I will be 42 years old in May this year. I currently have a nine-year-old son and am considering the possibility of another child. What is the possibility of having a normal child? Up to what age is it safe to conceive and have a normal baby? The previous delivery was by c-section and I had previously done a myomectomy.

Dr. Sharmaine Mitchell

The incidence of birth defects increases with increased maternal age. There is also an increase in the incidence of Down's Syndrome and other chromosomal abnormalities with increasing maternal age. This increased risk is significant from 35 years onwards with a risk of one in 200.

At 42 years the risk is approximately 1 in 39. The possibility of having a normal child is definitely good and despite this risk for Down's Syndrome, you should not allow this to prevent you from trying.

There are screening tests that you can do to detect the presence of birth defects and also Down's Syndrome. A blood test called the triple screen may be done between 16 to 18 weeks. This test determines the ratio of the following three hormones in the blood: estriol, human chorionic gonadotrophin (BHCG) and alpha-feto protein.

If the levels suggest a risk for a chromosomal abnormality such as Down's Syndrome or the presence of a neural tube defect (defect in the spinal cord) then more detailed testing will be recommended.

This includes a detailed ultrasound scan to check for birth defects and an amniocentesis. Amniocentesis involves the removal of fluid from around the foetus and this is sent for analysis to establish the chromosomal make-up of the baby, thus establishing whether there is Down's Syndrome or any other abnormality.

There is truly no cut-off in terms of an absolute age for conception and women in their high forties (even up to 49 years) have conceived naturally and have had normal babies.

However, it is best that you try now before you get much older so as to reduce the risk of birth defects and all the maternal complications which tend to increase with advanced maternal age, such as diabetes mellitus and hypertension.

You will definitely need delivery by a repeat Caesarean section since you had a previous myomectomy and Caesarean section. This will reduce the risk of a rupture of the scar in the uterus from the two previous operations.

It is a good practice to start taking folic acid tablets (5mg daily) in preparation for conception. This will reduce your chance of having a baby with a defect in the spine and brain. If conception does not occur naturally, then consider doing a work-up for infertility.

Your partner will also need to be investigated. In vitro fertilisation is a real option if natural conception is not possible. This is available at the University Hospital and is relatively affordable and has comparable results with first-world countries.
Best wishes.

Dr. Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.

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