The process of becoming pregnant at age 35 or older can be overwhelming, and the information about the risks and considerations extensive. I know this because I am a 41-year-old woman who is currently embarking on my own fertility process, not having seriously anticipated having to do so.
It has been an emotional, and at times harrowing, process that includes researching, learning things about my body I thought I knew but really didn’t, talking to myriad experts, and having to be flexible about my perfectly (and naively) laid plans for pregnancy and delivery.
There is a lot of information available about becoming pregnant at an older age, but that doesn’t mean it is easy to process all of it in relation to one’s own experiences. Every case is different. As I began to push myself to be open and honest about my journey, I encountered more and more women who are in the same predicament: sifting through the mounds of information and statistics, sorting emotional baggage, and coming to terms with related expenses and changes to life plans. I wanted to share what I’ve learned, in hopes of helping to cut through some of the noise.
The beginning age for an advanced maternal age pregnancy is not standardized but has typically been defined by the medical community as 35 years old, based on the risk of fetal Down syndrome increasing at this point. Other studies have defined advanced maternal age as 40 or older, and a category of “very advanced maternal age” has been proposed for those older than 45 or 50, depending on the study. Given preexisting conditions, the increase of fetal abnormalities, and egg quality and quantity, “advanced maternal age” is usually synonymous with “high-risk.”
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Just the mere mention of a high-risk pregnancy by an OB-GYN could mean specialists, special care needs, disruption of birth plans, and decreased chance of home delivery. Although this may be for safety’s sake, these dynamics can make someone feel like their autonomy is minimized. It can potentially impact lifestyle and finances of families. And as a patient, not being prepared for such consequences can also be scary and daunting—which, in turn, can cause negative effects, including higher blood pressure, higher blood sugar, and worsened mental health.
To be sure, the statistical consequences for older patients becoming pregnant should not be ignored or diminished. The American College of Obstetricians and Gynecologists (ACOG) states that if a patient is older than 35, they are more likely to develop high blood pressure and other related health problems for the first time during pregnancy. Diabetes and gestational diabetes are also top concerns for women over 35. Additionally, older persons should be aware about the increased risk of fetal disabilities like Down syndrome. According to ACOG, the risk of having a baby with a chromosome problem potentially resulting in developmental disabilities is 1 in 525 at age 20; 1 in 385 at age 30; 1 in 200 at age 35; and 1 in 65 at age 40.
Some of these concerns, if not managed, can be factors that contribute to maternal mortality—especially when they intersect with factors like race and geographical location—which is rising in the United States while declining around the world. When such chronic health conditions intersect with factors like race and geographical location, the statistics are sometimes worse than most developing countries. And as we age, our medical histories become more complex, we are exposed to more environmental toxins, and our health problems tend to amplify—meaning that such complications, which can occur at any age, can have more dangerous effects for older patients.
Dr. Shannon M. Clark is a double board-certified obstetrician and gynecologist and maternal-fetal medicine specialist, focusing on the care of people with either maternal or fetal complications. She is also an associate professor at the University of Texas Medical Branch in Galveston. Most of the patients Dr. Clark treats are considered high-risk, many over the age of 35; she herself intimately understands both the fear and risks that come from being labeled high-risk. When she was over the age of 40, Dr. Clark became pregnant—with twins, no less. She learned that even as a high-risk OB-GYN, she had to defer to, and trust, her care team to help make the best decisions. Because of her unique experience, she works to give a voice to those who have experienced pregnancy after age 35 and to be a source of reliable information for those who anticipate starting a family later in life.
She says age alone can constitute a high-risk pregnancy and that older women have a greater probability of having pre-existing conditions that can be exacerbated. However, she said, “It doesn’t necessarily mean you have to see high-risk specialists unless your condition necessitates it.”
Dr. Clark reminds patients that there are options available to access the required medical support but also for them to have less medicalized pregnancy and birthing experiences. Having monitored health issues, such as diabetes or high blood pressure, does not always necessitate additional care specialists like perinatologists; rather, it is a case-by-case situation.
“There are more and more options for delivery for example, and it doesn’t always have to feel like a sterile environment,” she told Rewire.News.
However, she said, safety should always be top priority: “It is crucial for you to do what you need to do for your health and the health of the baby; you have to sometimes make sacrifices.”
Making sound decisions for your situation, she argues, can be a source of empowerment. She also cautions against making medical assumptions based off information that may not be factual—like things you find on the internet, for example—and stresses that building trust with, communicating, and relying on your care team is best practice.
The general medical opinion seems to be that best practice and protocol is to treat the pregnancy of those over 35 as high-risk, even if they are in great health. But this does not automatically mean that it dictates involving additional specialists, costly care, or an upheaval in the life of the patient. Genetic and chromosomal testing should be a part of the care a patient of older age receives, so they can be prepared to make any necessary decisions. They should also be prepared to be flexible with any care plan and ready for any of the common complications associated with being an older pregnant person.
Experts and patients do agree that if a person wants to have children and has not by the time they’re in their late 20s and early 30s, even if they aren’t ready, it is imperative that they find out what they should do to become pregnant. The first step would be to schedule an appointment with their gynecologist, tell their provider they want to discuss what steps to take to become pregnant, and identify any potential issues and barriers. Sometimes having a standard “well-woman” exam and regular visits to gynecologists are not enough to identify impediments to pregnancy, and sometimes the patient has to be persistent. If they’re unsatisfied with the results after six months to a year, they should consider seeking a fertility specialist.
Learning about the considerations and possible threats to a healthy pregnancy, and managing them, can be very overwhelming. Every case is different. But it is important for a patient to be educated on those risks and treatment options, and to create a pregnancy and delivery plan with their physicians and care team. Doing so can help individuals feel empowered and affirmed to make decisions about their care.
In the end, Dr. Clark urges patients and families to take age and potential health concerns seriously but encourage them to be optimistic—as a high-risk pregnancy does not always mean a worst-case scenario.