Yes, congrats! If you are over 35 and pregnant you are of Advanced Maternal Age (AMA), and have what is known in the medical world as a “geriatric pregnancy.” I know, because I was pregnant at 37! And how about this one – “Elderly Multigravida.” That does not sound good. But wait. Multi means multiple, so a multigravida means “…second or more pregnancy in a woman who will be 35 years of age or older at the expected date of delivery.” For first time moms, we refer to them as a Primigravida or having a first-time pregnancy.
At 35 there is a definite decline in fertility and another big dip after age 40. Maybe you were lucky and got pregnant fairly easily, or maybe you went through years and tears, used fertility drugs, in vitro fertilization, and/or egg donation. Now, you are having a “geriatric” pregnancy.
What does it mean?
The truth is, now many doctors, midwives and NPs do not refer to all over 35’ers as “high risk.” The overall health of the mother is key. Your odds of a smooth pregnancy and delivery are good, but there are added risks to be aware of. It is true that as our eggs age there is a greater chance of genetic or chromosomal errors that can result in mild to severe outcomes for the baby, as well as miscarriage. Screening tests, such as ultrasound measurement of the fetus, or the new Non-Invasive Prenatal testing options, known as NIPT are available to determine if there is a higher risk for having a baby with a genetic or chromosomal abnormality.
NIPT is a test that looks for the baby’s cell-free DNA that’s in the mother’s blood! Amazing, right? These are over 99% accurate. If there are any concerns or the tests come back positive, then further diagnostic tests such as amniocentesis or chorionic villus sampling examining cells from the baby are recommended to provide solid information regarding Down Syndrome or other genetic conditions. Before and after age 35 your health care provider will probably recommend these screenings and tests.
Extra Joy & Possible Problems
Twins and triplets are more likely in your late 30s and early 40s according to a 2012 CDC report, as hormonal changes can cause the release of more than one egg at ovulation. Carrying more than one fetus raises the risks of early, low-weight, or preemie births, and increased complications with multiples can also lead to more C-sections.
Mothers-to-be of all ages should be aware of the symptoms and impact of both Pregnancy Induced Hypertension (high blood pressure), preeclampsia, which is a more severe type of high blood pressure, and gestational diabetes which do increase at 35 and again at 40.
The pregnancy hormones can impact a mom’s blood pressure. Preeclampsia is the presence of persistent high blood pressure that develops during pregnancy or the postpartum period, along with high levels of protein in the urine. Other signs include the development of decreased blood platelets, trouble with the liver or kidneys, fluid in the lungs, and abnormal vision and headache. Having used egg donation, in vitro fertilization, or donor insemination to become pregnant can also increase the chance of preeclampsia.
Gestational diabetes is often missed as many women have no clear symptoms, however, most providers are screening moms at the first prenatal visit, and later in the 2nd trimester. This form of diabetes develops during pregnancy and causes high blood sugar levels. Early blood sugar testing and the right diet and exercise can usually keep this under control.
Healthier You > Healthier Baby
Okay, I know this sounds like a lot can go wrong, but in all probability, you will have a successful pregnancy and delivery–even at your ripe (not so) old age. The risks of all of these conditions are increased, but that doesn’t mean that all moms will develop them, it’s just good to be more aware of what’s possible. Most moms do not develop complications, but if you do, regular prenatal visits will help ensure your health and the health of your baby.
I hope you are already taking prenatal vitamins with at least 800 micrograms of folic acid. Good nutrition, exercise, enough sleep, regular check-ups, and reducing stress all will help your body and mind be ready for the extra workout of pregnancy and delivery.