Too Busy for Baby?

Table 1

In 2010 (the year for which the most recent data is available), for women undergoing in-vitro fertilisation (IVF) using fresh embryos created with their own fresh eggs, the percentage of cycles started that resulted in a live birth (national averages) was:

Data from Human Fertilisation Embryology Authority (HFEA), United Kingdom website

Chart 1

Age-Specifi c Fertility Rates

Potential Problems for the Mother

Some problems are more likely to occur in older mums than in younger mums. These include:

1. Pregnancy loss

   Older women are at higher risk for miscarriage in early pregnancy. The risk is around 25% in women more than 35 years of age compared to 12% in women less than 30 years of age. Th e risk reaches more than 90% in those aged above 45.

2. Pregnancy in the wrong location (ectopic pregnancy)

   An ectopic pregnancy is a pregnancy outside of the womb. Mothers above the age of 35 years are four to eight times more likely to have an ectopic pregnancy compared with younger women. Th is higher risk of ectopic pregnancy is likely due to an accumulation of risk factors over time, such as pelvic infection and problems with the fallopian tubes. Th e condition may present with abdominal pain or abnormal bleeding or can be asymptomatic. Usually, either treatment with an injection or surgery will be required to treat the condition, as it can cause internal bleeding if left unattended.

3. Multiple pregnancy

   The chance of conceiving twins or other multiple pregnancies increases with age. Multiple pregnancies are associated with higher likelihood of problems to both the mother and the babies and require close follow-up throughout the pregnancy.

4. Gestational diabetes during the pregnancy

   Women over the age of 40 are three to six times more likely to develop gestational diabetes (diabetes that develops in pregnancy) compared to women aged 20 – 29. Th e risk of gestational diabetes in the general population is 3%, compared to 7% – 12% in women over 40. Gestational diabetes in pregnancy poses higher risk for potential complications for the mother and the baby during the pregnancy as well as during the delivery process.

5. High blood pressure during the pregnancy

   The risk of pregnancy-induced hypertension is higher in older mothers. This leads to a higher risk of developing a condition called pre-eclampsia, which is a pregnancy complication characterised by high blood pressure and signs of damage to another organ system, often the kidneys. Left untreated, pre-eclampsia is potentially life-threatening for both the mother and baby.

6. Complications from preexisting medical issues during the pregnancy

   With increasing age, the likelihood of obesity or of having medical problems, such as diabetes, hypertension, and heart problems, is higher. With any preexisting medical problem, the pregnancy would need monitoring for worsening of the condition, and for complications to the pregnancy. Th ere may be increased rates of hospitalisation, cesarean delivery and pre-term birth.

Potential Problems for the Baby

The following problems are more common in the babies in pregnancies of older mothers:

1. Chromosomal abnormalities

   The risk of all chromosomal abnormalities increases with the age of the woman, especially after 35 years of age. This includes Down syndrome, which is the most common chromosomal abnormality detected in pregnancy

   The risk of a Down syndrome pregnancy at different maternal ages is:
   At 30 years of age: 1 in 950
   At 35 years of age: 1 in 350
   At 40 years of age: 1 in 100
   At 45 years of age: 1 in 30

   In view of the increased risk, you may want to speak to your obstetrician about screening for chromosome abnormalities.

2. Non-chromosomal abnormalities (e.g. heart defects)

   The risk of heart defects in the babies of women over 40 years of age is almost four times that of women 20 – 24 years of age. The risk of clubfoot (inward turning of the feet at the ankle) and diaphragmatic hernia (a hole in the diaphragm that allows the organs in the abdomen to move into the chest cavity) also increases. Your obstetrician will arrange a detailed scan to look out for these defects.

3. Stillbirth

   At maternal age of 40 – 44 years, the risk of stillbirth is three times that of women between 25 and 29 years of age. Chart 2 shows the risk of stillbirth increasing exponentially after 39 weeks in women more than 40 years of age. The baby will thus be monitored more closely toward the end of the pregnancy.

4. Pre-term birth or low birth weight

   Pre-term babies may have problems with breathing at birth due to inadequate development of the lungs. They are also more susceptible to other early problems such as infection, bleeding in the brain and problems with regulation of temperature and glucose levels. Also, premature infants are more likely to develop hearing and vision problems, as well as cerebral palsy especially if they are born before 32 weeks of gestation

Are there any benefits for me to be pregnant after 40?

In spite of all the risks mentioned above, there are some advantages to parenting when one is older. In one study, it was observed that the older a woman is, the better the health and development of her child up to five years of age. The outcomes that were studied were unintentional injuries, immunisation rates, language development, and social development.

Children of older parents have indicated that they enjoyed benefits such as the devotion, patience, and attention of their parents, as well as their emotional and financial stability.

What can I do if I am pregnant or planning for a pregnancy after 40?

• See a gynaecologist to screen for existing medical problems and ensure that you are in your best state of health before trying for a baby. Your gynaecologist can also monitor your progress and discuss investigations and treatment options including assisted reproductive techniques like IUI (intra-uterine insemination) or IVF if you have difficulty achieving a pregnancy
• Adopt a healthy lifestyle by exercising and eating right and aim to achieve a normal weight, prior to pregnancy.
• Avoid unhealthy lifestyle choices such as smoking or excessive drinking of alcohol
• Take folic acid when trying for a baby to reduce the risks of abnormalities of the spinal cord or brain development in the baby
• Once you realise you are pregnant, you should book a visit with the obstetrician so that a scan to confirm the location of the pregnancy can be done.
• Attend follow-up appointments as scheduled by your obstetrician to allow for close monitoring of the baby’s development and detection of any complications that may occur.