Many women are becoming pregnant later in life.
Providers use the term advanced maternal age
to describe a pregnancy in
a person greater than 35 years old.
If this term applies to you,
I'd to reassure you that with
good prenatal care you can have a completely normal,
healthy pregnancy and delivery.
It does mean that the risks for
certain complications during pregnancy are slightly
increased and it's important to know what
you can do to help minimize those risks.
Becoming pregnant can be more difficult after age 35 and
once you are pregnant there is
an increased risk of ectopic pregnancy,
miscarriage, and chromosomal abnormalities for the fetus.
Some studies have shown that
a miscarriage loss rate can be as
high as 40 percent for women
over age 35 and this increases to
greater than 60 percent for women older than age 40.
This information may be helpful to you as
you consider when you want to share
the news that you were pregnant with
others and also if you do
experience a loss to know it is not your fault.
The risk of the pregnancy having abnormal chromosomes
such as down syndrome is increased after age 35.
For example, at age 20 the risk of your fetus
having Down syndrome is about one and 1,500.
But at age 35 the risk of
your fetus having Down syndrome is about one and 350.
You will be offered
genetic screening and diagnostic tests
to help identify abnormal chromosomes if you desire.
For a more detailed explanation of
the options you will have for fetal chromosome testing,
please see our motherhood TV video on this topic.
Pregnancy can be thought of as
a stress test on your body.
As we age, the chances of
high blood pressure and diabetes go up in
general and when we're pregnant this
might manifest clinically for the first time.
As your pregnancy progresses,
you are at higher risk for
hypertensive diseases and pre-eclampsia,
increased risk of gestational diabetes,
and a slightly increased risk of
stillbirth when compared with younger women.
High blood pressure during pregnancy
for a woman who has never previously
had high blood pressure
is called gestational hypertension.
If the high blood pressure impacts
other organs such as the kidneys,
then the diagnosis might be pre-eclampsia.
If the blood pressure or end-organ impact is severe,
pre-term delivery may be necessary for your health.
Consistent prenatal care can help
protect women who develop these conditions by
catching these conditions early and
home blood pressure monitoring is often helpful.
Antenatal testing during the pregnancy and
sometimes induction of labor
before your due date may be recommended.
All women greater than 35 years old should be tested for
gestational diabetes
between 24 and 28 weeks of pregnancy.
The placenta secretes a hormone
that increases the chances of
diabetes in an effort to
ensure sufficient food for the fetus.
In older women or women with other risk factors,
this can actually lead to a dangerous excess
of glucose or sugar in the bloodstream,
impacting both the fetal and the maternal health.
Again, consistent prenatal care
and management can help minimize these effects.
Sometimes medication may be recommended and
home blood glucose monitoring is often helpful.
Antenatal testing during the pregnancy and often
induction of labor before
the due date may be recommended.
There is a small but increased risk of stillbirth,
especially for pregnant patients
greater than 40 years old.
A woman who is pregnant for
the first time after age 40 has an
approximately one in 116 risk of stillbirth.
Depending on your exact age and risk factors,
your provider may recommend antenatal testing and
possibly an early induction of labor
between 39 and 40 weeks of gestation.
One of the most important things you can do to ensure
a healthy pregnancy is to seek early prenatal care.
If possible, schedule a preconception appointment with
your primary care provider to
discuss your current medications,
health status, and if
any vaccines or genetic screening may be helpful.
Risk factors compound on each other.
So the healthier you're starting weight and
your baseline health is when you become pregnant,
the more likely you are to have a smooth pregnancy.
Discuss with your provider if you qualify to start
a low dose course of oral aspirin during your pregnancy.
This is especially important if you have
any other risk factors such as this is your first baby,
you have a BMI of greater than 30,
a family history of pre-eclampsia,
especially in your mother or your sister,
or a history of high blood pressure or diabetes,
auto-immune or renal disease,
a twin pregnancy, a triplet pregnancy,
or other socio-demographic factors.
As always, aim to start
a prenatal vitamin with folic acid at least 1-3
months before trying to become pregnant and
initiate a health routine for foods and exercise.
Regardless of your age,
we here at UC San Diego Health
are here to support you for a happy,
healthy, and enjoyable pregnancy.