Older moms face special risks

With continuing changes in societal and economic trends, more and more women are electing to defer childbearing until their mid- to late 30s or even later. Are you one of them?

You are not alone. Childbirth demographics in this country are changing:

  • The average age of U.S. women who give birth for the first time has been increasing for decades. From 1970 to 2006, it rose 3.6 years, from age 21.4 to 25.
  • Women ages 35 and older accounted for one out of every 12 first births in 2006 compared with one out of 100 in 1970.
  • Between 1980 and 2004, the number of women ages 40 and older who gave birth for the first time increased 15-fold.

A boost from technology

Around menopause (the late 40s or early 50s), a woman’s chances of naturally conceiving are low. But it is now possible for women to wait until they are close to or even at menopause to have children using assisted reproductive technology (ART).

“Pregnancy and childbirth are safest between ages 25 and 35,” says David Hackney, MD, a maternal fetal medicine specialist at University Hospitals MacDonald Women’s Hospital. “It is when a woman reaches her 40s and beyond – with or without ART – that she and her unborn baby have a higher risk of developing complications during pregnancy. Most of these pregnancies, however, can still result in the successful delivery of a healthy baby at term.”

Key risks with age

The pregnancy of a woman in her 40s may be threatened by existing age-related health issues, such as chronic high blood pressure, diabetes or a history of cancer. “Pregnant women who are 40 and older are twice as likely as younger women to struggle with high blood pressure,” says Dr. Hackney. “This condition can lead to a range of complications including problems with fetal growth, preeclampsia and premature delivery.”

Dr. Hackney says that women in their 40s have a higher incidence of delivering by cesarean section compared with younger women, though most women can still have successful vaginal deliveries and age alone is not an indication of performing a cesarean section. A cesarean section raises risks for infant mortality and problems with the placenta in future pregnancies.

Other potential risks

According to Dr. Hackney, there are other issues more likely among older moms:

  • Preterm births. “Preterm babies are not fully developed,” says Dr. Hackney. “As a result, they have significant health problems and a lower chance of survival than full-term babies.”
  • Miscarriage, when pregnancy spontaneously ends by its 20th week.
  • Chromosomal abnormalities, such as Down syndrome.
  • Stillbirth. Though uncommon at or after the 20th week of pregnancy, the chances rise with the mother’s age.

Steps to a healthy pregnancy

“No matter your age, it is important to take care of yourself before you conceive and throughout pregnancy,” says Dr. Hackney.

The American College of Obstetricians and Gynecologists suggests women ages 35 and older take these steps to ensure a healthy pregnancy:

  • Schedule a preconception appointment and seek regular prenatal care.
  • Discuss the risks and benefits of prenatal testing with your health care provider.
  • Eat a healthy diet, maintain a healthy weight, reduce stress and get plenty of sleep.
  • Take a daily supplement that contains folic acid, such as a prenatal vitamin.
  • Avoid smoking, alcohol, nonprescription drugs and exposure to harmful substances.
  • Ensure your immunizations are up-to-date.

High-risk pregnancy services

With six locations across the region, maternal fetal medicine specialists from UH MacDonald Women’s Hospital provide focused care for all phases of high-risk pregnancy – from conception, through delivery and postpartum care – including:

  • Maternal fetal consultation
  • Prenatal ultrasound
  • First and second trimester screening for genetic disorders
  • Genetic counseling services
  • Antepartum fetal testing

In addition, an advanced care nurse practitioner and a fetal care nurse navigator help to augment care that is specialized for each patient.

DAVID HACKNEY, MD

DAVID HACKNEY, MD
Maternal Fetal Medicine Specialist, UH MacDonald Women’s Hospital
Assistant Professor, Case Western Reserve University School of Medicine

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