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Advanced Maternal Age: What You Need to Know About Getting Pregnant After 35

Motherhood at any age is never risk-free. Seeing your doctor and going to all of your prenatal care visits helps most mothers have a safe and healthy outcome for their pregnancy. It is important to know that having a baby at an older age increases the risks for both mother and baby.

Cynthia DeTata - obstetrician at Stanford Health Care - tells about the possible complications.

A woman pregnant after 35

What is considered advanced maternal age?

Age 35 is a starting point for advanced maternal age.  

For many reasons, women may delay having a baby to an older age, and this is becoming more popular. Celebrity stories in the media can make it seem common and easy to have a baby after 35 or even many years later. Advances in infertility treatments, and the ability to save eggs and embryos make it easier for women 40 and over to get pregnant.  

Despite developments and improvements in our ability to take care of older pregnant mothers, the risk of advanced maternal age remains and becomes even riskier as age increases, and with multiple pregnancies, which can be common after infertility treatments.

What are the risks of advanced maternal age?

Risks for the mother

Older mothers are more likely to have chronic diseases such as high blood pressure, diabetes and thyroid disease. Even when the mother is healthy prior to pregnancy, the physical stress of pregnancy can make pregnancy problems more common.  

Older mothers have an increased risk of the following issues:

  • Ectopic pregnancy
  • Miscarriage
  • Hypertension of pregnancy and preeclampsia
  • Anemia
  • Preterm labor
  • Hypertension
  • Gestational diabetes
  • Thyroid disease
  • Placental problems
  • Prolonged labors
  • Delivery problems
  • Postpartum hemorrhage
  • Blood clots, stroke
  • Pulmonary embolism
  • Cardiac problems such as myocardial infarction and cardiomyopathy 

While the overall risk of death for mothers at any age is very low, this risk increases with advancing maternal age.

Fetus

There is an increased risk of genetic problems due to aging of the eggs. While men continuously make sperm, a woman is born with all of her eggs, so the age of her eggs increases over her lifetime. 

Embryos from older eggs have an increased risk of genetic problems, particularly chromosomal problems as they develop.For example, the risk of Down syndrome, a chromosomal problem, is 1 in 1480 at age 20, 1 in 353 at age 35, and 1 in 35 at age 45. Prenatal screening and diagnostic testing for women at older ages is done differently than for younger women.  

Older women are more likely to have poor blood circulation to their placenta which can lead to poor fetal growth, low fluid, spontaneous preterm delivery and stillbirth. 

Older mothers also are at increased risks for illnesses that can affect the growth of their baby such as preeclampsia or gestational diabetes. 

At times, problems with the fetus or the mother may make it necessary to have an early delivery, also increasing the risk of having a premature baby. There is also an increased risk of miscarriage and stillbirth.

How to prepare for pregnancy at advanced maternal age?

It’s time to get into your best shape! Get down to the healthiest weight possible, exercise, eat a healthy diet, and alleviate unnecessary stress.   

See your doctor for a checkup. They can run tests for diabetes, thyroid disease and hypertension. It is best to test for these diseases before getting pregnant, as they may be present without any symptoms. Be sure to tell your doctor that you are trying to get pregnant, so that any medicines they give you to treat problems are medicines that are safe for your baby.  

You should make sure that you are immune to diseases that can affect a growing baby, such as varicella and rubella.  While some vaccines can be given safely during pregnancy, the vaccines for varicella and rubella should not be given to pregnant mothers. It is best to check your immunity before trying to conceive so that you can get these vaccines before becoming pregnant. 

You can also perform genetic testing to learn if you or your partner may be a carrier of some genetic disease. Even if the carrier testing is negative, your baby might still be at risk of genetic problems due to the age of both mother and father.

How does advanced maternal age affect the management of labor and delivery?

As a pregnant woman nears her due date, her placenta starts to degenerate. This means that the blood vessels age and the circulation through the placenta to the baby can decrease. With a degenerating placenta, the fetus may not receive the nutrition and oxygen it needs to grow well and remain healthy. 

This happens earlier in women who are over 35 in comparison to younger women. Becasue of this accelerated aging of the placenta, doctors often recommend inducing labor for delivery at 39 weeks.  

Older mothers are at increased risk for needing a cesarean delivery. An aging uterus does not contract well. Older women more commonly have prolonged and ineffective labor. 

With an aging placenta, the fetus may have some decreased circulation that becomes noticeable with the added stress of labor. Babies of older moms are more likely to have abnormal heart rate tracings that make delivery by cesarean safer than continuing to labor.

Fortunately, advanced maternal age does not have an effect on breastfeeding. Older mothers are able to breastfeed as well as younger mothers, and may even more likely to breastfeed longer. 

What are the pros and cons of waiting until older to have a baby? 

Pros: Older mothers are more secure in their careers, may be in better financial shape, and have more resources to help care for and raise a child. 

Women who have children early in their careers have more difficulty advancing due time away to have their baby. 

Cons: Already described earlier in this article.  It is important to recognize that seeing a doctor before deciding to get pregnant and having good prenatal care help reduce risks and make it more likely that older mothers will have a safe pregnancy ending with a healthy mother and baby.  

Summing up

Having a baby at a younger or older age is not often a conscious choice but dictated by life circumstances. 

I recommend that all women consider whether or not to have a baby and make a reproductive life plan. It is good to discuss pregnancy plans every year when visiting their doctor for a checkup.

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