Just a few decades ago, getting pregnant after age 35 was relatively uncommon. More recently, though, a growing number of women in this age group are having babies or trying to become pregnant. This is known as advanced maternal age pregnancy.
While the vast majority of these babies are born healthy, it’s important to know about the increased risks of pregnancy after 35 and how to prepare.
In this video, San Diego Health host Susan Taylor talks about advanced maternal age pregnancy with Daniela Gomez, MD, an OB-GYN who specializes in maternal and fetal medicine at Scripps Clinic, and Alex Fite, a genetic counselor at the Scripps Perinatology Program.
Much of the increased risk has to do with changes in the quality of a woman’s eggs as she ages.
“Even before birth, women have all the eggs that we’re ever going to have. Therefore, we progressively lose them as we get older,” says Dr. Gomez. “And there’s damage that can happen to the cells themselves, which then can lead to issues with decreasing quality.”
One concern involves the chances of the chromosomes in the egg being normal or abnormal. Chromosomes are the structures inside of our cells that contain all the DNA; normally, humans have 46 chromosomes in every cell.
A chromosome abnormality called aneuploidy occurs when an extra chromosome is present or one is missing. Aneuploidy is a type of condition that’s more likely to develop as a woman’s eggs age and become more prone to changes over time.
Still, Fite notes, “Even though the risk does increase gradually with age, it’s overall much more likely for any pregnancy to be chromosomally normal regardless of the mother’s age.”
In addition to chromosomal abnormalities, there are increased health risks for moms over 35. In some cases, the pregnancy forms outside of the uterus. This is known as an ectopic pregnancy and can be dangerous. Other complications, such as developing high blood pressure during pregnancy or needing a cesarean section, are more likely in advanced age pregnancies.
Because chromosome abnormalities can form up until the point of conception, there is no way to test an egg’s chromosomes before becoming pregnant. However, a type of testing called carrier screening can be done for both parents before they attempt conception. This blood or saliva test can determine if someone is a silent carrier for a condition that may be passed down in the family.
Once a woman becomes pregnant, tests can detect chromosome abnormalities. Starting at about 10 weeks of pregnancy, a screening blood test called cell-free fetal DNA or noninvasive prenatal testing (NIPT) can analyze DNA from the placenta and measure the makeup of certain chromosomes. It looks for Down syndrome as well as the more rare but severe trisomy 18 and trisomy 13 disorders.
Amniocentesis is another test that can be done after conception. This diagnostic procedure uses a needle inserted into the mother’s abdomen to withdraw an amniotic fluid sample, which is then sent to a laboratory to test for several different conditions.
Pregnant women who have increased risks may be referred to a perinatologist who specializes in high-risk pregnancies. The Scripps Perinatology Program encompasses a team of perinatologists, nurses and other professionals who specialize in high-risk pregnancies.
“We provide consultations and can also manage your pregnancy very closely with your obstetrician throughout to make sure that nothing is overlooked,” says Dr. Gomez. “We know that sometimes we are dealing with very sensitive conditions and our entire team is very empathetic.”
Additionally, genetic counselors at the Scripps Perinatology Program are available to meet with anyone who has a risk factor for a genetic condition or abnormal testing or ultrasound findings.
“We can discuss the significance of these findings and your options for testing,” explains Fite. “If you have genetic testing, we will interpret and communicate the results to you and help you understand all of this information.”
Dr. Gomez adds that while advanced maternal age pregnancy does have additional risks, women over 35 shouldn’t be discouraged.
“If you see us early on, we can help manage these risks. And we can get you through your pregnancy, both you and your baby, very safely,” she says. “Having a pregnancy later is becoming a lot more common and we’re here to help.”