Older Moms: Pregnancy After Age 35
Many women are delaying pregnancy for a number of reasons, from establishing careers and completing education to better birth control and better health. The average age of pregnancy today is 27. Fifty years ago, it was 21. Dr. Erin Brown, assistant professor, residency program director and department chair in Obstetrics and Gynecology at Oklahoma State University Medical School, says that women are considered “advanced maternal age” if they are age 35 or older at the time of delivery. She has seen more older patients, and more women delaying pregnancy among friends and colleagues, but women should know that it is not without risk.
“It’s safer to have a baby now than in the past,” Dr. Brown said, “but the risk is still there.”
Better technology, more data and better, more specific, medical interventions have all made it possible to give older moms and their babies the best possible outcomes. Older women are often more settled in careers and relationships, giving them more resources to care for a child. However, older moms need to be aware that they have a higher risk of problems with pregnancy and delivery.
What are the risks?
“Pregnancy risks to women over age 35 increase with age, in general,” Dr. Brown says, “but we’re able to delineate more exactly what is age-based risk or if individual patients have other conditions that contribute to risk.”
Some of the complications for women during pregnancy include gestational diabetes, hypertension, miscarriage, cesarean delivery and preeclampsia (a serious form of high blood pressure).
“As a mom develops hypertension or gestational diabetes, we have research and data to monitor her more closely,” Dr. Brown says. “For example, we may do fetal monitoring on a weekly basis.”
Women over 35 are at a higher risk of having a stillbirth, or labor and delivery complications such as postpartum hemorrhaging. Knowing the risks, doctors can plan the timing of delivery to improve the outcomes for mom and baby.
Other risks for older moms include birth defects, Down syndrome or other genetic abnormalities.
Because the complications for both moms and babies increase as mothers age, it is important for women to see their OB-GYN very early in pregnancy, even if they have had a healthy prior pregnancy. Doctors can discuss available tests and screenings that can help identify possible problems.
“Ultrasounds can find abnormalities,” Dr. Brown says. “Getting in early is really important. There is non-invasive testing for Down syndrome. We also do an anatomy scan in the second term that gives you an opportunity to pick up birth defects or abnormalities.”
Have a preconception appointment
All women can benefit from a preconception appointment, but it’s especially important for women over 35.
Women who are considering getting pregnant should have a health screening with their general practitioner to review medical history, surgical history and to help establish a healthy lifestyle prior to pregnancy.
“The primary care doctor can screen for any condition like diabetes, and also give recommendations for a healthy weight,” Dr. Brown says. “An OB-GYN can do a well-woman exam and counsel you on what to do.”
Dr. Brown encourages any woman anticipating pregnancy to start a prenatal vitamin with folic acid. Women should get to a healthy weight and make necessary lifestyle changes such as quitting smoking, alcohol or other drugs, and starting a healthy diet. She points out that obesity exacerbates problems such as diabetes and hypertension during pregnancy. Doctors can also do genetic testing for many conditions, including cystic fibrosis.
The bottom line
Dr. Brown says women should know the risks of pregnancy at an older age, and how those risks increase as women approach age 40 and older.
“If you are considering being pregnant over 35,” she says, “talk to your doctor. The overall risk is still low; it’s just an increased risk. Even if you’re healthy without preexisting conditions, you’re still at increased risk because of your age.”
Your doctor can educate you on potential problems, assess your individual risk and talk to you about screenings, tests and how various conditions and difficulties can be handled.
“People do need to know the risks of miscarriage, birth defects, chromosome problems and pregnancy complications such as hypertension and gestational diabetes as well as risks at the time of delivery,” Dr. Brown says. “If you are age 35 or older, your pregnancy will be monitored more closely. Get early prenatal care. There’s a lot we can do early, screen for and watch for.”