<p><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/pregnancy%20and%20heart%20disease%20body%20image.jpg" alt="" style="margin: 5px;"/>A</span></p><p><span style="font-family: helvetica;">As more women choose to have children later in life, pregnancy at 35 and beyond—sometimes referred to as "advanced maternal age"—has become more common. While many women over 35 have healthy pregnancies, it's important to recognize that age can bring some unique challenges. Understanding these risks can help women take the right steps to ensure a smooth pregnancy journey.</span></p><p><strong style="font-family: helvetica;">What is Advanced Maternal Age?</strong></p><p><span style="font-family: helvetica;">In general, advanced maternal age is considered to be 35 or older at the time of delivery. Some women in their late 30s are in the "advanced" category, while those over 40 are often considered "very advanced."</span></p><p><span style="font-family: helvetica;">More women are delaying childbearing today, often due to career, education, or personal reasons.</span></p><p><span style="font-family: helvetica;">While waiting longer has its benefits, like financial stability and emotional maturity, it also comes with some added risks.</span></p><p><strong style="font-family: helvetica;">Why are more women having babies later?</strong></p><p><span style="font-family: helvetica;">The trend of having children later in life has become more popular around the world. For many women, this is due to better access to education, more career opportunities, personal choices and advances in reproductive technology.</span></p><p><span style="font-family: helvetica;"> While it's great to have these options, it also means more women are facing the decision to start families in their late 30s or early 40s.</span></p><p><strong style="font-family: helvetica;">What health risks come with being an older mom?</strong></p><p><span style="font-family: helvetica;">While most women over 35 can expect a healthy pregnancy, there are some risks that become more common with age, these include;</span></p><p><span style="font-family: helvetica;">Hypertension and diabetes: Older women are more likely to have high blood pressure or diabetes, which can complicate pregnancy. These conditions are often linked to complications like premature birth or the need for a caesarean section.</span></p><p><span style="font-family: helvetica;">Difficulty conceiving: It's not uncommon for women over 35 to face difficulties when trying to get pregnant. As women age, fertility naturally declines due to a decrease in egg quality and quantity. For many, this means it can take longer to conceive, and some might need fertility treatments like IVF to achieve pregnancy.
</span></p><p><span style="font-family: helvetica;">Pregnancy loss: The risk of miscarriage increases with age, especially for women over 40. This is often due to changes in egg quality and hormonal fluctuations that can affect early pregnancy.</span></p><p><span style="font-family: helvetica;">Multiple pregnancies: Older women are more likely to have twins or other multiples, especially with fertility treatments. While this can lead to exciting news, it also comes with its own set of risks that need close monitoring.</span></p><p><span style="font-family: helvetica;">Placenta problems: Women over 35 are at higher risk for issues like placenta previa (when the placenta covers the cervix) and placenta abruption (when the placenta detaches early from the uterus). These problems are rare but can be serious.</span></p><p><span style="font-family: helvetica;">Caesarean section: Due to complications like high blood pressure or diabetes, older women are more likely to require a C-section to safely deliver their babies.</span></p><p><span style="font-family: helvetica;">Ectopic pregnancy: The risk of ectopic pregnancy, where the embryo implants outside the uterus, increases with age.</span></p><p><strong style="font-family: helvetica;">Are there fetal and neonatal risks associated with older mothers?</strong></p><p><span style="font-family: helvetica;">While maternal health is crucial, these risks to the baby are also important to consider:</span></p><p><span style="font-family: helvetica;">Chromosomal abnormalities: The likelihood of having a baby with conditions like Down syndrome increases with maternal age. This happens because as a woman ages, the eggs can experience more errors during division, leading to chromosomal issues in the baby.</span></p><p><span style="font-family: helvetica;">Preterm birth and low birth weight: Babies born to older mothers are more likely to be born prematurely or have a low birth weight. These babies often require more medical care after birth, but with modern healthcare, many thrive with the right support.