Despite the fact that your doctor will refer to you unflatteringly as an “elderly primigravida” if you’re pregnant for the first time and older than 34, there’s no reason you shouldn’t have a healthy, happy pregnancy – once you’re actually pregnant. That’s the word from gynaecologist and obstetrician Dr Philip Zinn in Cape Town, who warns women that good quality eggs decrease with age.
What it means for mom
So apart from perhaps battling to conceive after 35, there is one major issue with an older pregnancy and that is the increased incidences of chronic health problems in older women. “The older you get, the more chance you have of acquiring other medical problems,” explains Dr Zinn.
This means that any medical issues that you may get before or during your pregnancy as a result of your age add to the complexity of pregnancy and its risks. For instance, as we age, we tend to retain more weight, so you might begin your pregnancy at a weight which could pose a health problem, such as increased risks of hypertension, heart problems, gestational diabetes, and pre-eclampsia. Still, the great majority of women who fall pregnant for the first time over 35 will have an uncomplicated pregnancy.
“What’s more, women over 35 are actually very healthy today because times have changed. In fact, 20 years ago, many 35-year-old women smoked but today, it’s generally the 25-year-olds who still do,” says Dr Zinn.
For example, Sue Smith, a 40-year-old lawyer and mom of two children aged 23 months and three months, maintains that both of her pregnancies went smoothly. “I hardly had morning sickness, I didn’t develop any complications, I wasn’t all that tired (the lack of sleep didn’t bother me) and apart from being told to take it easy, I wasn’t treated any differently by my gynaecologist,” she recalls.
“I also worked right up until the end of both my pregnancies and that took its toll on my body more than my age did. My high blood pressure was also monitored closely but I don’t think that was because of my age but rather because of the stressful nature of my job. Had I had my babies ten years earlier, I wouldn’t have had job security, and that would have been for more stressful for me than my job itself,” she says.
“Postnatally, I definitely don’t look like the younger, trim moms who I see at the clinic and I don’t think my belly’s ever going to go away. But at 40, I’m not too worried about that yet. Even during my pregnancy, I wasn’t too concerned about my growing size.”
What about the health of the baby?
Before she fell pregnant for the second time at 37, Sue sadly had a miscarriage. According to Dr Zinn, the older you get, the higher your risk of miscarriage. The same can be also said for having a baby with Down syndrome – and the risk increases exponentially.
“Most miscarriages before 12 weeks are the result of a genetically abnormal embryo. This could be due to it having one chromosome too many, as in Down syndrome or because one is missing, such is the case with Turner syndrome,” he explains.
A miscarriage doesn’t always occur, though, and a baby with Down syndrome may be born at full term. Your odds of this happening also increases with age.
“The chances of having a baby at 35 with Down syndrome are still relatively low at 1 in 400. The risk is regarded as significant enough to offer further testing when it is 1 in 280 or higher. A 45-year-old has a risk of 1 in 35. That said, when a pregnancy continues past the first trimester, the odds are still in favour of an older mother having a normal baby.”
Whatever your age, you’ll be offered a screening for Down syndrome because there are better techniques to determine your risk than just by age alone. An amniocentesis may be offered if the risk is high but should not be done lightly as miscarriage can occur as a result.
Sue, for example, had screening tests and amnios for both of her pregnancies as she was told that because of her age, she had a high risk of having a baby with Down syndrome.
“I wasn’t prepared to worry about it for nine months, and I knew that it was something that I needed to do for my peace of mind. Although being pregnant late could be seen by some as a disadvantage, at least I was at a stage where I could afford the expensive tests,” she says, adding that she had the emotional stability and maturity to deal with them too.
“It was interesting, also, to notice just how much my risk increased from my first pregnancy, at 37 years old, to my second one at 39,” she says.
Does your pregnancy need to be managed differently?
Most women between 35 and 50 (if they are able to fall pregnant) have healthy pregnancies and their pregnancies don’t require any special treatment, unless they develop other age-related medical problems or conditions.
“It’s actually the pregnancies that are routine and regarded as low-risk that should be viewed more seriously, in order to avoid missing something,” says Dr Zinn. “The high-risk pregnancies are managed well because the risks are well known and everyone on the medical team remains on their guard.
“The challenge we have in modern obstetrics is to pick up problems in those who are seemingly young and healthy,” cautions Dr Zinn, adding that to go into a pregnancy healthy, to maintain that health throughout your pregnancy and to be screened regularly is what is considered vital when it comes to managing a pregnancy at any age.
We're having babies later and later in life
“Research indicates that the average age for professional women to have their first child in the 21st century is 30-plus,” says Dr Zinn. And Sue agrees it was changing social mores plus her desire to establish her career that led to her decision to have her babies later on in her life.
“Women have careers today and it’s very difficult to pause them to have babies when you’ve worked so hard to
get to a certain point. By the time I was 36, I’d done what I needed to do and now I only work from 8.30AM until 5PM. More importantly, women today don’t have to feel like they’ve failed if they haven’t had a child by the age of 35 or if they do decide to delay the process; they have options in the form of fertility treatment, which can give them more child-bearing years, if their eggs are still viable.”
With plenty of career women in the field today, older moms are socially acceptable and by no means unusual or extraordinary.
“At first I thought I would be the odd one out and that I would be the only old parent. I soon realised this wasn’t the case at all,” explains Sue.
Besides, Sue reckons that at 40, she has far more patience for children than she’d have had at 30. Her life, she thinks, would also have been inhibited by her kids had they come along earlier. “I’ve done my extensive travelling, my career is established, and I don’t resent my children for holding me back. I wouldn’t even want to put my backpack on now,” she jokes.