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. Advances in infertility treatments, and the ability to save eggs makes it easier for women 40 and over to get pregnant.
Despite developments and improvements in our ability to take care of pregnancies of older mothers, the risk of advanced maternal age remains and becomes even riskier with multiples.
What are the risks of advanced maternal age?
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
- Preterm labor
- Gestational diabetes
- Thyroid disease
- Placental problems
- Prolonged labors
- Delivery problems
- Postpartum hemorrhage
- Blood clots, stroke
- Pulmonary embolism.
While the overall risk of death for mothers at any age is very low, this risk increases with advancing maternal age.
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 egg age increases over her lifetime.
For example, the risk of Down syndrome is 1 in 1480 at age 20, 1 in 353 at age 35, and 1 in 35 at age 45. Simply due to maternal age, there is an increased poor fetal growth and spontaneous preterm delivery.
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, run tests for diabetes and hypertension (these can be present without symptoms).
You can also perform carrier testing to learn if you may be a carrier of some genetic disease. However, as the egg quality deteriorates, there is no 100% certainty that the negative carrier testing will result in no defects in the fetus.
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, and the circulation through the placenta to the baby can decrease. This happens earlier in women who are over 35. It is often recommended to induce labor for delivery at 39 weeks.
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With a degenerating placenta, the fetus may not receive the nutrition and oxygen it needs to grow well and remain healthy. The fetus may seem fine but may not be able to tolerate the added stress of labor. In some cases the fetus may be stillborn.
An aging uterus also does not contract well. Older women have an increased risk of prolonged and ineffective labor, and needing a cesarean.
However, advanced maternal age does not have an effect on breastfeeding.
What are the pros and cons of waiting until older to have a baby?
Pros: more secure in career, more resources to help care for and raise a child.
Women who have children early in their careers have more difficulty advancing.
Cons: increased risk of significant illness injury, and preterm birth.
Although this is not often a conscious choice but dictated by life circumstances, I recommend women make a reproductive life plan and discuss the pros and cons of having a baby every year when they visit their doctor for a checkup.