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Pregnant After 35?

Don’t Panic: An Uncomplicated, Low-Risk Pregnancy May Await

    After the age of 35, women who are pregnant or who plan to get pregnant will be ushered into a particular group. They will belong to the “35 and older” bracket, and because of their age, their pregnancies may be monitored for additional risks.
    This doesn’t mean women in their late-30s and 40s can’t have just as healthy and uncomplicated a pregnancy as their 20-something counterparts. While every woman ages differently and every woman’s pregnancy is unique, a pregnancy at or after the age of 35 means the mother-to-be should be familiar with the following issues.

Fertility
     Sometimes, getting pregnant in the first place can be an issue. Angelyn Thomas, an Alta Bates Summit Medical Center obstetrician and gynecologist for 12 years, notes that fertility in general can decrease significantly from a woman’s early 30s to her late 30s. But Thomas, who sees many women bearing children later in life, says there’s no reason to be panicked after hitting the 35-year mark.
     She recommends that older women — ones who are in the right relationship and those who’ve seriously contemplated the lifestyle considerations of raising a family — not delay too long in trying to conceive. And when the time is right, women should strive to be in their best physical condition. “There is no pill you can take to maximize fertility,” Thomas says. “But you can maximize your health. Managing your weight, refraining from smoking and taking prenatal vitamins preconception can help.”

Genetic Screening
     The risk of having a baby with chromosomal abnormalities goes up every year after this magic number. A woman who is 35 or older on her due date often meets with a genetic counselor to discuss potential risks that may be associated with her pregnancy. Depending on her individual health and family history, she may opt for genetic screening tests, often covered by insurance policies based on age alone at 35 and above.
     First-trimester screening tests include chorionic villus sampling, or CVS, and amniocentesis. Both are considered invasive procedures that require withdrawing a placenta sample or fluid from the uterus, respectively, to help uncover genetic disorders before birth.
But, again, Thomas says women over 35 shouldn’t be panicked. “The risks depend on the individual. Some women may be 35, but their bodies are genetically like 30-year-olds.”
     Thomas describes the basis for recommending the more invasive tests as a mathematic equation, when the risks of having a baby with chromosomal problems based on the mother’s age and individual health are weighed against the risk of the procedures themselves. “In general in terms of screening, we don’t treat women any differently in terms of age. We offer genetic screening for anyone. A woman can have a baby with chromosomal problems at 28, and a woman of 38 may not.”

Women’s Health
     Keeping regular appointments with the gynecologist is important in general, and it is especially the case prior to conception, when appointments help women monitor gynecological conditions that they are more likely to develop with age.
     “Some gynecological conditions that can affect fertility can affect pregnancy,” Thomas explains, citing fibroids and endometriosis as two such conditions. Both become more common as women get older. “Fibroids may decrease fertility and also cause pain and preterm labor during pregnancy.”
     Women in their 40s face a significant decrease in fertility from their 30s and often make appointments with their gynecologist not only to assess ovarian reserves and the likelihood of getting pregnant, but the likelihood of staying pregnant, Thomas says.
     There is the potential for older women to suffer from other general health complications like diabetes, high blood pressure and being overweight, she says. “We take family history, individual health and risk factors, whether or not this is a first baby, or previous pregnancies and how they went into account then decide which tests we should order.”
    Typically, she recommends that women in their 40s get a non-invasive, fetal non-stress test during their last month of pregnancy. Thomas may also recommend gestational diabetes testing early if a woman is at risk for the condition. Ultimately, however, she says these tests are based on the individual as opposed to age.

Overcoming Fear
     Overall, the outlook for pregnancy after 35 is positive. Carol Gerdes, an Alameda-based obstetrician and gynecologist, says women in their 30s often face pressure to get pregnant because of their age. This may have negative repercussions when women who haven’t found the right relationship or aren’t ready for pregnancy for other reasons decide not to wait. In general, Gerdes says women 35 and over should not be fearful of being “too old.”
     And Thomas agrees: “Certainly with reproductive technologies like IVF, women can conceive and deliver at much older ages,” she says. “If you are planning to conceive, make an appointment with your gynecologist to assess individual risk factors and maximize your health. Basically, the evaluation of your pregnancy is not going to be significantly different than someone who is 33. Women 35 and older can have a very uncomplicated low-risk, nice pregnancy.”

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