</span></p><p><span style="font-family: helvetica;">Stillbirth: Unfortunately, the risk of stillbirth increases with age, especially after 35. Women over 40 face an even higher risk, particularly after the 37th week of pregnancy. However, it's important to remember that with the right prenatal care, the majority of pregnancies go smoothly.</span></p><p><strong style="font-family: helvetica;">Preconception care: What are the key to a successful pregnancy if over 35 years?</strong></p><p><span style="font-family: helvetica;">For women planning to conceive after 35, preconception health is critical. This is the time to get your body ready for pregnancy, which can help avoid complications. Here's what to focus on:</span></p><p><span style="font-family: helvetica;">Achieving a healthy weight: Being at a healthy weight reduces the risks of conditions like hypertension and diabetes, which are more common as you get older.</span></p><p><span style="font-family: helvetica;">Avoiding smoking and alcohol: These habits can seriously affect both fertility and pregnancy health, so it's important to stop smoking and limit alcohol consumption before trying to conceive.</span></p><p><span style="font-family: helvetica;">Taking folic acid: Folic acid is essential for preventing birth defects like spina bifida, so make sure you start taking it even before pregnancy.</span></p><p><span style="font-family: helvetica;">Managing existing health conditions: If you have conditions like diabetes or high blood pressure, it's important to manage them carefully before and during pregnancy to improve the chances of a healthy outcome.</span></p><p><strong style="font-family: helvetica;">Managing pregnancy at an older age</strong></p><p><span style="font-family: helvetica;">Pregnancy in your late 30s or early 40s does require more attention, but with the right care, many women enjoy smooth and healthy pregnancies. Here's what to expect:</span></p><p><span style="font-family: helvetica;">Routine prenatal care: Regular prenatal visits are crucial to monitor for conditions like high blood pressure, diabetes, and fetal growth issues, all of which are more common as you age.</span></p><p><span style="font-family: helvetica;">Ultrasound and testing: Early ultrasounds are recommended to estimate your due date and check for multiple pregnancies or abnormalities. Genetic screenings like non-invasive prenatal tests are also offered to screen for conditions like Down syndrome.
</span></p><p><span style="font-family: helvetica;">Gestational diabetes screening: Because gestational diabetes is more common in older mothers, it's recommended to get tested early in your pregnancy, especially if you have a higher BMI.</span></p><p><span style="font-family: helvetica;">Low-dose aspirin for preeclampsia prevention: For women with additional risk factors, low-dose aspirin may be suggested to help prevent high blood pressure during pregnancy.</span></p><p><span style="font-family: helvetica;">Fetal monitoring: Because older mothers have an increased risk of stillbirth, close monitoring of the baby is important. This may include regular ultrasound and more clinic visits.</span></p><p><span style="font-family: helvetica;">Timing of delivery: For women over 35, delivery is often planned for around 39 weeks to minimize the risk of stillbirth. Induction of labour may be considered earlier if there are other risk factors, like obesity or a history of stillbirth.
</span></p><p><span style="font-family: helvetica;">Labour induction: For women over 40 or those with significant risks, induction is usually recommended by 39 weeks. Waiting for labour to start on its own past 40 weeks is generally not advised due to the increased risks of complications.
</span></p><p><strong style="font-family: helvetica;">The takeaway: Embracing older parenthood</strong></p><p><span style="font-family: helvetica;">While pregnancy after 35 comes with higher risks, many women have healthy pregnancies and children. The key is to stay informed, maintain a healthy lifestyle, and work closely with healthcare providers to monitor risks. With careful planning and support, older women can successfully navigate the challenges of pregnancy and childbirth.</span></p><p><span style="font-family: helvetica;">For those considering starting a family later in life, it's also worth noting that children of older parents often benefit from the wisdom, financial stability, and emotional maturity that comes with age. However, it's important to acknowledge the challenges.
</span></p><p><span style="font-family: helvetica;">In the end, the decision to have a baby later in life is deeply personal, but with the right support, many women over 35 are having healthy pregnancies and thriving in their roles as parents.</span></p><p><strong style="font-family: helvetica;"><em>By Dr Joan Okemo, Consultant Obstetrician Gynaecologist at Aga Khan University Hospital Nairobi</em></strong></p>
