Later Childbearing

Today, more and more couples are starting families later in life.  Most women over age 35 have healthy pregnancies and healthy babies.  There is not set age that is unsafe for women to become pregnant.  There are some things to think about, though, to help your pregnancy go more smoothly. 

 

 

    

FERTILITY

     With the current interest in health, nutrition, and fitness, many people find themselves in better shape than they were at a younger age.  Also, medical advances have opened the door for women to have safer pregnancies in their 30s and 40s.  Even so, some questions arise for these women.  They may have concerns about whether their age will affect their ability to become pregnant, their health, and the health of their baby.  There is no precise age at which you become less fertile.  All women have some decrease in fertility, though, starting in the early 30s.  Men also have decrease in fertility as they age.  One reason that women may become less fertile is that ovulation, the release of an egg from one of the ovaries, occurs less as a woman ages.  It also may be that an older woman's eggs are not as easily fertilized as a younger woman's.  Also, problems such as blocked tubes and endometriosis are more common in older women.  These are only some of the causes of infertility.  If you are in your mid-30s or older and are concerned about your fertility, or if you have not conceived after 6 months of having sex without any form of birth control, you may want to talk to your doctor.

 

 

HEALTH PROBLEMS

     Certain medical and obstetric problems occur more often as women age.  You should be aware of problems that can arise so that special care can be given if it is needed.  Talk with your doctor about any risks that concern you.  Some women have conditions-such as high blood pressure or diabetes-that are present before pregnancy.  Because pregnancy puts new demands on a woman's body, the risk of complications during pregnancy is higher for these women.  They are more likely to need more frequent office visits, to stay in the hospital before the birth of the baby, and to have special tests.  About 10% of women over 35 have high blood pressure.  high blood pressure poses some risks to mother and baby.  They include problems with the placenta and with the growth  of the fetus.  High blood pressure also may worsen during pregnancy.  This increases the risks for mother and baby. 

     Women aged 35 and over also are more likely to have diabetes or to develop gestational (during pregnancy) diabetes.  Women with diabetes are at greater risk for high blood pressure, pregnancy loss, and a condition in which a fetus grows too large (macrosomia).  Women with diabetes need special care during pregnancy.  They are more likely to give birth  by cesarean delivery.  Miscarriage-loss of pregnancy before 20 weeks-occurs 15-20% of all pregnancies.  It is often the body's way of dealing with a pregnancy that was not growing or developing normally.  It is more common in older women.  Stillbirth-delivery of a baby that has died before birth-occurs more often in women over the age of 35 than in women aged 20-35.  Older women also are more likely to have infants of low birth weight (weighing less than 5 1/2 pounds).  Cesarean delivery also is slightly more common for women  having their first child after age 35.   It is more common with the first births than later births. though, no matter the mother's age. 

     Doctors rely on personal and family medical history, physical exams, and special procedures and tests to help find those pregnant women who are more likely to have problems.  In most cases, couples with risk factors have normal, healthy children.  They need to be well informed about their risks and discuss their plans and any known problems with their doctor.  That way, proper care can be given.

 

 

BEING PREPARED

     Being prepared for pregnancy is the best way for couples of all ages to improve their chances of having a baby.  Older couples may have special concerns about a healthy pregnancy.  Advances in medicine, along with good care during pregnancy, can help them assess their situation and get the best care they can. 

 

 

PRECONCEPTION AND PRENATAL CARE

     Good health care before you become pregnant-sometimes called preconception care-will help you throughout your pregnancy.  Preconception care provides a chance to find any risks and to treat any medical problems you may have.  Your doctor may make suggestions for any special needs you may have.  Medical problems such as high blood pressure and diabetes should be under control before a woman becomes pregnant.  Many women do not know they are pregnant until a few weeks after they have conceived.  These early weeks are some of the most important for the baby.  It is during this time that the organs are formed.  Cigarettes, alcohol, and other drugs can interfere with normal growth, whereas good nutrition and healthy habits can help promote it.  Early and regular prenatal care-care before the baby is born-may increase a woman's chance of having a healthy baby.  If you have any medical problems or a family history of genetic defects that might affect your baby, they should be found early.  If you start prenatal care early and visit your doctor regularly, many problems can be prevented or controlled.

 

 

GENETIC COUNSELING

     Genetic counseling is advised for women who will be 35 or older when their baby is due, couples who have already had a child with a birth defect, and couples with a family history of genetic problems, birth defects, or mental retardation.  If your doctor feels that your chance of having a child with a birth defect is greater than average, he or she may advise genetic counseling.  This allows you to assess your risks and make an informed choice about having a child.  Counseling is done by doctors, nurses, or health educators with special training in genetics.  Genetic counseling involves a detailed family history and sometimes a physical exam along with lab tests.  The result of the history and tests help the counselor find out the couple's chances of having a baby with a birth defect.  They also can help to show a pattern of inherited genetic disorders, if one exists.

 

 

TESTING

A number of tests can help detect disorders before, during, and after the pregnancy.  Advances in medicine have made having a child safer.  Because older women are more likely to have certain problems, they are more likely to have tests to detect them.  Testing for genetic problems is offered to women who will be 35 or older when their baby is due.  You will want to discuss with your doctor the pros and cons of having these tests done:

Amniocentesis- In amniocentesis, a small sample of amniotic fluid (the fluid in the sac that surrounds the fetus) is withdrawn from the mother's uterus for testing.  This procedure can help detect certain birth defects in the fetus during pregnancy, such as Down syndrome and many other genetic conditions.  Amniocentesis is usually done at 16-18 weeks of pregnancy.  It may be done even earlier in some cases.

Chorionic villus sampling (CVS)-With CVS, a small sample of cells is taken from the placenta.  It is tested in a lab for abnormalities.  CVS is done earlier in pregnancy than amniocentesis.

 

 

PERSONAL ISSUES

      A woman having her first child in her mid-30s or older may be faced with issues besides her health and that of her child.  She may be used to having control of her life.  But complete control of a pregnancy is not possible.  It may take longer to become pregnant than she thought.  When the baby arrives, her life will change.  She will have to make choices to balance career and family and make room for the time the baby demands.  On the other hand, an older woman may feel sure that she is ready to have a child.  She may be secure in her career, have more personal and financial resources, and feel more prepared to meet the demands of raising a child. 

 

FINALLY...

      Most women have healthy pregnancies and normal babies.  Many older women show no greater signs of problems than younger women.  If you want to have a baby, discuss any concerns you might have with your doctor.  Pregnancy and childbirth can be exciting, rewarding events.  Age need not be a barrier to a safe, healthy pregnancy.

 

 

 

ACOG PATIENT EDUCATION