Fighting the Clock: The Risks of an Older Pregnancy
Tick tock, tick tock. Postponing children carries elevated risks. Before you opt for a baby past your child breaing prime, here’s what you need to know.
Joanna* stared at the monitor as her unborn baby's heart rate crashed. It was 5 a.m., and the first-time mother was exhausted: She'd been in labour for almost 20 hours and was only dilated one-and-a-half centimetres. Things weren't progressing. Suddenly, everyone in the room began shouting as doctors rushed to prep the 38-year-old for an emergency C-section.
When Joanna married her husband, Ahmet, in 2011, they wanted to start a family right away. She was worried her age would be an issue. But she conceived naturally two months after their wedding, and all the tests came back better than fine. There was no way to anticipate what was going to happen: Joanna's placenta began prematurely separating from her uterus wall. It's a condition known as placenta abruptio and can cause profuse bleeding during delivery. Cut off from vital nutrients, Joanna's baby was asphyxiating. The condition is relatively rare, but like so many complications related to childbirth, its likelihood increases as a woman grows older. The caesarean was successful, and a daughter-Ayla-was born healthy. But it could have gone very badly. Hemorrhaging could have sent Joanna into shock, endangering her vital organs. As for Ayla, the doctors' quick response likely saved her from dying in utero; by quickly removing Ayla and the placenta, they rescued both mother and child.
All of this was news to Joanna. "No one really told me that my age could affect the pregnancy so dramatically," she says. She's not alone. Today, one in five Canadian women are giving birth in their late 30s and early 40s. Joanna hadn't intended to wait so long; she just happened to be that age when she found her husband. But many women have put off marriage and parenting to more firmly establish their careers. The choice involves risks that, to the frustration of doctors, are going increasingly unheeded. Suzanne Tough is professor of pediatrics at the University of Calgary. For the last decade she has researched the effects of advanced maternal age and is troubled by women making irrevocable decisions about child-bearing without knowing all of the facts. "Our studies show the only bad outcome many people recognize is Down's syndrome," says Tough. And while it's true older mothers are four times as likely to conceive baby with a Down's syndrome baby, "that's just one risk," says Tough. There are a host of other medical complications.
Along with facing higher odds of placenta abruptio, older women are twice as likely to develop placenta previa, where the placenta blocks the cervix, putting the mother in danger of bleeding to death. Older women are also at increased risk of pre-eclampsia, a condition related to high blood pressure which can cause strokes and seizures as well as affect the flow of oxygen and nutrients to the baby. The biggest threat to the child is premature birth, also known as preterm birth (in which a baby is born at least three weeks ahead of time). "People seem unaware of what preterm can mean," says Tough. Because their bodies are underdeveloped, preterm babies often have problems with breathing and heart function. They also have an elevated risk of cerebral palsy, cognitive difficulties and impaired hearing and vision.
*Last name withheld for reasons of privacy. The above image is not the real Joanna.
It's a worrisome list. But for a woman over 35, just getting pregnant is the ultimate hurdle. "Most women know that fertility decreases with age," says Dr. Anick Bérard, who heads a research team at the Sainte-Justine Research Centrr in Montreal, "but they don't realize how much and how quickly." A recent study of fertility knowledge conducted by researchers at the University of British Columbia found that over half of the more than 3,000 childless women surveyed were unaware that they were born with all of the eggs they will ever produce. The quality and quantity of those eggs shrink as a woman ages. At 20, a woman has about a 25 percent chance of getting pregnant after a month of regular unprotected sex. At 30, that figure drops to about 22 percent, and at 40, as low as 5 percent.
"Women often think they have more time than they do," says Emily Koert. A doctoral candidate at UBC, Koert was involved in the fertility knowledge survey (and has contributed to the public awareness website MyFertilityChoices.com). Koert says that images in the media of older mothers combating age with forms of assisted reproductive technology like in vitro fertilization (IVF) can be misleading. While there's no doubt it's the answer for many couples-recent numbers from the Canadian Fertility and Andrology Society reveal that, in 2011, over 3,000 babies were conceived in Canada through IVF. However, the effectiveness of the treatment decreases dramatically with age: For women under 35, the success rate is 40 percent, yet over 40 it drops to just 12 percent. "The success stories make it seem like IVF can make up for age," says Koert. "But you don't hear about the failures to conceive. Women keep that grief hidden."
Joanna considers herself blessed to have been able to conceive naturally, even if the birth was difficult (older moms are 44 percent more likely to have caesarean deliveries). Today, Joanna sits in the living room of her north Toronto home, a wide-eyed, seven-month-old baby in a pink onesie squirming on her knee. She admits it's been hard. "We used to think we would have a second baby," says Joanna. "But now that I know all the statistics and risks, to have another child at our age feels like we might be pushing our luck."
1. Maintain a healthy weight: Studies show that about 12 percent of infertility cases are the result of obesity or extreme thinness.
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2. Take folic acid: Daily doses of 400 to 800 mg of folic acid beginning a few months before conception and lasting all the way through pregnancy have been shown to greatly reduce the chances of major birth defects like spina bifida.
3. Limit alcohol intake: Drinking by male or female partners has been shown to affect conception rates.
4. Visit your doctor: A pre-conception visit to your GP is a good idea. He or she can review your medical history and identify any elevated health risks, and also make sure that any medication you are taking will not interfere with the health of your pregnancy.
Oocyte cryopreservation works by flouting a women's biological clock. It allows women 31 and younger to store their eggs in liquid nitrogen for later use (the eggs can be kept on ice for up to ten years). The procedure comes at a price, both physical and financial. Multiple hormone treatments are required to generate the eggs need for harvesting, followed by minor surgery to extract them. The cost is around $5,000, plus the yearly egg maintenance fee. "It's an option," says Suzanne Tough, professor of pediatrics at the University of Calgary, "but it's far from an easy answer."