This post is a slight departure from my prior posts as I have been inspired to discuss an excellent article in New York Magazine by Lisa Miller, published September 25,  2011 entitled “Parents of a Certain Age”. Ms. Miller’s article thoughtfully addresses the pros and cons of having babies later in life, especially the social issues and biases. I urge you to read it if you are ‘older’ and pregnant, it is easily found if you ‘google’ it. It provides some great food-for-thought, as well as some reassurance that babies of older parents very often do VERY well. I don’t intend to address the larger social issues in this post since I certainly couldn’t do it as well as Lisa Miller already has, but I do think that readers on this site might be interested in a discussion of the risks for you and your baby if you are one of these mothers of ‘advanced maternal age’ (known as AMA).  Meanwhile, feel free to post any of your thoughts about ‘older’ moms and dads using the ‘COMMENTS’ tool. It could be a very interesting thread!

For most women, the biggest risk of being of advanced maternal age is the INability to get pregnant. Every day in practices around the country, women struggle with fertility issues at ever increasing rates. This is often because they have been trying to conceive but they are now in their mid-thirties or older. It is a sad but unswerving fact of life that it becomes harder and harder to have successful pregnancies as women age, and unfortunately this begins as early as age 30-32.  This won’t be a discussion on infertility since this site is dedicated to post-conception, but needless to say, it is an issue. But it is an issue that is quickly being overcome for many families, and certainly, society as a whole is seeing a drastic increase in the numbers of ‘AMA’  parents.  The article mentioned above quotes some impressive statistics:

• The median age of first-time mothers has been steadily increasing with every decade, now up to 30 in parts of Europe, 25 in the U.S., and 27 in  New York State.
• In 2008 (the most recent data available), there were 8000 babies born in the U.S. to women 45 years and older. This is more than TWICE the number of babies born to the same age group in 1997.
• Of the 8000 quoted above, 541 were born to women 50 years and older.  This shows an astounding 375% increase compared to 1997.

Does being 35, 40, and even 50 truly make you “high risk”? And if so, what exactly are the risks?? When conception and pregnancy has occurred in an ‘older’ woman, there are some increased health risks that they need to be aware of.

• After 35, the risk of pre-term labor rises 20%. Pre-term labor and birth poses serious risks to the baby of physical and cognitive impairments, and potentially even death.
• After 40, there is an increased risk that the mother will suffer pre-eclampsia, which is a pregnancy-induced increase in blood pressure, the consequences of which can threaten the health and survival of both mother and baby, especially if a pre-term birth is required. Additionally, the risks  of gestational diabetes rise.
• After 40, the risk of autism is noted to be increased by 30%.

And it’s not just you, Mom! Studies have repeatedly demonstrated that there are also risks associated with advanced PATERNAL age.  Miscarriage rates are higher, as are the rates of autoimmune disease, childhood cancers, schizophrenia, and other psychiatric disorders. Autism rates are noted to be at a 50% increase when fathers are over 40, which is surprising since the maternal rate is lower at 30%.

AMA and risks for Chromosomal abnormalities:

It is no secret that the risk of having a baby with Down’s Syndrome increases with maternal age. By age 35, the risk is approximately 1 in 271, which is still a pretty low risk. However, it is at this point that the medical community feels the risk of a chromosomal abnormality is now greater than the risk of doing invasive testing with amniocentesis or CVS (at least in the United States. The threshold in the UK and Europe is 38). With the advances in screening tests and availability of amnio or CVS, diagnosing Down’s Syndrome in older mother can easily be done, IF she so chooses. For some older women, the ability to detect and diagnose Down’s in pregnancy is an important consideration, allowing them greater peace-of-mind in choosing to get pregnant. Click the bold for a full discussion about screening for Down’s and other chromosomal abnormalities.

