Pregnancy after age 40
Donald Aulds, M.D.
Dealing with pregnancy at any age can be a challenge, but after the age of 40, pregnancy brings a new gamut of concerns for many women. Usually the woman suddenly has to face how the pregnancy will impact the family she already has, how it will impact her health, and how it may impact her career and eventual retirement. In this age group, pregnancy can lead to fear, frustration and denial. There are many misconceptions about pregnancy after 40 as well as some increased risk for the pregnancy and the mother. In most cases the pregnancy will advance and delivery will be normal. Fear is the womanís worst enemy and it usually arises from a lack of knowledge about the optimum care a woman can provide for herself. Get the right information, so that the fears can be alleviated and reassurance can be obtained.
It is often possible that the news of a pregnancy will draw all types of reactions from friends and family. The woman may have to make it clear to them that it is her life and she can make the right decisions for herself and her unborn baby. Avoidance of negativity can help to lower stress. Pregnancy at any age is difficult and after 40 it is with greater risks to the mother and unborn child.
The risks associated with pregnancy after 40 include risk of genetic disorders, stillbirths, miscarriage, gestational diabetes, pregnancy-induced hypertension, premature births and placental problems. With prenatal care, the woman has the best chance to become pregnant and have a successful pregnancy. Increased risks with pregnancy after 40 include:
- Genetic disorders include Downís syndrome, trisomy disorders and birth defects. Testing is available to attempt to
diagnosis these problems. Screening tests can be done by blood samples at 16 weeks or a combination test at 11 weeks
and 16 weeks to see if the pregnancy is at risk for a genetic disorder. Chorionic villus sampling is a process in which
a catheter is guided through the cervix to sample the edge of the placenta to obtain cells for genetic studies. It is
usually performed around eleven weeks of pregnancy and must be done in a high risk center. Amniocentesis is the
placement of a needle into the uterus to draw fluid from the area around the baby at 16 to18 weeks. The cells in the
fluid are tested for genetic abnormalities.
- Gestational diabetes is a diabetic state that develops during pregnancy and may or may not be present after the
pregnancy. Studies have revealed that women over 35 are at higher risk for the development of diabetes during pregnancy
than younger women. Glucose levels are monitored, and therapies are available to try to control the glucose levels.
Women who develop gestational diabetes are more likely to have a large baby who may be at risk of injuries during
delivery and newborn health problems.
- Pregnancy-induced hypertension is the development of high blood pressure during pregnancy and is usually a sign
that the woman may have problems with hypertension later in life. This can worsen during pregnancy and develop into
preeclampsia which involves the alteration of liver function, kidney function and might lead to seizures.
- Premature births have been reported to be more common in women over 40 which can lead to a baby having an increased
risk of health problems and possible lasting disabilities.
- Pregnancy losses are reported to be more frequent including miscarriages and stillbirths. Stillbirth is the death of a baby after 20 weeks of pregnancy. Usually the cause of death is unknown. Miscarriage is the loss of the pregnancy before 20 weeks.
- Placenta problems may occur, and the most common type is placenta previa. Placenta previa, the partial or complete coverage of the cervix with the placenta, is reported to be three times more frequent after age 40. It can produce severe bleeding in the last few months and can lead to the need of cesarean section for delivery to prevent major trauma to mother and baby.
Studies indicate that women over 40 have twice the risk of needing a cesarean section than younger women. This is probably due to the risks associated with the pregnancy.
By now you are probably asking what you can do to try to avoid complications of pregnancy. The following list may help in deciding whether or not to give birth after 40 or to help reduce complications for women who are already pregnant:
- Have a preconception checkup with an obstetrician or the doctor who will be caring for the pregnancy.
- Begin regular prenatal care and by the eight week of pregnancy.
- Take prenatal vitamins with folic acid. Try to start the vitamins before getting pregnant.
- Avoid alcohol and tobacco Ė even secondhand smoke, if possible.
- Avoid over-the-counter medications unless approved by your doctor.
- Eat healthy foods and keep the diet balanced with protein, carbohydrates and grains.
- Donít eat undercooked meats and avoid changing your catís litter box to avoid exposure to toxoplasmosis.
- Donít eat fish that has been associated with high levels of mercury, including shark, swordfish, king mackerel or tilefish. Women may eat up to 12 ounces of seafood such as shrimp, salmon, pollock, catfish, and tuna.
- Get tested for immunity to rubella (German measles) and chickenpox.