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Being Pregnant After 35
Being 35 and over is commonly associated with a higher chance of having a child with altered DNA. These changes are unpredictable and can't be prevented. With each passing year, the odds of a problem increase. A 35-year-old woman has a 199/200 chance of having a healthy baby. Therefore, on closer examination, the risk and benefits are equal. For this reason, there is a barrier at 35 years of age. The table will give you an idea of the gradual increased risk of having a baby with a chromosome problem.
Except for the health issues and the DNA, women over 35 do quite well. But remember that it is so important to speak with your doctor about your specific health concerns, especially if you are considering pregnancy. Since the late 1970s, birth rates for women in their late 30s and 40s have increased dramatically. According to the National Center for Health Statistics, between 1978 and 2000, the birth rates for women age 35 to 39 and 40 to 44 more than doubled. How much does age affect fertility? Women generally have some decrease in fertility starting in their early 30s. It is not unusual for a woman in her mid-30s or older to take longer to conceive than a younger woman. Age-related declines in fertility may be due, in part, to less frequent ovulation or to problems such as endometriosis, in which tissue similar to that lining the uterus attaches to the ovaries or fallopian tubes and interferes with conception. While women over age 35 may have more difficulty conceiving, they also have a greater chance of bearing twins. The likelihood of naturally conceived (without fertility treatment) twins peaks between ages 35 and 39. How do pre-existing health problems affect pregnancy? At any age, a woman should consult her health care provider before trying to conceive. A preconception visit helps ensure that she is in the best possible physical condition before conception. It is especially important if a woman has a chronic health problem, such as diabetes or high blood pressure. These conditions, which are much more common in women in their late 30s and 40s than in younger women, can endanger the pregnant woman and her developing baby. Careful medical monitoring and appropriate choice of medications, started before conception and continued throughout pregnancy, can reduce the risks associated with these conditions and, in most cases, result in a healthy pregnancy. With early diagnosis and proper treatment, these disorders usually do not pose a major risk to mother or baby. The risk of birth defects The risk of bearing a child with certain chromosomal disorders rises with age. The most common of these disorders is Down syndrome, a combination of mental retardation and physical abnormalities caused by the presence of an extra chromosome 21 (humans have 23 pairs of chromosomes). At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 30, a 1-in-1,000 chance; at age 35, a 1-in-400 chance; at age 40, a 1-in-100 chance; and at 45, a 1-in-30 chance. About 95 percent of women who undergo prenatal testing receive the reassuring news that their baby does not have one of these disorders. If prenatal testing rules out chromosomal defects and the mother is healthy, the baby probably is at no greater risk of birth defects. What is the risk of miscarriage as a woman gets older? Most miscarriages occur in the first trimester for women of all ages. The rate of miscarriage in older women is significantly greater than that in younger women. The risk rose to about 20 percent at age 35 to 39, and more than 50 percent by age 42. The increased incidence of chromosomal abnormalities contributes to the age related risk of miscarriage. Women over 35 have an increased risk of placental problems. The most common placental problem is placenta previa, in which the placenta covers part or all of the opening of the cervix. Placenta previa can cause severe bleeding during delivery, which can endanger mother and baby, but complications often can be prevented with a cesarean delivery. Some studies show that women having their first baby at age 35 or older are at increased risk of having a baby who is low birthweight (less than 51/2 pounds) or premature (born at less than 37 full weeks of pregnancy). These risks appear to rise modestly but progressively with a woman's age, even if she does not have age-related constant health problems such as diabetes and high blood pressure. The newborns of mothers in their 40s may suffer more complications (such as asphyxia and brain bleeds) than those of younger mothers. However, in spite of the increased risk of complications, there were no more deaths among babies of older mothers, and the vast majority of babies recovered and did fine. Pregnant women who are 35 or older face some special risks, but many of these risks can be managed successfully with good prenatal care. It is important to keep in mind that the increased risk, even for the oldest women, is modest. Problems in labor and delivery First-time mothers over 35 are more likely than women in their 20s to have difficulties in labor. Studies suggest that fetal distress and a prolonged second stage of labor are more common in older mothers. This may account, in part, for the increased rate of cesarean sections among women over 35. Studies have reported that first-time mothers over age 35 have about a 40 percent chance of a c-section, compared to about a 14 percent risk for first-time mothers in their 20s. How can you reduce risks? Some basic rules for a healthy pregnancy for women in their late 30s and 40s: • Eat a variety of nutritious foods, including foods containing folic acid, like fortified breakfast cereals, enriched grain products, leafy green vegetables, oranges and orange juice and peanuts. • Plan for pregnancy by seeing a health care provider before you conceive. Medical conditions, medications and immunizations can be reviewed at this time. • Take a multivitamin containing 400 micrograms of folic acid daily before you become pregnant and through the first month of pregnancy to help prevent neural tube defects. Get early and regular prenatal care. • Begin pregnancy at a healthy weight (not too heavy or too thin). Stop drinking alcohol before you try to conceive, and continue to avoid alcohol during pregnancy. • Don't smoke during pregnancy and avoid secondhand smoke. It's best to quit before you become pregnant. • Don't use any drug, even over-the-counter medications or herbal preparations, unless recommended by a health care provider who knows you are pregnant.
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