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Are you 35-plus and pregnant?

With good prenatal care, even a late pregnancy can be well managed

Sanjana and her husband were married late. She is 36 years old and is planning to go ahead with a pregnancy. Smriti and her husband, on the other hand, have been married for the past 7 years. She has conceived now after treatment for infertility. She is 37 years old. Shyamala is 35 and pregnant for the second time. Her first child is 13 years old. Will being 35 or older cause a problem in a pregnancy?

Social changes and career pressures are resulting in more and more women having children later in life. Most women over age 35 have healthy pregnancies and healthy babies. The anxieties and concerns which plague all pregnant women are magnified when a woman has a child later in life. It is therefore important for a couple to be aware of the risks involved and stay informed of the consequences of a late pregnancy.

Age and fertility

It is true that women have more difficulty in getting pregnant as they grow older. A woman in her mid-30s or older may take longer to conceive than a younger woman. At the same time, women over 35 have a greater chance of having twins.

Risk of miscarriage

At any age, most miscarriages occur in the first three months of pregnancy. The rate of miscarriage in older women is significantly greater than that in younger women. This is mainly because of the increasing risk of chromosomal abnormalities.

Pre-existing health problems

At any age, when planning a pregnancy, a woman should consult her obstetrician before trying to conceive. A preconception visit helps ensure that she is in the best possible physical condition before conception. Diabetes and high blood pressure are two conditions which are common in Indians and much more common in women in their late 30s and 40s. Moreover, women over 35 are twice as likely as women in their 20s to develop high blood pressure and diabetes for the first time during pregnancy. Careful medical monitoring is required and the appropriate medications must be started before conception and continued throughout pregnancy. This can reduce the risks associated with these conditions and, in most cases, result in a healthy pregnancy.

Risk of birth defects

The risk of bearing a child with chromosomal disorders increases as a woman ages. The most common of these disorders is Down syndrome, a combination of mental retardation and physical abnormalities caused by the presence of an extra chromosome 21. At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 30, a 1-in-1,000 chance; at age 35, a 1-in-400 chance; at age 40, a 1-in-100 chance. It is important for all women to undergo testing for Down syndrome but it is particularly essential for women who will be 35 or older at the time of delivery.

Risk of pregnancy complications

While women in their late 30s and 40s are likely to have a healthy baby, they do face more complications along the way. It is important to keep in mind that many of these risks can be managed effectively with good prenatal care and most women will have a happy outcome. Women having their first baby at age 35 or older are at an increased risk of having a baby who has a low birth weight or is premature (born at less than 37 full weeks of pregnancy). Women over age 35 are 20 to 40 per cent more likely than younger women to have a baby who has a low birth weight and 20 per cent more likely to have a premature delivery.

The placenta is the interface between the mother and child. The baby receives oxygen and nutrition from the placenta through the umbilical cord. Women over 35 have an increased risk of placental problems. The placenta may not function well and may result in poor growth of the foetus. Foetal growth has to be monitored carefully both with regular checkups and ultrasound scans.

Problems in labour and delivery

First-time mothers over 35 are more likely than women in their 20s to have difficulties in labour. This may account, in part, for the increased rate of caesarean sections among women over 35. First-time mothers over age 40 have the highest chance of having a caesarean section.

Reducing the risks

Most women in their late 30s and early 40s can look forward to having a healthy pregnancy and a healthy baby. However, given the special concerns about pregnancy past age 35, it is especially important for older couples to seek preconceptional counselling from their obstetrician before embarking on this very important step in their lives.

GITA ARJUN

The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues

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