Most women agree that pregnancy isn’t for the fainthearted at any age, but older women face heightened odds of miscarriage and birth defects along with the normal aches and pains of childbearing.
“We’ve certainly seen an increased complication rate in older women,” says Dr. Frederick Licciardi, assistant professor of obstetrics and gynecology at the New York University School of Medicine. “However, even with the increased risks, it’s not to the point where we tell our patients they can’t get pregnant.”
Dr. Licciardi says the most common problems associated with an “advanced-age” pregnancy are pregnancy-induced hypertension, gestational diabetes and premature delivery.
Pregnancy-induced hypertension is a disorder characterized by high blood pressure and the presence of protein in the urine, according to Dr. Richard I. Feinbloom in his book “Pregnancy, Birth, and the Early Months The Thinking Woman’s Guide.” Risks include stillbirth, placental abruption, which is the sudden breaking away of the placenta from the uterus, and prematurity.
Dr. Feinbloom writes that pregnancy can prompt diabetes in women with a predisposition to the disorder or intensify the condition in women already suffering from it. Adverse effects include increased incidence of congenital abnormalities and increased susceptibility to infection.
“Pregnancy is a physiological stress,” says Dr. Barry Rothman, an obstetrician in private practice in Alexandria and chairman of the Department of Obstetrics and Gynecology at Inova Alexandria Hospital. “People at around the age of 40 begin to have tendencies toward hypertension and diabetes anyway. The age itself plus this physiological stress make it more likely for a pregnant woman to develop these conditions.”
The third common problem, premature delivery, is defined as birth before 37 weeks of gestation. According to Dr. Feinbloom, premature delivery accounts for the majority of the deaths of babies after birth and scores of neurological disabilities, including cerebral palsy.
Despite the prevalence of premature delivery, the medical community is unable to define its cause with precision, Dr. Rothman says. He cites the possibility that circulation between the uterus and placenta becomes compromised, prompting labor.
“There are a number of philosophical reasons,” he says, “but anyway, we do see it more often in the older population.”
Throughout the nine months, the specter of birth defects also can weigh heavily on the minds of older pregnant women, and with good reason. According to Dr. Glade B. Curtis’ book “Your Pregnancy, Every Woman’s Guide,” the risk to a woman at age 25 of bearing a child with Down syndrome is one in 1,300. At 35, the risk is one in 365; and at age 40, the risk is one in 109. At age 45, the risk increases to one in 32 births, and at 49 it is one in 12.
Many older parents choose to learn the genetic makeup and detect malformations of their fetus via amniocentesis. This test usually is performed between the 14th and 16th week of pregnancy. Amniocentesis involves passing a needle through the abdominal wall of a pregnant woman into the uterus to extract fluid for study. Amniocentesis carries a risk of complications, including miscarriage. That risk, according to the March of Dimes’ Web site, is one in 400 to one in 200.
“If you are older and thinking about having a baby, the first thing I tell a couple is to consider the genetic risk,” Dr. Rothman says. “You should ask yourselves if this baby were to be genetically abnormal, what you would do? Since we are able to determine chromosomal problems, you need to have an answer before we do that.”
Next, Dr. Rothman says, he informs his patients that the closer they get to age 40, the closer they get to the risk of pregnancy-induced hypertension. “If this occurs, you will be off of work, so you will have to prepare for a situation of home rest or bed rest,” he says.
At 26 weeks of pregnancy, he says, patients are tested for gestational diabetes. Although the condition often can be controlled by diet, insulin may be required as well.
“Sometimes this can mean insulin three times a day, which can really screw up your day if you work,” Dr. Rothman says.
No one ever said birthing babies is a cakewalk, especially for the older patient.
“I’m just telling people to be prepared,” Dr. Rothman says.