Pregnancy After 35

Pregnancy After 35

How Does Age Affect Fertility?

As women reach their thirties, they experience a decline in fertility. Furthermore, complications during pregnancy are more common when women reach age 35. Age-related decline in fertility may be due, in part, to the following:

• A decrease in the number and health of the eggs to be ovulated.
• Changes in the hormones resulting in altered ovulation.
• Fewer number of eggs.
• A decrease in sperm counts.
• A decrease in the frequency of intercourse.
• The presence of other medical and gynecologic conditions, such as endometriosis, which may interfere with conception.

Pregnancy After Age 35, Is It Safe?

While advances in medical care can help women over age 35 have safer pregnancies than in the past, infertility and pregnancy complications for this age group are higher than for younger women. If you have decided to delay having a child, you should understand the risks associated with this so you can take precautions to minimize risks and improve your chances for a healthy pregnancy and child.

Pregnancy After Age 35, Does the Risk Birth Defects Increase?

The risk of giving birth to a child with a birth defect does increase as the mother's age increases. This is probably due to abnormal division of the egg, called nondisjunction. This leads to unequal chromosomes at the end of division. The traditional age at which a woman is considered to be at high risk for chromosomal abnormalities is 35. Approximately 1 in 1,400 babies born from women in their 20's have Down syndrome; it increases to about 1 in 100 babies born with Down syndrome from women in their 40s.

Pregnancy After Age 35, Will the Risk of Miscarriage Increase?

Studies show that the risk of miscarriage (loss of a pregnancy before 20 weeks gestation) is 12% to 15% for women in their 20s and rises to about 25% for women at age 40. The increased incidence of chromosomal abnormalities contributes to this increased risk of miscarriage in older women.

Pregnancy After Age 35, What Other Problems can Arise?

Chronic health problems, such as diabetes or high blood pressure, are more common in women in their 30s and 40s. Be sure to get these conditions under control before you become pregnant, since they pose risks to both you and your baby. Careful medical monitoring, begun before conception and continued throughout your pregnancy, can reduce the risks associated with these conditions.

• High blood pressure and diabetes can develop for the first time during pregnancy, and women over the age of 30 are at increased risk. If you are pregnant and over age 35, this makes it especially important that you get early and regular prenatal care to ensure early diagnosis and proper treatment.
• Stillbirth (delivery of a baby that has died before birth) is more common in women over age 35. Older women are also more likely to have low-birth weight babies (weighing less than 5.5 pounds at birth).
• Cesarean birth is also slightly more common for women having their first child after age 35.

Pregnancy After Age 35, How Can I Increase My Chances of Having a Healthy Baby?

Good health prior and during pregnancy will help you reduce your risk of complications. Here are some general recommendations.

• Be sure to get enough folic acid in your diet. The current recommendation for women of childbearing age is to take a daily supplement containing at least 0.4 mg. of folic acid, in addition to consuming foods naturally rich in folic acid. Folic acid is naturally contained in leafy green vegetables, dried beans, liver and some citrus fruits.
• Limit your caffeine consumption. Do not have more than 300 mg. of caffeine per day. The caffeine content in various drinks depends on the beans or leaves used and how it is prepared. An 8-ounce cup of coffee has about 150 mg on average while black tea has about 80 mg of caffeine. A 12-ounce glass of caffeinated soda contains anywhere from 30-60 mg of caffeine. Remember, chocolate contains caffeine -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.
• Maintain a healthy, well-balanced diet and eat a variety of foods to get all the nutrients you need. Choose foods high in starch and fiber. Make sure you are getting enough vitamins and minerals in your daily diet. Eat and drink at least 4 servings of dairy products and calcium-rich foods a day, choose at least one source each of Vitamin C, Vitamin A and folic acid every day.
• Exercise regularly. Review your exercise program with your health care provider. Generally, you may continue your normal exercise routine throughout pregnancy unless you are instructed to decrease or modify your activities.
• Don't drink alcohol during pregnancy and don't use any medications unless recommended by your doctor.
• Don't smoke during pregnancy.

