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Snouter

10-16-2001, 01:16 AM

From http://www.noah-health.org/

Most women over age 35 have healthy pregnancies and healthy babies. However, recent studies suggest that women who postpone childbearing do face some special risks. Since the late 1970s, birth rates for women in their late 30s and 40s have increased dramatically. According to the National Center for Health Statistics, between 1978 and 1997, the birth rate rose 90 percent for women age 35 to 39. Between 1981 and 1997, the rate increased 87 percent for women in their 40s. Advances in medical care now help women in their late 30s and 40s have safer pregnancies than in the past. However, women should be aware of the risks associated with delayed childbearing so that they can make informed decisions on when to start their families.

Women generally have some decrease in fertility starting in their early 30s. It is not unusual for a woman in her mid-30s or older to take longer to conceive than a younger woman. Age-related declines in fertility may be due, in part, to less frequent ovulation, or to problems such as endometriosis, in which tissue similar to that lining the uterus attaches to the ovaries or fallopian tubes and interferes with conception. If conception has not taken place after six months of trying, a woman should consult her physician. Many cases of infertility can be treated successfully. While women over age 35 may have more difficulty conceiving, they also have a greater chance of bearing twins. The likelihood of twins peaks between ages 35 and 39, then declines.

At any age, a woman should consult her health care provider before attempting to conceive. A preconception visit helps ensure that she is in the best possible condition before she conceives. This visit is a good time to discuss with a health care provider concerns a woman and her partner may have about a pregnancy. A preconception visit is especially important if a woman has a chronic health problem, such as diabetes or high blood pressure. These conditions, which are much more common in women in their late 30s and 40s than in younger women, can endanger the pregnant woman and her developing baby. But careful medical monitoring, begun before conception and continued throughout pregnancy, can reduce the risks associated with these conditions and, in most cases, result in a healthy pregnancy. High blood pressure and diabetes also can develop for the first time during pregnancy, and women over 35 are at increased risk. A 1990 study from Mount Sinai School of Medicine in New York City found that women over 35 develop high blood pressure and diabetes during pregnancy twice as often as women in their 20s. A 1996 Mount Sinai study found that women age 40 and older were almost three times as likely to develop diabetes, and almost twice as likely to develop high blood pressure as women in their 20s. Similarly, a 1999 study at the University of California at Davis found that first-time mothers over age 40 were 60 percent more likely to develop high blood pressure and four times more likely to develop diabetes during pregnancy than mothers in their 20s. This makes it especially important that older mothers get early and regular prenatal care. With early diagnosis and proper treatment, these disorders usually do not pose a major risk to mother or baby.

The risk of bearing a child with certain chromosomal disorders increases as a woman ages. The most common of these disorders is Down syndrome, a combination of mental retardation and physical abnormalities caused by the presence of an extra chromosome 21 (humans have 23 pairs of chromosomes). At age 25, a woman has a 1-in-1250 chance of having a baby with Down syndrome; at age 30, a 1-in-952 chance; at age 35, a 1-in-378 chance; at age 40, a 1-in-106 chance; and at 45, a 1-in-30 chance. Most doctors offer pregnant women who are 35 or older the option of prenatal testing (with amniocentesis or chorionic villus sampling) to diagnose or, more likely, rule out Down syndrome and other chromosomal abnormalities. About 95 percent of women who undergo prenatal testing receive the reassuring news that their baby does not have one of these disorders. If prenatal testing rules out chromosomal defects and the mother is healthy, the baby is at no greater risk of birth defects than if the mother were in her 20s.

Most miscarriages occur in the first trimester for women of all ages. The rate of miscarriage in older women is significantly greater than that in younger women. Studies estimate that this risk is about 12 to 15 percent of recognized pregnancies for women in their 20s and rises to about 25 percent at age 40. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.

While women in their late 30s and 40s are very likely to have a healthy baby, they do face more complications along the way. Besides the increased risk of diabetes and high blood pressure, women over 35 have an increased risk of placental problems. The most common placental problem is placenta previa, in which the placenta covers part or all of the opening of the cervix. The University of California at Davis study found that first-time mothers over age 40 were up to 8 times as likely as women in their 20s to have this complication. Placenta previa can cause severe bleeding during delivery, which can endanger mother and baby, but complications often can be prevented with a cesarean delivery. Some studies suggest that women who delay having their first baby until age 35 or older are at increased risk of having a baby who is low birthweight (less than 5 1/2 pounds) or premature (born at less than 37 full weeks of pregnancy). And these risks rise modestly but progressively with a woman’s age, even if she does not have age-related chronic health problems such as diabetes and high blood pressure. While a 1997 Canadian study found that women over age 35 were significantly more likely to experience stillbirth than women in their 20s, this was not the case in either of the Mount Sinai studies, even in women over 40. Most of the fetal deaths in the Canadian study were due to unexplained causes. The newborns of mothers in their 40s may suffer more complications (such as asphyxia and brain bleeds) than those of younger mothers, according to the University of California at Davis study. However, in spite of the increased risk of complications, there were no more deaths among babies of older mothers, and the vast majority of babies recovered and did fine. Pregnant women who are 35 or older face some special risks, but many of these risks can be managed effectively with good prenatal care. And it’s important to keep in mind that the increased risk, even for the oldest women, is modest.

First-time mothers over 35 are more likely than women in their 20s to have difficulties in labor. Studies suggest that fetal distress and a prolonged second stage of labor are more common in older mothers. This may account, in part, for the increased rate of cesarean sections among women over 35. First-time mothers over age 40 have the highest risk of c-section, 47 percent, according to the University of California study. Similarly, other studies have reported that first-time mothers over age 35 have about a 40 percent risk of a c-section, compared to about a 14 percent risk for first-time mothers in their 20s.

Today, women in their late 30s and 40s who have postponed pregnancy are generally in excellent health, and can look forward to healthy pregnancies. However, along with the special concerns about pregnancy past age 35, it’s important to take into account childbearing risks that apply to all women. It is especially important for women over age 35 to follow the basic rules for a healthy pregnancy

Take a multivitamin containing 400 micrograms of the B vitamin folic acid daily before and early in pregnancy to help prevent certain birth defects of the brain and spinal cord. (This applies to all women of childbearing age.)
Have a pre-pregnancy medical checkup and obtain early and regular prenatal care during pregnancy.
Eat a healthy diet, including foods rich in folic acid such as fortified breakfast cereals, orange juice and leafy green vegetables, and achieve proper weight for height before conception.
Have a pre-pregnancy medical check-up and obtain early and regular pre-natal care during pregnancy.
Don’t drink alcoholic beverages, i.e., liquor, beer, wine or wine coolers, during pregnancy.
Don’t smoke during pregnancy. Don’t use any drug, even over-the-counter medications, unless recommended by a health care provider who knows you are pregnant.