Pregnancy is an exciting time, and more women every year are happy to find they are pregnant in their 30s or 40s. Older mothers are giving birth to more than 675,000 babies a year.
During the 1980s, births to women in the 30- to 44-year-old age range nearly doubled. First births to women in their 30s in 1990 accounted for about 25% of all births to women in that age group. In 2008, it was reported nearly 15% of all births were to women 35 and older.
If you waited to start a family, you aren’t alone. Many couples choose to postpone having children until careers are on track or relationships are firmly established. Births to older couples may occur because they married late or a couple is in a second marriage and starting a new family together. Other couples have experienced infertility and do not achieve a pregnancy until they have gone through major workups and testing or even surgery. Or a single woman may have chosen donor insemination to achieve pregnancy.
Susan, a 38-year-old woman with two kids, recently married a man who had not fathered any children. Susan came to the office concerned about their chances of conceiving. I gave her a few suggestions and laid out a plan for the next few months. An ecstatic Susan called me 2 weeks later. She was pregnant and had probably been a few weeks along when we had discussed the possibility of infertility.
Today, many healthcare professionals gauge pregnancy risk by a pregnant woman’s health status, not her age. Pre-existing medical conditions have the greatest impact on a woman’s well-being during pregnancy. For example, a healthy 39-year-old is less likely to develop problems than a diabetic woman in her 20s. A woman’s fitness can also have a greater effect on her pregnancy than her age.
Most older women who become pregnant are in good health. A woman in good physical condition who has exercised regularly may go through pregnancy as easily as a woman 15 to 20 years younger. An exception—women in a first pregnancy who are over 40 may have more problems than women the same age who have previously had children. But most healthy women will have a safe delivery.
Some health problems are age related, and the risk of developing a condition increases with age. You may not know you have a problem unless you see your healthcare provider regularly.
If either you or your partner is over 35, genetic counseling may be recommended; see the discussion in Chapter 10. Two risks that increase for older pregnant women are chromosomal abnormalities and miscarriage. The risk of chromosome problems exceeds 5% for the over-35 age group. The risk of miscarriage is about 50% at age 42. Genetic counseling may help answer questions you have about these and other problems.
Genetic counseling brings together a couple and professionals who are trained to deal with the questions about the occurrence, or risk of occurrence, of a genetic problem. With genetic counseling, information about human genetics is applied to a particular couple’s situation. Professionals interpret this information so the couple can make informed decisions.
When a mother is older, the father is often older as well; a father’s age can affect a pregnancy. It can be difficult to determine whether the mother’s age or the father’s age matters more. More research is needed before we definitely know the effects of a father’s age on pregnancy.
As an older pregnant woman, your healthcare provider may see you more often or you may have more tests. You may be advised to have amniocentesis or chorionic villus sampling (CVS) to find out whether your child has Down syndrome or some other problem. Even if you would never terminate a pregnancy, this information helps you and your healthcare team prepare for the birth of your baby.
•The natural steroids produced during pregnancy may reduce symptoms of allergies and asthma and may help reduce inflammation, a common symptom of rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease and other autoimmune disorders.
•Pregnancy may protect you from breast cancer or ovarian cancer later in life.
•Migraine headaches often disappear during the second and third trimesters of pregnancy.
•Menstrual cramps are a thing of the past during pregnancy. An added benefit—they may not return after baby is born!
•Pregnancy stops the growth of endometrial tissue when ovulation stops and may help relieve moderate endometriosis. Endometriosis is the condition in which endometrial tissue attaches to parts of the ovaries and other sites outside the uterus; it causes pelvic pain, heavy bleeding and other problems during menstruation for some women.
If you’re over 35, you do have a greater chance of having problems. You may be watched more closely during pregnancy for signs of those problems. Some can be troublesome, but with good medical care, they can usually be handled fairly well.
Pregnancy when you’re older can take its toll. You may gain more weight, see stretch marks where there were none before, notice your breasts sag lower or feel a lack of tone in your muscles. Attention to nutrition, exercise and rest can help a great deal.