In addition, be sure to obtain prenatal care, especially early in your pregnancy. The first eight weeks are especially critical in your baby's development. Early and regular prenatal care (health care during pregnancy) can increase your chances of having a healthy baby.

Regular appointments with your health care provider throughout your pregnancy are important to monitor your health and prevent or control any problems that develop during pregnancy. In addition to medical care, prenatal care includes education on pregnancy and childbirth, plus counseling and support.

Pregnancy After Age 35, What Types of Prenatal Tests Should I Have?

Because women over age 35 are more likely to have certain problems during pregnancy, the following tests may be recommended. These tests can help detect disorders before, during, and after your pregnancy. Some of these tests require appropriate genetic counseling, including a detailed discussion regarding the risks and benefits of the procedure(s). Whether you choose to have the tests is up to you. Talk to your health care provider to find out if any of these tests are right for you.

Pregnancy After Age 35, What Types of Prenatal Tests Should I Have? continued...

Ultrasound: a test in which high-frequency sound waves are used to produce an image of your baby. Ultrasound is used early in pregnancy to determine viability (if the baby is in the uterus and if the baby's heart is beating), the presence of more than one fetus, and to determine your baby's due date or gestational age (the age of the fetus). Later in pregnancy, ultrasound may be used to see how the baby is doing, to determine placenta location and the amount of amniotic fluid around the baby.

Quad Marker Screen: a blood test in which substances in the blood sample are measured to screen for problems in the development of the fetus' brain, spinal cord, and other neural tissues of the central nervous system (neural tube) such as spina bifida or anencephaly. Neural tube defects occur in 1 or 2 out of every 1,000 births. The quad marker screen can detect approximately 75-80% of open neural tube defects.

The quad marker screen can also detect genetic disorders such as Down syndrome, a chromosomal abnormality. The quad marker screen can detect approximately 75% of Down syndrome cases in women under age 35 and over 80% of Down syndrome cases in women age 35 years and older. It is important to note that a "positive” result from this blood test is not definitive for a birth defect. Usually, the next step is to offer the mother an amniocentesis to evaluate the baby’s chromosomes as well as an ultrasound to evaluate the baby’s body for signs of birth defects.

The quad marker screen may be performed between the 15th and 20th weeks of pregnancy.

First Trimester Screen: A newer test done between weeks 10-14 detects the presence of 2 markers in a blood sample in conjunction with an ultrasound to measure the thickness of the back of the fetus' neck. It tests for chromosomal abnormalities, like Down syndrome. It is essentially as accurate as the quad marker screen but results can be obtained earlier in the pregnancy.

Amniocentesis: Amniocentesis, also called an amnio, is a procedure in which a small amount of amniotic fluid is removed from the sac surrounding the fetus and tested for birth defects. While it does not detect all birth defects, it can be used to detect sickle cell disease, cystic fibrosis, muscular dystrophy, Tay-Sachs disease, or Down syndrome if the parents have a significant genetic risk.

Amniocentesis can also detect certain neural tube defects (where the spinal cord or brain don't develop normally) such as spina bifida and anencephaly. Because ultrasound is performed at the time of amniocentesis, it may detect birth defects that are not detected by amniocentesis (such as cleft palate, cleft lip, club foot, or heart defects). There are some birth defects, however, that will not be detected by either amniocentesis or ultrasound.

Chorionic Villus Sampling (CVS): a test in which a small sample of cells (called chorionic villi) is taken from the placenta where it attaches to the wall of the uterus. Chorionic villi are tiny parts of the placenta that are formed from the fertilized egg, so they have the same genes as the fetus. If you have certain risk factors, you may be offered CVS as a way to detect birth defects during early pregnancy. CVS requires appropriate genetic counseling, including a detailed discussion regarding the risks and benefits of the procedure.