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    Pregnancy and Childbirth Over 40: Expert Q&A

    1-5-2017 1-30-13 PM

    By Jennifer Clopton
    WebMD Health News

    Janet Jackson made headlines this week for having a baby at the age of 50. Very little is known about how Jackson got pregnant or delivered, but her announcement is garnering great interest – not just because of her celebrity, but also her age.

    The birth rate for women aged 40-44 first started increasing in the 1980s and more than doubled from 1990 to 2012, according to the CDC. The most recent CDC data from 2015 shows:

    • Birth rates for women aged 35–39 increased steadily by 13% since 2010
    • The birth rate for women aged 40–44 in 2015 was up 4% from 2014
    • The number of births for women aged 45 and over increased 5% in 2015

    So what sort of health challenges do older moms face – not only in getting pregnant but also in carrying a baby and delivering? WebMD asked Nwamaka O. Obi, MD, a perinatologist (OBGYN specializing in high-risk pregnancies) at Inova Fairfax Hospital in Falls Church, VA.

    WebMD: Does your practice see many older moms?

    Obi: More than 60% of our practice is over the age of 35 and probably about 25% is over 40. We’ve seen a steady climb in older moms over the last five to 10 years and we even saw these numbers increase last year over the year before. That rise is evident in research studies too.

    WebMD: What challenges might women over 35 face when trying to get pregnant?

    Obi: There is an increased risk of infertility as you get older. There’s also an increased risk of miscarriage. Between ages 35 and 44, the risk of miscarrying increases up to 40% and over the age of 44 it can be as high as 50 or 60%. You’re more likely to have chronic medical conditions as you get older too, so things like hypertension, obesity and diabetes can certainly complicate pregnancy for older moms as well.

    WebMD: Are the challenges the same no matter your age, or do they differ between women ages 35, 40, 45 or even 50?

    Obi: The challenges do increase as you age. We tend to group older mothers into three groups – 35 to 40, 40 to 45 and 45 and above — and we see risks increase in the older groups, with the highest increased risk of the conditions I mentioned earlier in the oldest mothers — 45 and above.

    WebMD: What is different about pregnancy for older moms?

    Obi: Most complications associated with pregnancy increase significantly as you get older. That includes miscarriage, pre-term delivery, risk of cesarean delivery, risk of stillbirth, growth restriction (in which the baby doesn’t grow as much as it should), preeclampsia, hypertensive disease (high blood pressure-related conditions), diabetes in pregnancy, placenta previa (where the placenta covers the cervical opening), and placental abruption (where the placenta detaches from the uterus).

    WebMD: Is childbirth more difficult for a woman over 40?

    Obi: Yes. We see an increased risk of labor dysfunction and an increased need for cesarean delivery. Cesarean deliveries are also increased [because of] other complications associated with pregnancy at this age such as preeclampsia, growth restriction, and diabetes.

    WebMD: What health concerns might you have for a baby born to a woman over 40?

    Obi: There is an increased risk of chromosomal abnormalities like Down syndrome. There is also a higher risk of congenital anomalies such as cardiac defects. The number of multiple gestation pregnancies (twins/triplets) also increases. Multiple gestation pregnancies are associated with an even higher risk of some of the complications already mentioned. The risk of multiples is increased by advancing age and also use of assisted reproductive techniques.

    WebMD: What other issues do you talk about with older moms before childbirth?

    Obi: We discuss their health status before the pregnancy and at the time of pregnancy. Many adverse outcomes are not only related to age itself but also to pre-existing medical conditions. Women who are normal weight, who exercise and are healthy, have better outcomes. Being in your best health improves outcomes tremendously.

    WebMD: Taking care of a newborn and young children can be exhausting. Do you have any advice for older moms once they have made it through childbirth?

    Obi: I advise them to have a good support network and to ask for help when needed. Many first-time mothers do not anticipate or realize how much work it is to take care of a newborn. They are not really thinking of the future outside of pregnancy. Some of my patients will sometimes say after they’ve delivered that they didn’t realize how exhausting it is to break up your sleep cycle.

    WebMD: Are there any additional emotional concerns for women over 40?

    Obi: Women who have underlying psychiatric illness are at risk of worsening after pregnancy. Some research even says that there may be an increased risk of postpartum depression in women over 40, however this has not been substantiated.

    I actually find older couples are generally more emotionally mature and financially stable. Many can afford extra care for their babies in the form of a night nurse or nanny. This then takes some of the stress of a new baby away from them.

    WebMD: Any particular advice you give to over-40 women who are expecting?

    Obi: In addition to talking about risk factors, exercise and staying healthy, we stress the need for good follow up and ultrasound evaluation of the pregnancy and making sure they are with a physician that is aware of potential risks. I also talk about aspirin supplementation because it’s been shown to decrease the risk some complications like preeclampsia and growth restriction during pregnancy.

    While there is a fair amount of daunting news, in the end a lot of older women achieve pregnancy and do well. It’s really about preparing for it, knowing what you’re in for and how this may take a toll on your body and having the right medical professionals take care of you. I tell women, the good news is they are having a child and for many they have waited years for this or didn’t think they could achieve it. After doing a lot of deliveries for older women I can tell you they are very excited. Becoming a mother when you thought it wouldn’t happen in your lifetime really does bring a lot of joy.

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    The opinions expressed in WebMD Second Opinion are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. Second Opinion are... Expand

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