Because of demands on your time and energy, fatigue may be one of your greatest issues. It’s a common complaint of many pregnant women, no matter their age! Rest is essential to your health and to your baby’s. Rest and nap when possible. Don’t take on more tasks or new roles. Don’t volunteer for any big projects. Learn to say, “No.” You’ll feel better!
Moderate exercise can help boost energy levels and may ease some discomforts. However, check first with your healthcare provider before starting an exercise program.
Stress can also be a problem. Exercising, eating healthfully and getting as much rest as possible may help relieve stress. Take time for yourself.
Some women find that a pregnancy support group is an excellent way to deal with difficulties they may experience. Ask your healthcare provider for further information.
Through research, we know labor and delivery for an older woman may be different from a younger woman’s labor. Labor may last longer. Older women also have a higher rate of Cesarean deliveries. After baby’s birth, your uterus may not contract as quickly; postpartum bleeding may last longer and be heavier.
Pre-existing medical conditions are the most important indicator of a woman’s well-being during pregnancy and the health of her developing baby. Most women who become pregnant in their 30s and 40s are in good health. A woman in good physical condition who has been exercising regularly may go through pregnancy as easily as a woman 15 to 20 years younger.
Some health problems are age related—the risk of developing a condition increases with age. High blood pressure and some forms of diabetes are age related. These conditions can complicate a pregnancy and should be brought under control before pregnancy, if possible.
I’m 40 and just found out I’m pregnant. Am I considered high risk?
No, you are not high risk because of your age, although being pregnant at 40 is different from being pregnant at 20. You may do some things differently, such as have amniocentesis or seek genetic counseling. If you’re concerned about your risk, talk to your healthcare provider about it.
Age affects fertility, which begins to decline faster after age 35. Couples older than 35 may take twice as long to conceive a child as a younger couple. A woman older than 40 may take longer to conceive because of the declining number and quality of eggs in the ovaries and because ovulation is less frequent. The good news is that advances in fertility and reproductive technology have helped women conceive who might never have conceived before. Your healthcare provider can learn more about your ovulatory cycle by administering a test called the clomiphene challenge, which involves administering a drug to test the ovaries.
Other factors can affect fertility. One study showed drinking even one alcoholic beverage can lower a woman’s chances of getting pregnant. Caffeine can also affect a woman’s ability to conceive.
You may be advised to use a home ovulation-predictor kit, which can help confirm if and when ovulation occurs. A variety of over-the-counter tests are available. A kit works by measuring the increase or surge of luteinizing hormone (LH) in a woman’s urine. This hormone is made in the brain and promotes maturation of the ovarian follicle, resulting in ovulation. LH increases and can be detected 24 to 40 hours before ovulation. Kits range in price from $20 (a one-time-use test) to a few hundred dollars (kit can be used repeatedly).
Some older couples turn to assisted reproductive technology (ART) to achieve pregnancy. ART includes in-vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), in which a donor egg is paired to the partner’s sperm. Success relates to the woman’s age. For women at 34, the success of invitro fertilization is about 20% per menstrual cycle. At 44, a woman can expect a 5% success rate per cycle with the procedure.
As an older pregnant woman, you can take many positive steps to help ensure your pregnancy will go as smoothly as possible for you and your baby. Reading this book and our other pregnancy books can help you; see page ii for a current list of all the titles in our series.
If either you or your partner is older than 35, genetic counseling may be advisable. The risk of chromosome abnormalities exceeds 5% in this situation. For further information on genetic counseling, see Chapter 10.
Some researchers recommend men father children before they are 40. This is a conservative viewpoint, and not everyone agrees with it. More data and research are needed before we can make definite statements about a father’s age and its effect on pregnancy.
You will find many boxes in each weekly discussion that will provide you with information you will not find in the text. Our boxes do not repeat information contained in a discussion. Each box is unique, so read them for specific information.