What to Know About Pregnancies After 35
Opportunities for education, travel and career advancement are factors for young women today in deciding to postpone having children into their 30s and beyond. the good news is medical science is helping women over age 35 fulfill their dreams of a family. However, understanding the issues of pregnancy later in life can help equip women to make decisions that will ensure happy and healthy outcomes.
By Marcia Swearingen
Dr. Steven Wolf at Life Circle Women’s Healthcare in Cleveland, Tenn., says 40 percent of his practice involves pregnant women in their 30s and 40s. “That number is increasing,” Wolf says, “and will probably continue to increase.”
The latest statistics from the Centers for Disease Control and Prevention confirm this trend. While the most recent U.S. birth rates fell for teen mothers and women in their 20s and 30s, the birth rate for women in their 40s rose 4 percent.
Conception after age 35
Women usually have some decrease in fertility starting in their early 30s. Midlife changes in hormones can cause a woman to ovulate less frequently, even if she is still having regular periods. Certain medical and gynecological conditions, such as endometriosis, can also interfere with conception. Men also may have some decrease in fertility starting in their late 30s. None of this means pregnancy is impossible – it just may take longer.
A woman over age 35 should consult her health care provider if she has not conceived after six months of trying. Research suggests that about one-third of women between the ages of 35 and 39 and about half of those over age 40 have fertility problems.
“Everybody’s going to school longer and that delays things, careers delay things, people remarry – there are lots of reasons why people have babies later in life,” says Dr. Del Ashcraft of Chattanooga Women’s Specialists.
“I do see people who wait and then, all of a sudden, they really get serious about it around 40 or 42,” he continues. “They start counting days and doing ovulation kits to try to conceive and finally come in to me when they are 44. I send them to the infertility specialists and they say, ‘I’d really like to have seen you a couple of years before.’ The (patient) success rate, their numbers and their response to the medicines, go down pretty drastically after 42 to 44. It’s much better if I can get them referred out there sooner rather than later.”
The good news is that many fertility problems can be treated successfully. Tina Smith, marketing director at The Fertility Center in Chattanooga, understands the struggle of infertility and the options available to women today. She and her husband conceived their son through in vitro fertilization.
“For some women, it’s as simple as taking an oral medication, getting her cycles on track, and timing intercourse,” says Smith. “If the wife is unable to produce quality eggs or the husband has a low sperm count, in vitro fertilization (IVF) may be the answer. This process involves taking injectable medications that cause the woman’s body to overproduce eggs. These eggs are then collected, fertilized with the husband’s sperm in the laboratory, and inserted into her womb. Sometimes IVF must be repeated several times to achieve success. Sometimes women in their 40s choose to use donor eggs from a younger woman fertilized with their husband’s sperm because they can achieve a 70 percent success rate versus using their own eggs with only a 10 percent chance of pregnancy.”
Pregnancy Risks After 35
Doctors recommend that women over age 35 who are hoping to become pregnant consult with their health care providers before conception to help achieve the best outcomes.
“The older mother has a higher risk for most of the problems we see in pregnancy: gestational diabetes, increased risk of growth problems in the baby (as far as not keeping up with normal growth patterns), and an increased risk of high blood pressure,” says Wolf. “It doesn’t mean they can’t get pregnant, it’s just that the risks are higher and we keep a little bit closer eye throughout the pregnancy. The majority of them are healthy outcomes – we just do some additional surveillance.”
Studies suggest that women over age 35 are about twice as likely as younger women to develop gestational diabetes. If untreated, this condition can cause a baby to grow too large, which increases the risk of injuries during delivery.
Additionally, a woman’s risk of having a baby with certain chromosomal birth defects increases with age. Down syndrome is the most common chromosomal birth defect.
The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant women be offered a screening test for Down syndrome and certain other chromosomal birth defects. Screening tests are blood tests done in the first or second trimester, sometimes with a special ultrasound, to help evaluate a woman’s risk for having a baby with certain birth defects.
The ACOG also recommends that all pregnant women have the option of choosing a diagnostic test, such as amniocentesis or chorionic villus sampling (CVS). Amniocentesis and CVS are highly accurate in diagnosing or ruling out a birth defect, but these tests may pose a very small risk of miscarriage.
“I wouldn’t discourage anyone from attempting pregnancy later on in life – I think moms in their 30s and 40s make great new mothers,” says Ashcraft. “There are some advantages to being better established and having a better financial standing before you start childbearing. However, it does entail some additional testing and observation throughout the pregnancy to make sure things are going well. Women who are planning a pregnancy should have a consultation with their OB/GYN to look out for issues that may be specific to them before they attempt pregnancy.
“We do preliminary counseling where we share the statistics relative to older women, and then look at the medications they are taking to make sure the medicines are safe or if there are some things we can switch,” Ashcraft continues. “If they have diabetes and it’s not under control, the first thing we need to do is to get that under control before they conceive. If their blood pressure or their thyroid is not under control, all of those things can aggravate a normal healthy pregnancy and make it more difficult for the patient and the baby.
“Prenatal care is probably the most important thing because everything that is formed forms within the first 10 to 12 weeks, and the rest of the pregnancy is just getting bigger,” Ashcraft explains. “All the critical steps happen before most women realize they’ve missed a couple of periods. I don’t want them to stay home until they’re three months pregnant – some medications for thyroid and blood pressure can be harmful for the developing fetus, as well as high blood sugar.”
Women of all ages can improve their chances of having a healthy pregnancy by making healthy lifestyle choices, including:
• Get a preconception checkup with a health care provider.
• Get early and regular prenatal care.
• Take a multivitamin containing 400 micrograms of folic acid daily, starting before pregnancy and in early pregnancy, to help prevent neural tube defects.
• Limit caffeine consumption.
• Eat healthy foods.
• Exercise regularly.
• Don’t drink alcohol.
• Don’t smoke during pregnancy.
Tina Smith offers words of encouragement to those on the journey to parenthood later in life: “I feel that I am probably a better mom than I would have been 10 years ago. We are more financially set. I often feel my husband and I were more connected. Our marriage was stronger when the kids came along.
“There is an upside that comes from having children later in life,” Smith says. “It’s not what we planned – I didn’t have an infertility book in my hope chest. It’s not the path I expected that we would go down, but it’s always extraordinary to me when you’ve gone through a rough time, to then look back and see the good that came out of it. There are still blessings and surprises.”