Pregnancy after 35 - An Overview

To wonder if your time is really up after you cross 35 is a thing of the past for those women who have baby making plans on their agenda. You don't really have to watch the clock but you need to be aware of the facts, the pros and the cons. More and more women are having babies later in life due to career, lifestyle, late marriages; it's a personal choice to start this late although some of your counterparts are with kids in their teens.

Suddenly 35 or even 40 is no longer a dangerous number!

Agreed, the risk of certain complications is clearly age-related. If you have a good headstart with regular prenatal care, a healthy lifestyle and overall good health it is very likely that the pregnancy will progress smoothly with few or no complications. The other good news is the older mother today is considerably at a lower risk then the older mother, say, 20 years ago. Women in the past were having their last baby (after several babies!) after 35 with inadequate care (pre, ante & post) while today women giving birth over 35 are having either their 1st or 2nd child with good care programs. Further, evaluations for birth defects can be managed in utero through a variety of screening and diagnostic tests. Chronic conditions such as preterm labor more prevalent in older mothers can be controlled successfully through drugs and medical supervision.

The Cons for You

• Risk of miscarriage goes up with age, increasing even further after 40 because of the aging ova (1 in 4 pregnancies end in miscarriage). This is primarily due to fetal chromosomal abnormalities.
• With age the likelihood of developing high blood pressure rises too, even if you never had this problem before. Chances of preeclampsia too increases; swelling of hands and feet, traces of protein in the urine and high blood pressure become a possibility after week 20 of pregnancy
• Being over 35 also means you are at a greater risk of developing placenta previa during pregnancy. It's a condition where the placenta is lying in the wrong position either partially or completely covering the cervix. Bleeding may occur in the final trimester which would entail hospitalization and a Cesarean birth.
• Gestational diabetes is another probable complication as you age even if you have never had diabetes before. If left untreated diabetes during pregnancy can cause your baby to grow too big increasing the odds of a Cesarean delivery. The newborn in turn can develop jaundice and hypoglycemia (difficulty controlling blood sugar).
• Since IVF and other such procedures are more common in older women, so are multiple pregnancies. These procedures typically involve implanting 2-3 fertilized eggs in the uterus which results in twins or multiple pregnancies. Hormonal changes too play a part by causing the release of more than one egg at a time thereby increasing the chances of conceiving nonidentical twins in an older woman.
• Research indicates that breech positioned babies are more common in women over 35. Again Cesarean delivery becomes a possibility.
• Preterm labor is more common; the cervix dilates before the 37th week is up and this triggers contractions earlier.
• Finally Cesarean deliveries are more common when the woman is older. Apart from the reasons outlined above, c-sections are more probable when the pregnancy is induced, when excess weight is gained during pregnancy resulting in labor difficulties and consequently a Cesarean and when the pregnancy is closely monitored (very likely if it is a complicated pregnancy). The first sign of trouble such as a decelerating fetal heart rate results in a Cesarean birth.

The Cons for Baby

• For unknown reasons, stillbirths are more common in women over 35.
• There is an increased chance of women giving birth to low birth babies i.e. babies who weigh less than 5.5 lbs at birth. These babies are more likely to have hypoglycemia and hypothermia (trouble maintaining body temperature). Of course they go on to develop well and catch up in size and weight when they turn 2.
• Conversely a situation where the baby weighs more than 9 lbs at birth too is relatively common with the older woman. With a baby overly large, delivery becomes difficult for the mother and a c-section is resorted. Large newborns may suffer from birth injury, have trouble with hypoglycemia and jaundice.
• Studies suggest chromosomal abnormality increases with the woman's age. A woman below 30 is at risk of 1 in 1000 of having a Down syndrome baby. At 35 it is about 1 in 400 and the number dwindles to 1 in 100 at 40. This includes trisomy 21, 18 or 13. A trisomy is the most common type of chromosomal defect. In simple terms it means that the baby has 3 instead of 2 copies of a chromosome. Another term for trisomy 21 is Down syndrome and it is the most common type of chromosomal defect. Trisomies 13 and 18 though more severe than 21 are fortunately more rare.
• Research suggests women above 35 tend to give birth prematurely before 32 weeks.

Fine Points

• Pregnancy at any age isn't risk free
• The major challenge faced by the older woman trying to conceive is decreased fertility
• Chromosomal abnormalities are more common in the older woman because of the older ova.
• The older woman having lived longer has been exposed to more illnesses, infections, drugs etcetera.
• An estimated 25% of Down syndrome cases can be linked to the defective sperm
• Diagnostic testing is routine for mothers over 35.