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Pregnancy: Past 40 lies fertile ground

Catherine McDiarmid-Watt | Sunday, September 30, 2007 | 0 comments

Is 40 the new 30?

Frankie Branham of Dallas had her only child, 10-year-old daughter Leta, when she was 40. 'I never worried about what I might have been missing in terms of my social life,' Ms. Branham says. If you keep up with this country's childbirth trends, you might think so.

Britney Spears' headlong rush into young motherhood aside, the face of the American mother is beginning to look increasingly middle-aged.

"Advanced maternal age" is the medical terminology applied to any woman who is 35 or older when she gives birth. Because women's fertility lessens with age, and the incidence of pregnancy complications and birth defects increases, waiting to start a family can be a risky proposition, and one that grows more precarious with each passing year.

Still, the American Society for Reproductive Medicine reports that approximately 20 percent of American women are waiting until after age 35 to have children. And despite the risks, more and more women are giving birth on the far other side of the 40-year milestone.

Though the numbers are still relatively small, data from the Centers for Disease Control and Prevention indicate that the number of mothers giving birth after 40 has increased by almost 70 percent in the last 15 years.

The odds

This isn't news to Dr. Karen Lee, a reproductive endocrinologist with Presbyterian Hospital's ARTS (Assisted Reproductive Technology Services) Program, who has noticed the trend in her own practice.

"People can certainly be pregnant after 40, but there are two major issues to contend with," she notes. "The first is trouble getting pregnant. Female fertility is largely age-based, and we are born with all the eggs we'll ever have. ... There's a much higher incidence of eggs that are genetically not capable of either fertilizing or implanting" as women age, she says.
"There's also a higher risk of miscarriage: 50 percent if you're 40."

Older moms-to-be who sustain their pregnancies can expect a slightly harder nine months than younger women, she adds. "The second issue is a higher incidence of complications such as diabetes and high blood pressure, as well as smaller babies and higher need for a C-section. But I tell my patients that for most women who are healthy, there's no reason why they can't be pregnant. It just takes more luck."

Count Melissa Finn among the lucky. The Lake Highlands mother of four had her first child at 34 and delivered her youngest three years ago, when she was 40.

"I had no trouble conceiving ever," she says.
"My last two children are 20 months apart. I keep waiting for this decreased fertility to kick in. I read these stories about plummeting fertility and how these people over 35 better watch it or their clock is going to run out, and I think I'm ready for my clock to beep, you know?"

Though she knew about the increased risks of a post-40 pregnancy, she says she didn't let the worries consume her.
"I guess in the back of your mind, you know that the statistics are worse for you in terms of birth defects and gene problems the older you get. But since I started late and had good luck three other times ... I was hopeful that was a good indicator for me."


Under the best of circumstances, pregnancy is a stressful time, notes Dr. Jorge Saldivar, an OB-GYN at Methodist Charlton Medical Center. Add advanced age into the mix and the normal physical issues are compounded.
"Pregnancy is tough physiologically," he says. "It's a big stress on the heart, the kidneys, everything. And as you get older, you're less resistant, so you're not able to tolerate it as well. You're more prone to diabetes, to hypertension, to placenta previa," where the placenta covers the cervix, "placental abruption," when the placenta separates from the wall of the cervix,
"and Caesarian delivery."

Older moms are also more likely to give birth to multiples, whether conceived with assisted reproductive technology or naturally, and advanced maternal age is a leading culprit in chromosomal abnormalities, the most common of which is Down syndrome.

While a 25-year-old woman has approximately a 1 in 1,300 chance of giving birth to a child with Down syndrome, the chance jumps to 1 in 365 at age 35 and 1 in 110 at 40. By age 45, the rate is 1 in 30. Routine testing such as nuchal skin fold measurements and the triple screen test can indicate the likelihood of a chromosomal disorder, and more invasive testing such as chorionic villus sampling or amniocentesis can be considered if warranted.

Each case differs

Still, most doctors agree that personal history is more important than age when it comes to childbearing.

"I hope the terminology of advanced maternal age disappears," says Dr. Ali Toofanian, an OB-GYN and maternal-fetal specialist at Presbyterian Hospital of Dallas. "It really depends on what type of patient you're talking about. A 27-year-old woman who smokes and drinks and doesn't take care of herself is much more of a risk to herself and her baby than a 40-year-old who does everything right and gets great prenatal care."

Despite his optimistic outlook on late-in-life pregnancies, he recommends that older women who are actively trying to conceive wait no longer than three to six months to consult a specialist if they don't get pregnant on their own. "You don't want to waste time at this age," he notes.

While the drawbacks are well documented, there are benefits to waiting later in life to have children, including a higher likelihood of financial stability and emotional maturity.

Frankie Branham of Dallas was 40 when she gave birth to her only child, daughter Leta, 10 years ago. "The nice thing for me about having her later was that I never worried about what I might have been missing in terms of my social life. By 40, I was quite happy to stay in," she says with a laugh, then turns serious.
"I have been able to appreciate every moment of motherhood and, for me, I think that is a byproduct of having her at an older age."

Mrs. Finn is thankful to have a rich history to share with her four offspring. "I can tell my children, 'I've lived there, I studied that, I did that ... and you can do it, too,' " she says.
"Had I gotten married and had kids in my 20s, I would be saying, 'I hope you go farther than I did,' and I'm not saying that."

While she allows that being a mom to a preschooler is more tiring now than when she was in her 30s, she also notes that it has given her the last word.

"When you're in the hospital with your baby, nurses tell you, 'Enjoy your baby; you can sleep when you're old.' And I said to them, 'I am old!' When you're 40, you do have a comeback for that one."


Talk to your OB-GYN before you begin trying to get pregnant. Start a regimen of prenatal vitamins, eat healthfully if you don't already and eliminate unhealthy habits such as drinking or smoking. If you have additional risk factors, such as diabetes, get those in check before trying to conceive.

Chart your temperature each morning using a basal thermometer to determine if and when you're ovulating. Menstruating regularly does not necessarily mean you're ovulating. If you have questions about tracking your basal temperature, ask your doctor.

If you have any reason to suspect you're not ovulating or don't get pregnant within a few months of actively trying, ask your OB-GYN about a referral to a fertility specialist. And don't overlook testing the father-to-be's sperm; not all infertility problems are traced back to the female.

Talk to your doctor about the increased incidence of chromosomal abnormalities and the various screening and testing options available to detect them. Be aware of the risks, but don't obsess about them. Even with the increased rate of Down syndrome, a 40-year-old mother still has about a 99 percent chance of delivering a healthy baby.

If you're 44 or older and are considering in vitro fertilization, consult a reproductive endocrinologist as soon as possible.

SOURCE: Dallas Morning News research

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About Catherine: I am mom to three grown sons, two grandchildren and two rescue dogs. After years of raising my boys as a single mom, I remarried a wonderful man who had never had a child of his own. Unexpectedly, I found myself pregnant at 49!
Sadly we lost that precious baby at 8 weeks, and decided to try again. Five more losses, turned down for donor egg, foster care and adoption due to my age and losses - we have accepted that there will be no more babies in our house.

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