6 Risks (+ benefits) of Advanced Maternal Age and How We Reduce the Risk

Uncategorized Mar 22, 2021

 

Being an older parent is awesome. If you’ve waited until later in life to start your family (like me) you’ve no doubt recognized some benefits, such as increased financial and emotional stability.

You’ve probably also heard some scary terms thrown around like “high risk” or advanced maternal age. I want to address some of the increased risks, while also empowering you with the knowledge of what you can do to mitigate or prevent them when possible. 

Advanced maternal age (AMA) is traditionally defined as 35 years old at the time of birth, but some research studies use the cutoff of 40 years and older, so the definition is somewhat fluid. 

Here’s everything you need to know about becoming an older parent, including some evidence-based information on the BENEFITS. 

*trigger warning, this article discusses stillbirth

 

1 — Ectopic Pregnancy

 

Risk:
Ectopic pregnancy is when a fertilized egg grows outside of the uterus. Everyone is at risk, we’re just at a slightly higher risk. One of the possible explanations is that the finger-like projections that move the egg from the ovary to the uterus (called cilia) sometimes don’t function as well as we age. 

Symptoms:

In about 50 percent of the cases, people present with vaginal bleeding in the first trimester. There are a lot of causes of vaginal bleeding in the first trimester, so it’s not an automatic diagnosis but certainly, something to reach out to your provider about — especially if you are also experiencing pain. 

What you can do:

Stop smoking, which damages the cilia everywhere in the body (you also have them in your lungs). The other thing you can do is be aware of the symptoms, and see your provider immediately if you suspect an issue.

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BENEFIT

Increased maternal age has been associated with improved health and development in children up to five years old.

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2 — Chromosomal Abnormalities

Risk:

As we age, the quality of the genetic material in our eggs degrades to some degree, putting us at a higher risk for chromosomal abnormalities. Just as with ectopic pregnancies, everyone carries a risk. If you’re 33 for example, your chances of having a baby with trisomy 21 (Down Syndrome) is 1 in 625, and 1 in 345 for all chromosomal abnormalities. By age 45, the risk jumps to 1 in 30 for Down Syndrome and 1 in 19 for all others. It’s at about age 38 and 39 when we cross into a greater than 1% risk.

What you can do:

We offer cell-free DNA screening, which is blood at 10 weeks or later in pregnancy that screens for certain chromosomal abnormalities. This is a screening — not a diagnosis — but it is the most accurate noninvasive test. For a true diagnostic, we have the CVS, or chorionic villus sampling, which can be done as early as 10 weeks, and the amniocentesis, which usually happens after 18 weeks. 

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BENEFIT

Children of older parents have described several benefits, including the devotion, patience, and attention of their parents, as well as their emotional and financial stability.

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3 — Hypertensive Disorders

Risk:

This refers to blood pressure problems such as hypertension, gestational hypertension, and preeclampsia. Blood pressure issues in pregnancy can go from not too serious to very serious, very quickly.

Symptoms:

It’s not uncommon to feel totally fine. But three main things we look for are (1) a headache that isn’t resolved easily (2) vision changes such as seeing double, having blocked spots or seeing stars, and (3) pain in your upper abdomen.

What you can do:

Low-dose aspirin can reduce the risk of preeclampsia in certain people. Talk to your Ob provider to see if you would benefit from this preventative measure.

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BENEFIT

In a study of Israeli women, they reported that women with late age birth — birth at age 45 years or older — had approximately 40% lower mortality risk compared with women whose last birth was before age 35. 

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4 — Stillbirth

Risk: 

This is the risk I hate talking about the most. Now, to put in perspective, there is a risk of stillbirth in every pregnancy. It does increase with age, particularly if it is your first baby, but even so, it remains less than 1 percent. So while this is an increased risk, I want to keep things in perspective. 

What you can do:

You may consider an induction of labor at 39 weeks. There is some data to support a decrease in stillbirth with induction at 39 weeks.  In a randomized trial in which people of AMA were put into two groups (one induced at 39 weeks and one waited) there was no increased risk of c-section, which for many is the main concern about induction. Bottom line, the decision is a personal one you should make with your OB provider. 

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BENEFIT

Older maternal age was associated with fewer behavioral, social, and emotional difficulties in children.

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5 — Diabetes

Risk:

The older you get, the more likely you are to develop diabetes outside of pregnancy (pre-existing) as well as in pregnancy (gestational). Metabolic syndrome and/or obesity, defined as having a BMI higher than 30, puts people at an even greater risk. 

What you can do:

One option is to pre-screen for diabetes in the first trimester, rather than waiting until 24 to 28 weeks. There is some data that shows a program of diet and exercise can help prevent gestational diabetes for people considered high risk, but it’s less compelling data for those with average or low risk. Supplementation with Myo-inositol has also proven helpful in preventing gestational diabetes for those who have a body mass index of 30 and above.

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BENEFIT

Researchers found that women who were able to have their last child after 33 are likely to live to 95. In fact, they have twice the chance to live to 95 than those who had their last child before their 30th birthday. 

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6 — Preterm Birth

Risk:

Pregnant people over 40 are at the highest risk of preterm birth, defined as babies delivered between 32 and 36 weeks. Extremely premature is defined as before 32 weeks.

Symptoms:

A gush or leak of fluid could signal that your water has broken. Contractions are also concerning, which could be felt as back pain that comes and goes. 

What you can do:

We know that there is likely an infectious or inflammatory component to preterm birth, so stay on top of any signs of UTIs or vaginal infections — both of which are common in pregnancy. I also personally feel everyone who is AMA should have a transvaginal cervical length at the time of their anatomy exam, which actually measures the length of the cervix. We know when we do this we can identify any shortening in the cervix and use supplemental progesterone to prevent preterm birth. This is not universally recommended, but if we had unlimited resources this would be something we would want to do because we have data that it helps. 

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BENEFIT

Although people with advanced maternal age are more likely to give birth preterm, the risk of neonatal death is actually lower in preterm babies born to people of advanced maternal age than that of babies born to people younger than 35.

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Putting it all Together

The trend worldwide is an increase in maternal age — so we’re all in this together. Hopefully having a better understanding of the risks, symptoms, and possible solutions help put your mind at ease. If you want more information, consider joining the Sterling Parent community where I go into much more detail through videos, articles, FAQs, and expert interviews.

 

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