Many of today's women are delaying childbearing until later in life for a variety of reasons, including career choices, financial status, late marriage, and remarriage. In addition, successful treatment of previously infertile women over 40 is occurring. In fact, news reports indicate successful pregnancies in women over age 60.
While such extreme cases raise complex social, ethical, and medical issues, the fact of the matter is that more women over age 40 are choosing to start a new family or add to their present one. But what risks do these women incur? Let's examine the facts regarding pregnancy in this age group and strategies to reduce the risks.
Although women often have a healthy pregnancy later in life, there is a higher risk for pregnancy complications. These complications can be categorized as follows:
A higher risk of pregnancy complications can start as early as age 35. Nevertheless, proper preparation before pregnancy and early prenatal care can help assure the best chances of healthy outcomes.
Age 35 is not a clear line in the sand. Risks of genetic abnormalities and miscarriage rise progressively throughout a woman's reproductive years. This is because the woman's eggs age as she does.
Certain medical conditions occur more frequently in pregnant women over 40, including diabetes, high blood pressure, and thyroid disorders. Some of these conditions may not appear until pregnancy. If this is the case, they can be managed. In many cases, the condition will go away after the baby's birth.
Medical illnesses not related to pregnancy may be screened for, diagnosed, and treated in advance. In cases like these, treatment course can improve the chances of a healthy pregnancy and baby. Many of the medications used to treat these disorders can be safely used during pregnancy. If you currently take medication and you are planning a pregnancy, talk to your healthcare provider. A change in medication or an adjustment of dosage may be necessary.
If not properly treated, maternal illnesses can adversely affect the fetus. Uncontrolled high blood pressure can restrict fetal growth and in severe cases, can result in stillbirth. Undiagnosed diabetes can carry with it a higher risk of birth defects and stillbirth. In addition, poor blood sugar control during pregnancy can result in abnormally large fetus. Early prenatal care and judicious use of medication can lower these risks significantly.
It is an unfortunate fact that as a woman ages, a higher proportion of her aging eggs contain chromosomal abnormalities. Therefore, women who become pregnant after the age of 35, are at risk of having a child with a genetic defect. This risk increases with age. For instance, the likelihood of having a baby with Down's syndrome increases from nearly 1 in 700 in the general population to 1 in 353 at the age of 35. This number increases to 1 in 85 by the age of 40 and up to 1 in 35 at the age of 45.
Pregnancy loss is often seen in the first trimester and in many cases is due to genetic abnormalities of the fetus. Pregnancy loss also increases with advancing age. Below is the risk of miscarriage based on age:
|Age||Risk of miscarriage|
Note: Rate of miscarriage is for women without previous births. Risk of miscarriage increases further with previous miscarriage.
Complications of labor and delivery that are seen more frequently in women over age 40 include:
The rate of cesarean section is also considerably higher in this age group.
Although the risks associated with pregnancy after 40 are numerous and sometimes unavoidable, there are several strategies that women over 40 can use to reduce these risks.
First and foremost, make an appointment to see your healthcare provider before you get pregnant. This preconception visit will give your healthcare provider the opportunity to diagnose and treat any disorders that might otherwise go undetected prior to the initial prenatal visit.
A thorough evaluation prior to pregnancy will allow your healthcare provider to give you an idea of your individual risk. There may be cases in which pregnancy will be ill-advised. However, for the majority of women over age 40, early prenatal care and good health habits will result in a healthy baby and a happy mother.
The idea is to be as healthy as you can before you get pregnant. Here are some tips:
If you are concerned about the risk of genetic defects, especially if you have a family history, ask your healthcare provider about tests that can help identify these types of problems. Blood tests are available to screen for some genetic disorders either before or during pregnancy. A triple screen or quad screen blood test may be obtained to evaluate the risk of neural tube defects and Down syndrome.
Genetic amniocentesis (or chorionic villus sampling) is offered to women after the age of 35. Amniocentesis is usually done in the third or fourth month of pregnancy and involves removal of amniotic fluid from the womb for genetic testing. There is a small risk of miscarriage associated with this test.
Chorionic villus sampling can be done earlier in pregnancy and involves the removal of a small amount of placental tissue, which can then be tested for genetic abnormalities. There is also the risk of miscarriage with this test. Discuss the risks and benefits of these tests with your healthcare provider early on so that you will have ample time to make an informed decision.
Family Doctor—American Academy of Family Physicians
The American Congress of Obstetricians and Gynecologists
The Canadian Women's Health Network
Women's Health Matters
Amniocentesis. American Pregnancy Association website. Available at: http://americanpregnancy.org/prenatal-testing/amniocentesis. Updated September 2, 2016. Accessed May 9, 2017.
Chorionic villi sampling: CVS. American Pregnancy Association website. Available at: http://americanpregnancy.org/prenatal-testing/chorionic-villus-sampling. Updated September 2, 2016. Accessed May 9, 2017.
Down syndrome. March of Dimes website. Available at: http://www.marchofdimes.org/baby/down-syndrome.aspx. Updated October 2016. Accessed May 9, 2017.
First trimester pregnancy loss. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113658/First-trimester-pregnancy-loss. Updated March 17, 2017. Accessed May 9, 2017.
Nybo Anderson AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ.2000;320(7521):1708-1712.
Planning for pregnancy. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/preconception/planning.html. Updated February 13, 2017. Accessed May 9, 2017.
Pregnancy after 35. March of Dimes website. Available at: http://www.marchofdimes.org/complications/pregnancy-after-age-35.aspx. Updated April 2016. Accessed May 9, 2017.
Routine prenatal care. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114252/Routine-prenatal-care. Updated March 17, 2017. Accessed May 9, 2017.
World Down syndrome day. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncbddd/birthdefects/features/downsyndromeworldday-2013.html. Updated March 11, 2015. Accessed May 9, 2017.
8/26/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T113658/First-trimester-pregnancy-loss: Gaskins AJ, Rich-Edwards JW, Hauser R, et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstet Gynecol. 2014;124(1):23-31.
Last reviewed May 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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