During the last 40 years, there has been a 9-fold increase in women having pregnancies later in life.
Dr. Brian Brocato, assistant professor of obstetrics and gynecology in the division of maternal fetal medicine at the University of South Alabama College of Medicine, said advanced maternal age is a medical term that is given to a woman who is age 35 or older at the due date.
There are a lot of theories about why women are postponing pregnancy. “It could be because of education, career, or health,” Dr. Brocato said. “I think, too, that women are healthier during these years so there’s not a fear of pregnancy or a thought that it cannot be done.”
According to Dr. Brocato, there are definite benefits to having children at an older age – women are more likely to have a college degree and thus are more likely to be financially stable. There have also been studies showing that women who have pregnancies later in life may have a longer life expectancy.
As a woman ages, there are additional things to consider to ensure the healthiest outcomes for both mother and child. Miscarriages are more common in women who are 35 and older, and actually getting pregnancy can be more difficult because aging of the ovaries decreases fertility. Though the risk is small, the chance of having a baby with Down syndrome – a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21 – increases as a woman ages.
Dr. Brocato said the other thing to consider is that an older woman may likely have an older spouse. “When we look at the age of the father, we do see there are certain genetic conditions associated with this, and there is evidence these pregnancies may be at risk for children with autism spectrum disorders,” Dr. Brocato said. “One thing I want to be clear about, though, is that those things are still going to be very uncommon.”
Women who are older also may have chronic medical conditions, and Dr. Brocato said it's important to optimize any chronic medical conditions prior to conception. “A lot of times we start to discover between the ages of 30 and 40 that we have high blood pressure or diabetes,” he said. “We do see that when we add a chronic condition to older age, those folks may be at further risk for problems in pregnancy."
Dr. Brocato said there are some things you should expect during pregnancy if you are 35 or older:
• There will be a conversation with your doctor about age and pregnancy.
• Expect the evaluation of any chronic medical conditions.
• You may be referred to a maternal-fetal medicine specialist, which is a high-risk pregnancy expert specializing in the un-routine.
• You may need specialized/targeted ultrasounds.
• You may be screened for gestational diabetes early.
• You will be offered various tests for genetic disorders.
Screenings for genetic testing are broken up by trimester and are offered to all pregnant women. They are first-step tests (not genetic tests) that only speak in terms of risk. When you combine ultrasound with these screening tests, we will be able to detect Down syndrome at most 90 percent of the time. Ultrasound alone will only detect 50-60 percent.
On the other hand, genetic testing will tell you if a child has Down syndrome. All women, regardless of age, should have the option of invasive testing. “If they want to know beforehand or if we suspect Down syndrome, they have the option of testing,” Dr. Brocato said. As always, there are risks with invasive tests. However, these risks are generally quoted to be much less than 1 percent.
Dr. Brocato said that all women should optimize any chronic medical conditions prior to conception to ensure a healthy pregnancy. The most common conditions seen in women are high blood pressure, diabetes, thyroid dysfunction, mental health, seizures, and obesity.
Other ways to ensure a healthy pregnancy:
• Review all medications with your doctor before becoming pregnant.
• Exercise for 30 minutes daily.
• Take a multivitamin.
• Take folic acid – 400 mcg daily at least one month prior to pregnancy or 4000 mcg daily if you had a prior pregnancy that was affected by a neural tube defect such as spina bifida.
• Get your Immunizations – influenza and Tdap are not only safe, but also recommended during pregnancy. Hepatitis A/B and pneumococcal are also safe. Varicella, MMR, and inhaled flu vaccinations should NOT be given during pregnancy.
Dr. Brocato emphasized that you should first talk to your OB/GYN, and he/she will refer you to a specialist if needed. Those with chronic medical conditions, abnormal testing during pregnancy, abnormal ultrasound findings, development of pregnancy complications, and prior pregnancies with complications should expect to see a specialist during pregnancy.
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