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CHILDBEARING IN LATER YEARS

Delayed childbearing has become a common phenomenon as a result of social, educational and economic factors. With older mothers, however, come special considerations.

During pregnancy, the body undergoes considerable changes, like increases in blood volume and cardiac work and significant water retention. These changes may not be as well tolerated by older women with fewer reserves and a higher incidence of underlying medical conditions.

Several studies looking at pregnancy outcomes in women over age 40 found that they were two-to-three times more likely to experience hypertension in pregnancy, gestational diabetes and placental abnormalities. There is also an increased risk of miscarriages (three-fold), fetal congenital anomalies (two-to-three fold) and fetal chromosomal (nearly 10-fold).

It’s important to note that the higher rate of stillborn fetuses were seen primarily among women over age 40 who smoked throughout pregnancy—the risk was three times higher than young, non-smoking women. Besides smoking, other risk factors for poor pregnancy outcome are: increased pre-pregnancy weight (over 160 lbs), pre-existing medical complications and having had a previous pregnancy with a poor outcome.

Many individuals with pre-existing medical problems should see an obstetrician for pre-conception counseling. Furthermore, for patients receiving fertility treatment, specific issues related to multiple births should be considered in light of the increased cardiovascular demands of twins and triplets.

After conception, mothers who have had multiple gestations should be seen early in pregnancy to discuss the various options of prenatal diagnosis to identify genetic abnormalities. Later in gestation, fetal well-being testing has been shown to decrease the risk of stillborns, especially as pregnancy approaches 40 weeks gestation and beyond.

HEALTHY PREGNANCY TIPS

To maximize the chances of a good outcome, it is important that modifiable risk factors be addressed prior to conception. A general medical check up should be performed before a woman over age 40 attempts to conceive. If high blood pressure, diabetes or other problems are identified, correcting those abnormalities through medications or changes in lifestyle, could further improve the chances for a healthy pregnancy. For those who are overweight, beginning a weight-loss program prior to conception could decrease some complications. Similarly, smoking and alcohol abuse are all important risk factors that should be discontinued prior to pregnancy.

Adiel Fleischer, M.D., is chairman of obstetrics/gynecology at North Shore University Hospital and LIJ Medical Center.

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