Pregnancy among women age 35 or older has been on the rise in recent years. While moms giving birth in their late 30s and 40s are becoming more common, they still face increased risks.
In this video, San Diego Health host Susan Taylor talks about pregnancy after 35 with Erica Berggren, MD, an OB-GY at Scripps Clinic La Jolla, Scripps Clinic Encinitas and Scripps Clinic Hillcrest. Dr. Berggren specializes in maternal fetal medicine.
Pregnancy after age 35 is known as advanced maternal age pregnancy or, less commonly, geriatric pregnancy. While age itself can raise the risk of complications during pregnancy, the mother’s underlying health also plays a role. Conditions that tend to increase with age, such as cardiovascular disease, high blood pressure, autoimmune conditions and diabetes, can pose new risks to a pregnancy.
The potential risks of pregnancy after age 35 fall into two categories: risks to the baby and risks to the mother. Some risks affect the health of both.
High blood pressure or hypertension, for example, can raise the risk of a complication called preeclampsia. This can make it difficult for the baby to grow, a condition known as fetal growth restriction. In addition, preeclampsia may raise the mother’s risk of seizures. Women with preeclampsia require extra monitoring during pregnancy and may need to deliver their baby earlier than expected for their own health and their baby’s.
Gestational diabetes, or diabetes that develops during pregnancy, is another common concern among older moms. The placenta that supplies nutrients to the growing baby produces hormones that can interfere with insulin production, leading to poorly controlled blood sugar. As the mother’s blood glucose levels rise, her excess blood sugar is passed on to the baby. Gestational diabetes raises the risk of preeclampsia and significantly increases the baby’s insulin production, weight and risks of breathing problems and obesity.
If you are 35 or older and pregnant, what can you do to help promote a healthy pregnancy?
“One of the most important things is to see a health care provider early on, whether it's a physician, a nurse practitioner or a midwife,” says Dr. Berggren. “An early ultrasound is important for all pregnant women.”
If a woman is referred to a perinatologist — a physician who specializes in high-risk pregnancy care — she may have a detailed ultrasound, often called an NT ultrasound, between about 11 and 14 weeks.
“We’re measuring a small space in the back of the baby’s neck called the nuchal translucency, which in conjunction with other assessments can give us more information about a pregnancy’s risk of being affected by Down syndrome or many other chromosome or developmental differences,” explains Dr. Berggren.
“Genetic testing also gives women options. For instance, we can draw maternal blood anytime after about 10 weeks and assess the risk of that pregnancy being affected by Down syndrome and a handful of other genetic diagnoses.”
An assessment of the baby’s growth around 28 and 34 weeks may be recommended to identify any potential concerns and order additional testing if needed.
If a concern is identified on these types of screening tests, a woman may be offered prenatal diagnostic testing, such as amniocentesis or a chorionic villus sampling (CVS). These are procedures that only a perinatologist or maternal fetal medicine physician is trained to do, but they don’t always indicate a problem.
“Just because we do some additional testing or follow up does not mean these women should expect anything other than a healthy baby if there’s anything we can do to help them achieve that,” Dr. Berggren adds.
Through the Scripps perinatology program, women who have higher-risk pregnancies can receive detailed ultrasound exams and counseling to outline a plan of care in conjunction with their health care provider. Perinatologists are available for questions and concerns throughout the pregnancy and to update recommendations if new concerns arise.
“Women 35 years of age or older often walk into our office with a lot of misconceptions or fear, but most of these women can and should have a healthy pregnancy,” says Dr. Berggren.