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| |    Childbearing at Older Ages: Considerations Once You are Pregnant by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. Staying Pregnant Once pregnant, there are some hurdles for the older mom. For younger women, the chance of miscarriage is about 15 percent. In other words, one in eight pregnancies ends in miscarriage. At 35 the rate rises to one in four, and at 40 the miscarriage rate is almost one in three. This is mostly due to chromosomal problems of the embryo. Currently, there isn't a treatment that prevents these losses. Still, the odds are in your favor that the pregnancy will progress normally once you have conceived. Chromosomal Problems I have found that many people overestimate the risk of Down Syndrome and other hazards to the baby from advanced maternal age. There is a lot of publicity about the chance of Down Syndrome after the age of thirty-five, as if that were a major turning point for risk. Actually, the risk rises slowly with age, so that at 35, the chance of Down Syndrome is slightly less than 0.5 percent. That means that over 99 percent of fetuses carried by women this age will not have Down Syndrome. The risk rises to about 3 percent by age 45. That is still 97 percent without Downs. Discuss with your partner what you would do if testing showed a chromosomal problem. There are numerous testing options available to you, depending on your risks and your values. In the US, all women who will be 35 by delivery are offered genetic counseling and genetic testing. Other risks to the baby For pregnancies that are chromosomally normal, the risk of birth defects is not significantly increased. Although there may be some increase in premature birth and low birthweight, most babies born to older mothers are healthy. Little medical risk to healthy moms For a healthy older woman who becomes pregnant, the medical risks are minimal. She may be at some increased risk of gestational diabetes, pre-eclampsia, and cesarean section, but she is certainly not taking her life in her hands by choosing to carry a child. Some of the concerns about the mother's health with later childbearing are related to conditions that are more common as we age, particularly diabetes and hypertension. If a woman has these conditions before pregnancy, there are risks for her as well as for the baby. It is important to find out how your medical situation impacts a pregnancy and how the pregnancy will affect your health. All women planning pregnancy should have a pre-conception consultation with their doctor or nurse-midwife. This is particularly important for older women, and for women with known medical problems. Summing up the issues If you have waited until an older age and are now pregnant, take heart! The risks to healthy women are minimal, the chances of chromosomal problems are small and can be detected early, and many complications can be prevented by good healthcare.
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