An interesting fact:  When the mother is 45 or older, Down’s Syndrome is rare since nearly all of those pregnancies are conceived using donor eggs of much younger women. Again, the term ‘AMA’ refers to all women 35 or older, but we all know plenty of women between 35 and 40 who have very successful, healthy pregnancies. In my opinion, AMA really should mean women over 40. I think most of us find it really hard to think of a woman who is 35 to 40 as ‘old’, and certainly, we don’t think she’s too old to get pregnant. But within just a few years, once women reach 40, and especially after 42, clinical experience shows that our biology really begins to fight us in our attempts to reproduce. Infertility and miscarriage rates soar exponentially with each single passing year after 40. Even if conception occurs, it is very likely to be blighted or ceases to develop within the first 8 weeks. Yes, babies born to women over 40 have a much higher chance of being chromosomally abnormal, but it is the minority of pregnant women who even manage to progress beyond the first trimester, very likely due to the increased rate of chromosomal problems that are lethal to the developing fetus.  Early miscarriages far outweigh the number of normal AND chromosomally-abnormal babies  that women over 42  carry to term. It’s not the women themselves-many women over 40 are plenty fit and healthy enough to carry the pregnancy, but their eggs are just not up to the task. For these women, the best chances of a successful pregnancy can be achieved with donor eggs.

Meanwhile, there is a whole new option opening up to women who anticipate delaying parenthood; it is possible to freeze your eggs while you are young (before 30) to use when you are older. But, freezing a woman’s eggs is nothing like the simple act of obtaining and freezing sperm since it requires rounds of hormone injections and an invasive egg harvesting procedure. It is done at great expense and increases the risk of ovarian cancer, with no guarantee of successful egg thawing, conception, and implantation of the resulting embryos years later. This is a provocative subject begging greater discussion, BUT, I digress and will stick with the post-conception focus of the site. Again, feel free to start a discussion using the comment tool.

THE GOOD NEWS…!

After reading the information above, one might think having babies after 40 is full of risk and gloom. However, there are some studies which show that there are real biological up-sides to having babies later in life.

The relationship of Advanced Maternal Age and Intelligence:

Many older parents worry that their age puts their child at risk for intellectual impairments. Aside from the increased risk for autism, a study done at the University of Iowa yielded some very reassuring results. They tested the cognitive abilities and IQ’s of children born through IVF (in-vitro fertilization) and arrived at an interesting finding: On the whole, IVF kids scored better than their peers in all categories, and there was a direct correlation between maternal age and IQ.  To quote directly, they found that “the older the mother, the greater the kid performed.” It is unclear if this is due to some unknown biological factor, or if it is the result of the fact that parents over 40 tend to be better educated, wealthier, and perhaps better able to provide an enriching environment. Either way, it is a reassuring statistic.

Potentially increased life-spans:

One of the biggest arguments detractors make about people in the 40′s or 50′s having babies is that they might not survive to see their child into adulthood. Boston University did a study in centenarians and found that “women who gave birth after the age of 40 were four times more likely to live to 100 than those who didn’t.”  Why? There are probably multiple reasons, but one possibility is that the greater physical activity required to keep up with the demands of raising children translates into better health. However, this may be putting the cart before the horse- it may be that the people who have successful pregnancies in their 40′s and 50′s are physically strong and fit to begin with.

This brings me to a final point about the risks and complications associated with pregnancies at ‘advanced ages’.   In Ms. Miller’s article, she points to a saying fertility doctors have that: ‘there’s 50, and then there’s 50.’ Many 45-50 year old women today are as fit, vibrant, productive, and healthy many of their younger peers.  In fact, they are the among the fastest growing age-groups in  triathlons, and women in this age group are enjoying financial success like never before. On the other hand, there are at least as many  women who suffer from obesity, high blood pressure, and are on the path to type II diabetes. Pregnancy in this subset of women is going to be fraught with potential for complications, NO MATTER YOUR AGE.  Whether you are 25 or 45, your general state of health and lifestyle BEFORE you take on pregnancy can play a large role in the outcome.