What to Know When Expecting After 35
Before Hollie Barnett became pregnant, she and her husband, Adam, knew she would have to take extra precautions with her health to have a child after age 35.
Like thousands of other women who deliver their babies at or after 35, Hollie was considered to be of “advanced maternal age.” Each year, approximately 20 percent of all pregnancies occur in women in their mid-30s. And birth statistics suggest that this number is increasing as more and more women focus on their careers and choose to have children later in life.
Studies show that pregnancy outcomes are good for this age group, but there are some special considerations for both mother and baby. Early and routine prenatal care can provide a plan of action to closely monitor both mother and baby – and increase the chances of a healthy, happy experience for both mom and newborn.
By Susan Sawyer
Before You Become Pregnant
If you’re 35 or older, it’s best to optimize your health before becoming pregnant. Check with your primary care doctor to be sure your body is in the best shape it can be. Your obstetrician may also refer you to a maternal-fetal medicine specialist – either before your pregnancy or once you become pregnant – to discuss the increased risks of becoming pregnant after 35.
“When you decide to become pregnant, treat your body like a baby is already growing inside. Start taking a multivitamin and at least 400 µgrams of folic acid daily before you actually conceive,” advises Christian Briery, MD, maternal-fetal medicine specialist with Regional Obstetrical Consultants. “Try to begin pregnancy at a healthy weight, eliminate alcohol and tobacco, and decrease caffeine intake.”
Aware of the possible risks and complications associated with pregnancy after age 35, Hollie made every effort to get into good shape before becoming pregnant. “I worked out a lot and watched my diet,” explains the Chattanooga resident. “By the time I became pregnant, my doctor said I was in excellent health and at an ideal weight.”
Be Aware of the Risks
As always, making healthy eating choices, stopping smoking, and regular exercise during pregnancy are important to you and your future baby’s health. Moreover, talking with a maternal-fetal medicine specialist will help you better understand your risks not only with genetic concerns but also with other medical complications associated with being pregnant and older than 35.
“While most moms-to-be in this age group are healthy, some may encounter complications that could pose problems to the developing pregnancy,” Dr. Briery explains. “Maternal complications may include gestational diabetes, preeclampsia, and preterm birth. And miscarriage and cesarean section rates are higher in advanced maternal age patients.”
Infants born to women over 35 face increased risks, too, including prematurity, poor fetal growth due to maternal illnesses, and multiple gestations, such as twins and triplets. The rate of multifetal pregnancies (twins and triplets) is increasing in women over 35, but more women in this population are also seeking fertility treatments – which can increase the rate of multiple gestations.
“Some women may also have preexisting medical conditions such as diabetes, high blood pressure, or obesity, which can put a strain on a developing pregnancy and the mother when compared to healthy women over 35,” says Dr. Briery.
Throughout her pregnancy, Hollie made regular visits to her obstetrician, David Barker, MD, of OB/GYN Centre of Excellence. She also exercised regularly, ate healthy meals, and took daily doses of vitamins and folic acid. Dr. Barker also referred Hollie to Regional Obstetrical Consultants for ultrasound and chromosome testing, following standard procedure for high-risk pregnancies in women over 35.
One special consideration in mothers over 35 is an increased rate of fetal chromosomal abnormalities such as Trisomy 21 or Down syndrome, the most common chromosomal birth defect. Risks for fetal chromosomal abnormalities increase with age, regardless of how young a woman feels.
“At age 35, the risk of delivering a baby with any chromosome abnormality is approximately one per 192 pregnancies. Though this is less than a one percent risk, it’s significantly higher than the risk for a 25-year-old pregnant woman, at one per 476 pregnancies,” explains Dr. Briery.
Your obstetrician may offer you several noninvasive tests at different times during the pregnancy.
The first trimester screen combines a maternal blood test with an ultrasound evaluation of the fetus to identify risk for specific chromosomal abnormalities, including Down syndrome, Trisomy 21, and Trisomy 18. A portion of this test can also assist in identifying other significant fetal abnormalities, such as cardiac disorders.
The quadruple screen is performed between weeks 15 and 20. This simple blood test helps to assess probabilities of potential birth defects.
High-risk Labor and Delivery
The Barnetts also made plans for Hollie to deliver at the high-risk labor and delivery unit at the Erlanger Baroness Campus, a designated Level III Perinatal Center for both expectant mothers and infants. The Perinatal Unit has all the capabilities to care for mothers experiencing complications during pregnancy or recuperating from complications during labor and delivery.
“Erlanger provides mothers with immediate access to high-risk obstetricians who are specifically trained in maternal and fetal medicine,” explains Theresa McClure, Director of Women’s Services at Erlanger. “Mothers can receive 100 percent of their care here without having to be transported to another facility.”
Level III Neonatal Intensive Care Unit (NICU)
Just as important as treating expectant and new mothers, the Neonatal Intensive Care Unit (NICU) at T.C. Thompson Children’s Hospital takes care of the sickest and smallest newborns. The unit is a Level III NICU, the highest level assigned by the state of Tennessee and the highest level designated in our region. The 50-bed unit provides immediate access to pediatric and surgical sub-specialists, all backed by specially trained neonatologists, nurses, and neonatal nurse practitioners.
Healthy and Happy
After following doctor’s orders throughout her pregnancy, Hollie arrived at the high-risk labor and delivery unit at the Erlanger Baroness Campus three weeks before her anticipated due date. When Paul Brody Barnett arrived on August 1, 2007, the Barnetts were thrilled to welcome their son into the world at a healthy weight of 7 pounds, 4 ounces. “It was a reassuring feeling to be at Erlanger,” Hollie says, “because you know you’re in the best possible place to be for a high-risk pregnancy and delivery.”