. Because the risk of genetic disorders increases with age your physician may suggest genetic counseling so you and your partner can assess your particular risks and make educated decisions about getting pregnant or getting tested if you are pregnant. Some screening tests, routinely offered to all women, are even more important in the older patient. These include:
 These tests are usually done between the 15th and 20th week of pregnancy. While these tests identify 60% of the babies with Down’s and 80-90% of the babies with neural tube defects, they are controversial because of the high rate of “false positive” results obtained in healthy babies. A positive test should be repeated and if it is still positive follow-up testing will be suggested.
There are other complications associated with pregnancy over 40 such as higher rates of multiple pregnancy. The need for a Caesarean section is typically greater women of advanced maternal age since older moms have a higher risk of pregnancy related complications that include pre-eclampsia or pregnancy induced hypertension and gestational diabetes. C-sections are also indicated if the baby is too big, a common occurrence with gestational diabetes or if the position of the fetus makes vaginal delivery risky. Finally, if the placenta is covering the cervix partially or completely- placenta previa or if the placenta separates prematurely- placenta abruption, C-section will be indicated. One study suggests that the latter condition may be precipitated by aging of the uterine blood vessels or related to chronic hypertensive disorders. In addition to those already mentioned the prevalence of postpartum hemorrhage, pulmonary embolism and prolonged hospital stays is higher in older women.  Despite higher risks the chance for an uncomplicated pregnancy are good proper planning and care. The Mayo Clinic suggests the following if you are considering pregnancy: If you are considering pregnancy after 40 you are not alone. A recent Google search elicited 7,290,000 results from various sites. Books such as Hot Flashes, Warm Bottles: First Time Mothers Over Forty describe not only the physical challenges, but the emotional and spiritual challenges faced by midlife moms. In another article entitled, “The Clash of the Titans: Motherhood Meets Menopause” the same author describes the clash of needs that stems from the demands of motherhood while experiencing the biochemical effects of peri-menopause that often leave women feeling too fatigued to care for their children. Another author addresses the question, “Will my child think I’m too old?” She suggests replacing the word “old” with wise or experienced. In conclusion, for many midlife moms having a child makes them feel alive again, even though it requires some adjustment. Good preconception counseling and regular prenatal care along with healthful life style habits can enhance the probability of a positive outcome for mother and baby. More information on this topic is available at these websites: References: Blackstone-Ford J. The new normal. Available at: http://www.midlifemother.com/The%20New%20Normal/Me%20to%20Mommy.htm Callaghan W, Berg C. Pregnancy-Related Mortality Among Women Aged 35 Years and Older, United States, 1991-1997. Obstetrics Gynecology 2003; 102: 1015-21. Cunningham F, Leveno K. Childbearing among older women-the message is cautiously optimistic. N Engl J Med 1995; 333: 1002-4. Hook EB, Cross PK, Schreinemachers DM. Chromosomal abnormality rates at amniocentesis and in live-born infants. JAMA 1983; 249: 2034-8. Jolly M, Sebire N, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod 2000;15:2433-7. London N. The clash of the titans: motherhood meets menopause. Available at: http://cwhn.ca/resources/afi/meno-mother.html Salihu H, Shumpert M, Slay M, Kirby R, Alexander G. Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstetrics Gynecology 2003; 102: 1006-14. |
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A couple in which the woman is younger than 35 years is considered infertile if they've had problems getting pregnant for more than 12 months.