In my periconception consultation service, I see many women who are usually considered “older” and who want to get pregnant. First, they want to know how to improve their chances of getting pregnant. But they also want to know what the possible risks are once they are pregnant.
"What is older? How old is old?"
There is no precise age beyond which a woman becomes more susceptible to pregnancy complications. The age of 35 years is often used as a cutoff point, especially if it’s the first pregnancy. But don't expect that you suddenly wake up at midnight of your 35th birth and your risk has suddenly changed. It’s a gradual process which accelerates around 35 years of age,
The good news is that most women who are older will get pregnant and deliver a healthy baby, though you should be aware of an increased risk of infertility and certain complications both to you and the baby once you get pregnant.
Getting pregnant as you get older becomes more difficult. As a woman reaches her late 30s and early 40s her biological clock starts ticking faster, and the risk of infertility and miscarriage significantly starts to rise. Studies have shown that infertility rates increase by about 3% for each year beyond 35.
In the United States, about one in 12 first-time babies are born to women over 35, but at our New York hospital, 1 in 3 first-time babies are born to mothers that age.
The number of pregnancies of American women giving births at age 35 or older has significantly increased over the last decades, partially because of an increase in the number of ‘baby-boomer’ women of childbearing age but also because of the help of reproductive technology. The rate of pregnancy complications increases steadily, affecting both mother and fetus or newborn.
Some of the increase in fetal and neonatal problems among women with a more mature age (I hate to use the words “older women”) is related to the fact that they are more likely to become pregnant with help of reproductive technology.
Babies conceived with IVF are more likely to have complications. That's mostly because after IVF there are more twins or triplets, and those pregnancies have an increased risk of complications such a preterm labor and delivery and an increased risk for cesarean section.
But even if it's one baby, there is an increased risk after IVF
Women over 35 have an increased risk of miscarriages mostly related to an increase in chromosomal anomalies among older women. A woman under 30 has a miscarriage risk of about 10 %, while woman over 40 has a 55% miscarriage risk.
The increase in the mother’s age increases the risk for fetal malformations and other chromosomal anomalies such as Down syndrome.
Pregnancy complications in more mature women are often related to preexisting medical problems, mostly high blood pressure and diabetes:
About 10% of women over 35 have high blood pressure before pregnancy, and it complicates 10 to 20 percent of pregnancies in women over 35. Hypertension may also worsen during pregnancy, further increasing the risks for mother and baby. High blood pressure poses some risks to mother and baby and includes problems with the placenta and with the growth of the fetus.
There is also a higher incidence of gestational as well as overt diabetes in older women than in younger women, although the exact cause is unknown. Women with diabetes are at greater risk for pregnancy loss and a condition in which a fetus grows too large (macrosomia), and they are more likely to give birth by cesarean delivery.
In addition to high blood pressure and diabetes, complications of the kidneys, heart, liver and other organs also increase with age and could make a pregnancy more at risk.
Increased pregnancy complications in older women
- Ectopic pregnancy
- Hypertension and Preeclampsia
- Congenital abnormality
- Heart Disease
- Chromosomal anomaly
- Kidney Problems
- Preterm labor and delivery
- Abruptio placentae
- Fetal growth restriction
- Placenta previa
- Cesarean section
- Maternal death
If you are older and become pregnant, you can expect that your doctor will probably monitor your pregnancy closer than that of a younger woman.
If you have a choice, see a doctor such as a maternal-fetal medicine (MFM) specialist who has experience with women of advanced age and high-risk pregnancies.
Ten Tips to improve your chances of a healthier pregnancy
- Have a periconception check-up: See your ObGyn or the MFM before pregnancy and get checked for medical and other conditions
- If you are at risk, get tested for diabetes before pregnancy or as soon as you find out that you are pregnant
- Have a mammogram if indicated before pregnancy
- Start taking prenatal vitamins and folic acid 2-3 months before you get pregnant
- If you take medications, make sure you switch to medications that are safe in pregnancy
- Stop smoking and drinking alcohol. Don’t use illicit drugs.
- Eat a healthy diet and exercise regularly
- Begin pregnancy at your optimal weight
- See your doctor as soon as you find out that you are pregnant
- Genetic counseling is advised for women who will be 35 or older when their baby is due
Though studies have shown that pregnant women with advanced age but without underlying chronic medical disorders do not appear to be at a significantly increased risk for many medically related pregnancy problems, they are still at risk for many other problems. Fortunately, many of these disorders are identifiable and can be successfully treated.
If you have a child in your late-30s or older you may be faced with issues other than just your and the baby’s health. It may take longer to become pregnant than you thought and there is an increase in pregnancy complications.
On the other hand, you may be more secure in your career and your relationship with your partner. You probably have more personal and financial resources, you feel sure that you are ready to have a child. and you feel more prepared to meet the demands of raising a child.
Your life will change when the baby arrives and you have to make choices to balance career and family and make room for the time the baby demands.