More women are putting pregnancy on hold—but what about the risks?
About 40 years ago, women began advancing their careers first, having babies second.
For decades, that trend has continued but some medical experts are saying the risks associated with being older may outweigh the financial stability.
Known to the medical community as advanced maternal age, the trend began in the 1970s, during the women’s rights movement, says Diana Behling, Obstetrics Right program manager for Sentara Healthcare.
“Back in the 1950s, 1960s and into the 1970s, women went to high school and got married. If they went to college, they became either teachers or nurses. Then, for many, once they had children, they stayed home to take care of them,” Behling says.
The baby boomer generation then had daughters who explored other career fields with more options and demands. Those women in turn now have their own daughters, who are continuing to move up the career ladder, says Mary Ann Graf, vice president of women’s and children’s services for Bon Secours Health System in Richmond and Hampton Roads.
“There is a difference between boomers and women today because there was less opportunity for the boomers. Now that there are more opportunities, women are putting their careers first and not just motherhood, but also marriage later,” Graf says.
She cites statistics showing the average age for women to marry has risen to 28 up from 25 in the past 10 years.
But while job opportunities for women have changed during the past 50 years, the body has not. Women who become pregnant after age 35 are likely to be considered “high risk,” which may impact their children as well.
Graf does say there are some slight risk differences between women who had a baby after age 35 several decades ago versus today, in that the former likely had several children already.
“No matter how old you are, if you are having your fifth, sixth or seventh baby, then you risk more complications with your pregnancy. So the woman who at age 42 is having her ninth baby probably had complications not just because of her age, but it was also her ninth pregnancy,” Graf says.
More advanced medical technology now helps manage those risks, she adds.
Unique challenges
The first challenge begins with conception, because the body is producing fewer eggs, says Dr. Susan Lanni, an associate professor in the Department of Obstetrics and Gynecology, director of Labor and Delivery and interim director for the Division of Maternal Fetal Medicine for Virginia Commonwealth University Medical Center in Richmond.
“Infertility can be a problem,” says Lanni, who knows this firsthand. She had her son, Asher, now 2, when she was 42 years old. She admits wanting to get her career started before having children.
However, with the development of in vitro fertilization in the early 1980s, many more couples have overcome fertility issues. In vitro fertilization and the increase of advanced-maternity mothers go hand in hand. They not only are more likely to need it, but because of their career advancement, are more likely able to afford it, Graf says.
Then there are issues with aging eggs and chromosome defects, which can cause Down syndrome and other genetic disorders.
For the pregnant woman, there is an increased risk of hypertension, gestational diabetes, placenta problems, still birth and premature birth.
Women considering a later-in-life pregnancy can have a successful one, but experts stress the process takes planning that starts before conception.
What to expect
Women considering pregnancy after age 35 should not smoke and should maintain a healthy weight, advises Graf. Any chronic illnesses, such as diabetes, should be under control.
Behling says good preconception care also begins with building a cooperative bond with a doctor.
“You really want to have a relationship with your doctor so that you are working together in a partnership,” she says.
Once conception has occurred, early prenatal care is important. Medical screening such as chorionic villus sampling (CVS) can be done very early, around ten to thirteen weeks into the pregnancy to help predict abnormalities. This test is not routine, however, for older mothers it may be recommended by their doctor. Although many abnormalities cannot be treated, Behling says CVS allows the family to make a decision to terminate the pregnancy or continue based on their beliefs.
Early prenatal care also can detect such issues as hypertension and gestational diabetes so that they can be managed and lead to a successful pregnancy, Behling says.
An ultrasound should be performed around 12 weeks of pregnancy. Lanni says that while an ultrasound will reveal much about the fetus, it may not determine if the baby is physically and mentally healthy. “It can show the structure of the organs, such as the brain, but it does not show how it is functioning,” she explains.
Advanced maternal aged mothers are strongly advised to have an amniocentesis when they reach 15 to 20 weeks of pregnancy, Lanni adds. Although this is not a requirement, it can detect genetic disorders and chromosome abnormalities to better prepare the parents if there are such issues.
Twins are also more likely for those who conceive after age 35, according to national statistics. As eggs age, they become more likely to split, creating identical twins. At the same time, in older women more than one egg is likely to drop from the Fallopian tubes, and this can lead to fraternal twins.
Advanced maternal aged moms can plan to make many trips to the obstetrician’s office for appointments. Graf says it is important to plan ahead for the multiple doctor visits, as well as the financial toll of being away from work.
“Because of the increase risk of preeclampsia, a woman should be prepared not to work during her last month of pregnancy. Many want to work right up to their last day, but they at least plan to either take the last month off or work from home,” Graf says.
At any age, pregnancy is ‘no less exciting’
Crystal Flynn, 40, is pregnant with her second child. Her first, child, Gabrielle, was delivered when she was 38. Flynn suffered a couple of miscarriages prior to her successful pregnancy with Gabrielle. Once the problem was determined, she and her husband, a physician, turned to in vitro fertilization. However, her second baby was conceived naturally.
Flynn represents many women who waited until the time was right.
“I married my husband when we were both 29,” she says. “He was in residency at the time, and residents do not make a lot of money. I was a manager of a pharmaceutical lab. I wanted more stability before we had a baby.”
While there are physical risks to waiting, there are some benefits.
Advanced maternal aged mothers have certain advantages: For example, they are more likely to listen to their doctors and not miss appointments, says Behling.
“Advanced maternal aged moms never miss an appointment, and they will stand on their head if we tell them it makes a successful pregnancy. They approach their pregnancy more informed. They have a strong [sense] of self,” she says.
Life experiences have shaped these women, Graf says. “Many of these moms are well educated and it spills over to their children. For example, the vocabulary of their preschoolers are usually through the roof.”
That holds true for Flynn’s family. Not only does her two-year-old have an advanced vocabulary, she can count to 20 and identify letters of the alphabet.
But most importantly, no matter when a woman chooses to have a baby, Behling says every hopeful mother-to-be is experiencing a lifetime event that “is no less exciting”—whether at age 25 or 35.