what are the risks?

With modern medicine, having a baby later in life can be both safe and healthy. But there are still reasons for educating yourself about the potential risks and challenges that are unique to couples planning a pregnancy later in life. Knowing the facts can help you set realistic expectations about getting pregnant later in life, and motivate you to get help at the right time.

• challenges with conception
• risks in pregnancy
• risks in childbirth

challenges with conception

The biggest challenge for couples who want a baby later in life is often getting pregnant. Estimates are that one in eight couples is affected by some degree of infertility.¹ At 35 plus, these rates increase. Compared with older couples trying to conceive, younger couples have the luxury of trying to get pregnant on their own for a longer period of time. Younger couples are advised to seek treatment for infertility after 12 months of trying, whereas those over 35 should get fertility guidance if they’ve been trying for half that time.

If you are older than 35 and have had challenges getting pregnant for more than six months, your healthcare provider may be able to offer limited assistance. If you need more specialized treatment, there are additional fertility specialists with whom you can consult.

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risks in pregnancy

Once pregnant, older women are faced with a new set of challenges or risks in pregnancy. Miscarriage, also referred to as spontaneous abortion, is the unintended loss of a fetus prior to the 20th completed week of pregnancy. Unfortunately, the risk of miscarriage does increase considerably as women get older. Experts believe this can be attributed in part to the fact that as women get older they are more likely to have fetuses with chromosomal abnormalities, and these fetuses often spontaneously abort. Some chromosomal abnormalities can result in a living child so it is important to understand the age-related risk of having a child with a chromosomal abnormality. A genetic counselor can help you understand those risks.

Here are some general statistics couples should keep in mind regarding the risk of age-related pregnancy loss. While these numbers are useful for comparison purposes, they may not reflect a specific couple's exact risk of miscarrying:

• Women in their early 20s have about a 10% chance of miscarriage
• Women in their late 30s have an 18% risk of miscarriage
• Women closer to age 45 have over a 50% risk of miscarriage

One of the biggest pregnancy risks in your 30s, 40s and 50s is that the chance of conceiving a baby with a birth defect goes up every year, particularly those involving chromosomal complications like Down syndrome. Pregnant women 35 or older are often advised to seek genetic counseling and prenatal testing to detect any chromosomal abnormalities.

A genetic counselor will help you establish your risk of having a baby with a genetic disorder, and interpret each couple’s unique genetic and reproductive histories so they can make informed choices both before and during pregnancy. Prenatal testing looks for chromosomal problems in your baby while you are pregnant.

Women older than 35 are at higher risk of developing other complications during pregnancy, including gestational diabetes, preeclampsia and placental problems. Gestational diabetes is a form of diabetes that occurs in some women only while they are pregnant. Although it usually resolves after pregnancy, babies born to mothers with this condition are larger than average which can lead to complications. As with diabetes, high blood pressure, or preeclampsia, is a greater risk to pregnant women who are in their mid- to late 30s or early 40s. This condition can be dangerous because it reduces the flow of blood and nutrients to the fetus via the placenta.

In addition, placental complications of pregnancy are more frequent among older women. The most common of these is placenta previa, in which the placenta covers part or all of the cervix (uterine opening). This can cause serious bleeding during delivery which can be dangerous for both mother and baby.

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risks in childbirth

Labor and delivery may also be different for a woman in her 30s or 40s compared to a younger woman. Labor may be longer because the cervix may not dilate as easily, and longer labors are associated with more delivery interventions, such as induced labor, a cesarean section, an epidural and a forceps or ventouse delivery. First-time mothers over age 40 appear to be more than twice as likely as first-time mothers under age 30 to have a cesarean delivery.

Despite the potential risks, studies agree that the outcome for the baby is most likely just as good as that for younger mothers.

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