Pregnancy after 35
A few decades ago, one of the biggest challenges for women in their late thirties was conceiving. But now, with the advancement of fertility-boosting technologies, more women can delay starting a family until they are secure in their careers and financially stable. But while the problem of getting pregnant may be solved, obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan says that these women are at a higher risk of developing pregnancy-related complications.
“The risks associated with getting pregnant increase with age. Obstetricians consider giving birth at age 35 and older as advanced maternal age. Most pregnancies that occur in women over age 35 occur without complications, but the risk of complications for both mother and babies are higher at that age,” Dr Buchanan said.
She argued that while most healthy women who get pregnant in their late 30s – and even in their 40s – have healthy babies, especially when guided by an OB-GYN, the biological clock is a fact of life which means your body changes as you age, making you susceptible to certain health conditions that can cause complications before and during pregnancy, including:
You’re more likely to have a miscarriage
“There is an increased risk of miscarriage as there is a higher chance of genetic defects the older you get,” Dr Buchanan said. She explained that this is also linked to the fact that women over 35 are more prone to having conditions that increase the risk of miscarriage, such as lupus and thyroid disease.
Your child is at an increased risk of genetic/chromosomal defects
The risk of Down’s Syndrome is one in 350 at age 35 and one in 100 at age 40. “Down’s Syndrome and other genetic defects are higher. Apart from a difference in facial appearance, with this condition there may be associated heart defects, mental retardation and short stature,” Dr Buchanan said. Fortunately, she explained that nowadays, with the help of the Harmony test, Down’s Syndrome may be reliably detected from as early as 10 weeks into the pregnancy. Other tests can be done later, such as the Quad Screen to screen for Down’s Syndrome.
You’re more likely to have multiple pregnancies
“The incidence of multiple pregnancies may be higher, as there is a higher chance that there was fertility treatment to women over 35,” Dr Buchanan shared. She pointed out that fertility techniques such as in vitro fertilisation are associated with a higher chance of twins and higher-order pregnancies, such as triplets. In addition, the hormonal changes that come with age could also trigger the release of multiple eggs.
Increased risk of premature deliveries
“The risk of premature delivery is higher with advanced age. This is due to the higher risk of pregnancy complications that are greater with age and requiring earlier delivery,” Dr Buchanan said. This also increases the possibility of low birth weight.
You are at an increased risk of pregnancy-related complications
Pregnancy complications such as antepartum haemorrhage, high blood pressure, preeclampsia, eclampsia, and gestational diabetes are more likely to affect pregnant women 35 and older. Dr Buchanan said in addition to these conditions, complications from fibroids such as degeneration with the associated pain, premature labour and heavier bleeding post-delivery are more common with fibroids. Malpresentation of the foetus requiring a C-section is also more common with advanced maternal age. Rarer pregnancy complications such as liver disease are also more prevalent with advanced age.
Increase in the possibility of a C-section
With an increased possibility of pregnancy-related complications such as hypertension or placenta previa – where the placenta blocks the cervix, for example – women aged 35 and older have a higher rate of C-sections.
Usually struggle with existing complications
“There is higher chance that these women may have pre-existing conditions such as high blood pressure, diabetes, heart disease, lupus, kidney disease, and some may have been cancer survivors,” Dr Buchanan said. She notes that there is a higher risk of heart disease and heart attacks linked to some pre-existing risk factors such as high blood pressure, high cholesterol and atherosclerosis. Uncontrolled diabetes in the first trimester, for example, increases the risk of birth defects such as caudal regression syndrome (spinal cord defect), anencephaly (absence of the foetal skull), heart defects such as a ventricular septal defect (hole in the heart), and failure of the kidneys to develop, called renal agenesis. Uncontrolled diabetes in the second and third trimester increases the risk of sudden stillbirth, large babies requiring caesarean section, and premature delivery. However, lupus tends to improve during pregnancy, but the patient must be closely monitored after pregnancy for a possible flare-up in lupus.
And while the complications associated with pregnancies in older women can be quite discouraging, Dr Buchanan says that effectively managing existing conditions and changing lifestyle practices can reduce these risks.
“Controlling these [pre-existing medical] conditions and getting them optimised before pregnancy is the ideal situation. For example, controlling high blood pressure decreases the risk of foetal growth restriction, placental abruption (where the placenta prematurely separates before delivery), and sudden stillbirth. Unfortunately, this is not usually the case,” Dr Buchanan cautioned.
She underscored that prenatal care such as pre-pregnancy planning, proper nutrition, and adhering to prenatal visits are very important. These practices will optimise best pregnancy outcomes.
“Other factors that increase the chances of a successful pregnancy with a low risk of complications are keeping the maternal weight normal, attaining physical fitness prior to pregnancy, having a healthy diet high in fruits, vegetables, and low in saturated fats, avoiding alcohol, cigarettes, and other drugs, and getting chronic illnesses such as diabetes and high blood pressure under control before pregnancy,” Dr Buchanan advised.
