Pregnancy Over 35:
Today, women in their late 30s and 40s who have postponed pregnancy and are generally in excellent health, can look forward to healthy pregnancies and healthy babies. Nevertheless, it is important for them to take into account childbearing risks that apply to all women and follow the basic rules for a healthy pregnancy.
At any age, a woman should consult her obstetrician before attempting to conceive. A preconception visit helps ensure that a woman is in the best possible condition before she conceives. It is especially important if a woman has a chronic health problem, such as diabetes or high blood pressure. These conditions, which are much more common in women in their 30s and 40s than in younger women, can endanger the pregnant woman and her developing baby. High blood pressure and diabetes also can develop for the first time during pregnancy, and women over 40 are at increased risk. Careful medical monitoring, begun before conception and continued throughout pregnancy, can reduce the risks associated with these conditions and, in most cases, result in a healthy pregnancy.
Women generally have some decrease in fertility starting in their early 30s. It is not unusual for a woman in her mid-30s or older to take longer to conceive than a younger woman. Age-related declines in fertility may be due, in part, to less frequent ovulation, or to problems such as endometriosis, in which tissue similar to that lining the uterus attaches to the ovaries or fallopian tubes and interferes with conception. If conception has not taken place after six months of trying, a woman should consult her physician. Many cases of infertility can be treated successfully.
While women in their mid-30s and 40s may have more difficulty conceiving, they also have a greater chance of bearing twins. The likelihood of twins peaks between ages 35 and 39, then declines. Most miscarriages occur in the first trimester for women of all ages. The rate of miscarriage in older women is greater than that of younger women. The risk of bearing a child with certain chromosomal disorders increases as a woman ages. The most common of these disorders is Down syndrome, a combination of mental retardation and physical abnormalities caused by the presence of an extra chromosome. Most obstetricians offer pregnant women who are 35 or older the option of prenatal testing (with amniocentesis or chorionic villus sampling) to diagnose or, more likely, rule out Down syndrome and other chromosomal abnormalities. About 95 percent of women who undergo prenatal testing receive the reassuring news that their baby does not have one of these disorders. If prenatal testing rules out chromosomal defects and the mother is healthy, the baby is at no greater risk of birth defects than if the mother were in her 20s.
The incidence of Cesarean section is slightly high in women who are older and are having their first child, however the majority of older women can have a successful vaginal delivery.
The best advice for any pregnant woman, regardless of her age is to follow these rules for a healthy pregnancy:
Consume 400 micrograms (0.4 milligram) of the B vitamin folic acid (the amount found in most multivitamin supplements) daily before and during pregnancy.
|Robert Stiller, MD, is a practicing perinatologist & Chief of Maternal-Fetal Medicine at Bridgeport Hospital. For information on The Birthplace at Bridgeport Hospital, their nationally accredited obstetrical ultrasound service & American Diabetes Association-recognized gestational diabetes education program, call 203.384.3510.|
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