Later Childbearing

What is later childbearing?

You are in your later childbearing years if you are 35 years old or older. This is also called advanced maternal age. The number of women getting pregnant after the age of 35 has increased since the 1970s. This is probably because advances in medical technology have made it easier for women to get pregnant and have a safe pregnancy later in life. Most women who are 35 or older have normal pregnancies and healthy babies. However, there are some issues and risks that you should be aware of if you are pregnant or plan to have a baby during your later childbearing years.

Will it be harder for me to get pregnant?

It may be harder for you to get pregnant as you get older. Women become less fertile as they age, although this does vary from woman to woman. As you get older, your ovaries do not always release an egg each month during your menstrual cycle. If you have been trying to get pregnant for more than 6 months, you should talk to your healthcare provider. Infertility may be successfully treated in some cases.

What problems are more likely to occur during pregnancy?

• Miscarriage: The risk of miscarriage increases as you get older. About 1 in 4 pregnancies end in miscarriage at age 35 and 1 in 3 at age 40. Miscarriages are usually caused by genetic problems with the baby.
• High blood pressure and diabetes: You are more than twice as likely to develop high blood pressure or diabetes during pregnancy as a woman under 35 years of age.
• Placenta problems: There is an increased risk of placental abruption (placenta separates from the wall of the uterus) and placenta previa (the placenta covers the opening to the birth canal).
• Difficult delivery: More women in their late 30s and 40s end up having a Cesarean section because of problems during labor and delivery.

What problems might the baby have?

Most older women have healthy babies. However, as you get older, there is an increased chance that your baby will have a genetic disorder. A genetic disorder is a problem with the baby's chromosomes or genes. The problem can be passed on from the parents or it can happen on its own. A common example of a genetic disorder is Down syndrome. Down syndrome causes some physical problems as well as mental retardation. The chance of a baby having Down syndrome increases with the mother's age. There is a 0.5% chance by age 35 (1 out of 200 women) and a 3% chance by age 45 (1 out of 30 women). Before you become pregnant, talk to your partner about what you would do if your child had a genetic problem such as Down syndrome.

What can I do to prevent problems?

To decrease your chances of having problems, it is a good idea to have a thorough and complete physical exam and counseling on the risks related to pregnancy. This is especially true if you have diabetes, high blood pressure, or other ongoing health problems.

You may need to change your lifestyle before getting pregnant. If you smoke, abuse drugs, or drink alcohol, it is best to quit before getting pregnant. You should start your pregnancy at a healthy weight. You will also want to think about your job and if there are any problems such as stress, long work hours, or hazardous materials present in your workplace that you will need to avoid.

You may want to talk to a genetic counselor about your family's health history. In some cases, you can have genetic testing done before you become pregnant to figure out your chances of having a baby with certain genetic problems.

Taking vitamins such as folic acid before you are pregnant can help prevent some birth defects.

What tests can be done to check for problems during pregnancy?

Once you are pregnant, you should visit your healthcare provider early in the pregnancy to confirm that everything is okay, and then have regular checkups for the pregnancy with your healthcare provider. Your provider will regularly check such things as your blood pressure, urine, weight, and growth of the baby.

You may have an ultrasound early in the pregnancy to check if everything is normal. This is one way to tell if you are likely to have a miscarriage. You may need more than one ultrasound during the pregnancy.

There are several tests that can be done during pregnancy that can help detect genetic problems. Common tests offered to mothers over age 35 are a blood test called a triple screen, quad screen, or integrated test and either amniocentesis or chorionic villi sampling. A triple screen, quad screen, or integrated test is a blood test that is usually done when you are about 15 to 18 weeks pregnant. It measures several different substances in your blood to look for a problem in the baby's spine and other conditions. It includes a test for alpha-fetoprotein (AFP), which may signal a possible genetic problem.

Amniocentesis and chorionic villi sampling (CVS) are tests used to check for genetic problems with the baby. An amniocentesis is usually done when you are 15 to 18 weeks pregnant. Fluid from the pregnancy's sac is removed through your abdomen with a needle for lab tests. A chorionic villus sampling test is similar to an amniocentesis, except cells of the baby are taken from the placenta rather than from fluid in the sac. This test can be done earlier--as early as when you are 10 to 12 weeks pregnant.

Many other tests may be done to check your health and the baby's development and health during the pregnancy, such as tests for diabetes and strep infection of the cervix.

How can I take care of myself?

• See your healthcare provider before getting pregnant to discuss risks and things you can do to get ready for pregnancy, such as taking folic acid.
• See your healthcare provider as soon as you think you are pregnant and continue to go in for your prenatal checkups.
• Take a multivitamin every day. It is especially important to take a vitamin containing folic acid while you are trying to get pregnant and during pregnancy to help prevent neural tube defects.
• Eat a variety of healthy foods.
• Get enough rest and exercise.
• Stop drinking alcohol before you try to conceive and avoid alcohol while you are pregnant.
• Don't smoke during pregnancy and avoid breathing secondhand smoke.
• Do not take any drug or medicine, including nonprescription medicines or herbal medicines, while you are pregnant without asking your healthcare provider first.

When should I call my healthcare provider?

Call your provider right away if you:

• Have bleeding from the vagina with or without abdominal pain.
• Develop a severe headache.
• Have problems with your eyesight.
• Have a great deal of swelling of the face, hands, ankles, or feet.
• Are leaking fluid from your vagina.
• Are having contractions before your due date.

Call during office hours if you have questions or concerns.