If you’re 35 years old or older and considering starting a family, you’re not alone. In fact the number of women having babies later in life has been growing steadily. According to a report by the National Vital Statistics System, between 2000 and 2008, when the pregnancy rates of women in their early 20s fell nearly 18%, the rate for women from 35 to 39 increased from 67.5 to 78.5 per 1000 women, and in those women age 40 to 45 it grew from 15.4 to 18.8 per 1000. However, the growing trend toward older first-time moms, does not erase the fact that waiting until later in life to try to conceive can come with some difficulties. Approaching motherhood as an older woman poses both positives and negatives that should be explored before you make the decision to pursue pregnancy after age 35.
Know your risks.
There is no hard and fast rule that determines whether a woman will have trouble conceiving after 35. However, knowing the risks and challenges of getting pregnant and carrying a healthy baby to full term after 35, can help you plan for a healthier pregnancy.
It might take longer to get pregnant. Let’s face it, you are born with a limited number of eggs. By your early 30s, your eggs can begin to decline in quality – and you could be ovulating less frequently. This doesn’t mean you can’t get pregnant, but it simply could take longer. If you’re over 35 and you haven’t been able to conceive after six months of trying, you should talk to your OB/GYN about options for increasing your chances.
There is a greater chance of having a multiple pregnancy. The odds of having twins increases with age. The use of assisted reproductive technologies (ARTs) – such as in vitro fertilization – also can play a role. Since these procedures typically enhance ovulation, they’re more likely to result in twins or other multiples.
You’re more at risk for gestational diabetes. This type of diabetes occurs only during pregnancy, and it’s more common among older women. Careful monitoring of blood sugar through diet, exercise and other lifestyle factors is crucial. Medication may be required if common sense measures are not successful. Left untreated, gestational diabetes can cause a baby to grow too large, increasing the risk of problems during delivery.
You’re at higher risk of developing high blood pressure. Some studies suggest that high blood pressure that develops during pregnancy – before 20 weeks (chronic hypertension), after 20 weeks (gestational hypertension) or after 20 weeks and accompanied by protein in the urine (preeclampsia) – might be more common in older women. Your OB/GYN will closely monitor your blood pressure and your baby’s growth and development. There is a chance you might need to take medication or deliver your baby before your due date to avoid complications.
There is a greater chance for a C-section delivery. Older moms have a higher risk of complications, which could result in the need for a C-section delivery. One such condition is placenta previa – in which the placenta blocks the cervix. Labor problems tend to be more common in first-time mothers older than 35.
The risk of chromosome abnormalities is higher. Babies born to older mothers have a higher risk of certain chromosome problems, such as Down syndrome. The age of the father at conception can also carry risks for birth defects. It is important to discuss these risks with your physician.
The risk of miscarriage is higher. The risk of miscarriage also increases as you get older, perhaps due to the higher likelihood of chromosomal abnormalities.
How to Prepare for Pregnancy
Taking good care of yourself is the best way to take care of your baby.
See your doctor for a pre-pregnancy appointment. Meet with your OB/GYN before you try to conceive to make sure your body is prepared for the task ahead. He or she will assess your overall health and discuss lifestyle changes that might improve your chances for a healthy pregnancy and baby. The preconception appointment is a great time to address any concerns you might have about fertility or pregnancy at your age or the age of your partner. Ask about the best ways to boost the odds of conception – and options if you have trouble conceiving.
Get regular prenatal care. During pregnancy, regular prenatal visits help your OB/GYN monitor the health of both you and your baby. Be sure to relay any signs or symptoms that concern you, even if they seem silly or unimportant. Talking to your doctor may also help put your mind at ease.
Nutrition counts. During pregnancy, you’ll need more folic acid, calcium, iron, protein and other essential nutrients. If you’re already eating a healthy diet, keep it up. Your doctor may prescribe a prenatal vitamin a few months before conception – to fill any nutritional gaps.
Watch your weight. It’s important to gain the right amount of weight to support your baby’s health. A weight gain of 25 to 35 pounds is generally recommended for women who have a healthy weight before pregnancy. If you’re overweight before you conceive, you might need to gain less weight. If you’re carrying twins or triplets, you might need to gain more weight. Your physician will help determine what’s right for you.
Stay physically active. Unless your doctor advises against it, regular physical activity can help ease or even prevent discomfort, boost your energy level and improve your overall health. It also can help you prepare for labor and childbirth by increasing your stamina and muscle strength. But, remember to get your physician’s approval before starting or continuing an exercise program, especially if you have any underlying conditions.
Steer clear of risky substances. Alcohol, tobacco and illicit drugs are off-limits during pregnancy. Clear any medications or supplements with your healthcare provider ahead of time.
Talk to your doctor about prenatal testing. Diagnostic tests such as chorionic villus sampling and amniocentesis provide information about your baby’s chromosomes or the risk of specific chromosomal abnormalities, but also carry a slight risk of miscarriage. Your physician can help you weigh this risk against the value you place in knowing the test results.
Embrace the positives.
After considering all of the risks of later-life pregnancy, there are also benefits to being more established in your career and personal life. As a woman over 35 you are likely to be in a more stable financial situation and feel more secure in your career. You and your partner have had a chance to get to know each other under a variety of circumstances and as a couple you are making a conscious decision to conceive a child together – a solid foundation for starting a family.
There is also some evidence that older mothers, who may be better educated than young mothers, make wiser parenting decisions. They’re more apt to breastfeed and, according to one recent study published in the Journal of the American Dietetic Association, are more likely to make healthier nutritional choices for their baby. Additionally, the careful attention a woman pays in her efforts to conceive and give birth to a healthy baby after 35, can have a lasting effect in the form of a healthy diet, exercise and life-style choices that make for a healthier mom.
Understand your odds.
About half of women over 40 have fertility problems, according to the American Society for Reproductive Medicine (ASRM). According to a leading fertility expert, once you pass 40, you have about a 5 percent chance of getting pregnant in any single ovulation cycle. At 40 your chance of conceiving within a year of beginning to try is about 40 to 50 percent, compared to a woman in her mid-30s, who has a 75 percent chance. By age 43, your chance of pregnancy drops to 1 or 2 percent. Even for women who use assisted reproductive technology (ART), the chances of conception are small when using their own eggs. One large study showed that, of women 44-and-up using in vitro fertilization (IVF) and their own eggs, only about 4 percent got pregnant, and 2 percent carried to term. With donor eggs, the chances are much better.
The good news is…
There has never been a better time in history to try to get pregnant as an older mother, given the range of ART techniques now available. Although IVF success rates fall significantly after age 35, the chance of success using donor eggs remains high, with a pregnancy rate of about 50 percent. For women in their 40s whose eggs are donated by a woman in her 20s or 30s, the risk of miscarriage and chromosomal problems is consistent with the age of the egg donor.
Special thanks to John D. Isaacs, Jr., M.D., a double board-certified fertility specialist at Mississippi Fertility Institute for his assistance with this article.
Resources: Mayo Clinic: “Pregnancy after 35: Healthy moms; healthy babies” July 2011 Baby Center, LLC: “Age and fertility: Getting pregnant in your 40s” August 2011 Discovery Health: “5 Tips for getting pregnant after 40” October 2012