Older motherhood offers benefits, problems

Study: Later maternal age for a woman’s last child may indicate greater longevity

A study published in Menopause, the journal of The North American Menopause Society, suggests that later maternal age for a woman’s last child may indicate greater longevity for the mom.

While it is yet unknown if the ability to naturally achieve a later pregnancy indicates a healthier woman or if the later pregnancy causes a longer life, it is still an interesting finding.

Most news for older moms is not as positive. For many reasons, it is ideal for the health of moms and babies for mothers to become pregnant younger; however, life does not always happen that way.

“From what we know so far, if you’re 35 or older, it presents more challenges and you’re at greater risk for birth defects, premature birth, getting pregnant with multiples and complications in pregnancy,” said Darcy Dryer, director of maternal and child health for March of Dimes across the region from Buffalo, Rochester to Syracuse.

She said one of the reasons behind the uptick in complications is that many women as they hit their mid-30s are more likely to have chronic health problems such as diabetes, hypertension and high blood pressure. Fertility also begins to decline.

Dryer encourages women who want to have a baby to get healthy before getting pregnant. “Everyone should try to get healthy, but if you’re hoping to have a baby, these things carry more weight. Get a pre-conception health check up at the OB-GYN and manage any chronic health conditions.”

If left untreated and unmanaged, chronic health conditions can contribute to more problems; however, the age of the mom also matters. A woman’s eggs are formed when she is developing as a baby in her mother’s uterus. She is born with all the eggs she will ever have. New eggs do not develop. The eggs age along with the woman, so with many women, eggs fertilized at age 37 are more likely to have suffered age-related degradation than those fertilized at age 27. To an extent, her lifelong health habits do play a role in the health of her eggs.

Physician Ahmed I. Ahmed is an assistant professor with University of Rochester and is board-certified in both clinical genetics and genomics and obstetrics and gynecology. He works with at-risk pregnant women. He said that a major risk of later conception is “having a baby with a chromosomal abnormality, mainly Down Syndrome, trisomy 13 and trisomy18. The higher the age, the higher the risk.”

According to the National Institutes of Health (NIH), most children with trisomy 13 die before their first month of life and survivors commonly experience lifelong disabilities and complications, including breathing issues, deafness, feeding problems, heart failure, seizures and vision problems. Those surviving infancy may also have intellectual disabilities and developmental delays and higher risk for cancer. The NIH describes trisomy 18 as a chromosome disorder that can cause a hole in the heart, wasting syndrome, permanent flexion of the finger and cognitive impairment.

Ahmed added that mothers above 40 also have higher risk for preeclampsia, gestational diabetes, premature labor, premature rupture of membranes, labor problems, post-partum hemorrhage, labor problems, and prolonged labor.

While some younger mothers experience complications and it is impossible to eliminate risk during pregnancy, it is helpful for any mother to take care of herself prior to and during pregnancy. Ahmed said this includes achieving a healthy weight before conception as well as managing any pre-existing conditions.

“If she’s diabetic, or has thyroid problems, she should have strict control of them at least three months before the pregnancy,” Ahmed said. “Optimal control of health problems before pregnancy will be a major factor in improving the outcome of pregnancy.”

He also recommends a healthy lifestyle, including avoiding tobacco use, alcohol, contraindicated prescription and over-the-counter drugs and street drugs.

Exercising regularly before pregnancy and as advised during pregnancy, along with taking prenatal vitamins support healthy pregnancy.

“See your provider for prenatal appointments,” Ahmed said. “Mental health is very important. If she has anxiety, depression or if she’s on any medication, she should discuss it with her primary care provider as not all are safe with pregnancy.”

Birth defects can occur even before a woman knows she is pregnant, so pre-conception care is vital.

Ellen Derby, certified birth doula, post-partum doula and breastfeeding counselor in Clifton Springs, has worked with numerous mothers near or over age 40. The oldest was 45.

“It generally goes pretty well,” she said. “I think for women — whether 22 or 42 — it’s always good to practice good nutrition, maintain good health and get some movement and chiropractic in your life.”

She urges women to choose their provider wisely.

“If you have a doctor who views you as ‘older maternal age’ and they assume because of that you will have complications, it may help you to find someone who’s supportive and doesn’t think there will be complication upon complication upon complication despite your good health. Some are 40 and unwell and some are as healthy and active as at 29 because they have a good weight and are healthy.”

She said that most moms near 40 experience more fatigue while pregnant and after delivery, so resting more is important; however, at this age her parents may be elderly and not as able to help them. Hiring a post-partum doula may help, as these professionals assist the mom with caring for the baby and light housekeeping right after the baby is born. At this point in her life, a near-40 mom is likely better financially situated to afford the help, compared with when she was in her 20s.

They may lack the energy of the 20-something mom, but older moms are more likely to have more patience and maturity to cope with the nearly overwhelming changes a new baby brings to a household.