I have been bombarded at my office recently with information about the risks of pregnancies in women of “advanced maternal age”, also known in obstetric lingo as “elderly parturients”, a term I consider particulary offensive. I do not consider a woman who is pregnant after the age of 35 as elderly.
I have cared for a significant number of women over the age of 35 during the years I’ve been a midwife, and have become increasingly frustrated with the modern obstetrical approach to this age group.
There is nothing magic about the age of 35 that predicts a higher risk pregnancy. Women don’t turn 35 and experience some dramatic biological change in their bodies, placing them at higher risk. The medical community settled upon the age of 35 as the indication to step up dscreening for genetic disorders because it was the age at which the risk of a miscarriage caused by an amniocentesis done for diagnosis of chromosomal disorders was equal to the risk of having a baby with Down syndrome. Nothing mysterious happens in your body when you turn 35. This age was chosen pragmatically, based on statistics.
Another pet peeve of mine is the assummption that all pregnant women over the age of 35 are in need of incresed “surveillance” during pregnancy. This generally includes the recommendation for multiple genetic screening tests, such as the quad screen and PAPP-A, followed by an amniocentesis. In addition, many providers recommend that the woman of advanced maternal age take a baby aspirin daily (to prevent pre-eclampsia, though aspirin not been proven to have any protective benefit), have twice weekly non-stress tests after 32 weeks of pregnancy, and monthly ultrasounds. Many providers are also recommending induction of labor at 39 weeks, “just in case” anything might go wrong after that point.
Recent studies have indicated that women over the age of 35 or 40 (depending on the particular study) are at higher risk for complications of pregnancy, not just increased risk of a baby with Down syndrome. However, some studies have concluded that this risk is more likely a result of prior health problems in women who become pregnant.¹
As we age, we cannot be as careless with our bodies as we can in our teens and twenties, without noticing adverse effects. Ideally, all pregnant women would be in good healthand physically fit before conceiving, and would take optimal care of themselves during pregnancy. The reality is that many women will not start pregnancy in excellent health, and complications they experience during pregnancy may very well be a result of their health condition prior to pregnancy.
Sophie was a 42-year old client of mine, pregnant with her fourth child. Though this was an unplanned pregnancy, Sophie was in good shape. She exercised regularly, maintained optimal weight, and ate a balanced diet of whole foods. Due to the protocols of the office where I work, I was required to review with Sophie the standard medical recommendations for a pregnant woman of her age. Sophie balked at the suggestion of multiple tests, pills, and ultrasounds. ”I am very healthy, and would prefer to be treated that way unless there is an indication of a problem during my pregnancy,” she stated. “I don’t want any routine tests. If I have a problem, I will consider tests at that time.” She paused. “Do you think that is an irresponsible approach?”
I told Sophie I thought she had a lot of common sense, and I would support her in declining increased testing based on her age alone.
I have cared for numerous pregnant women over the age of 35, and those who made the effort to begin pregnancy in optimal health, and continued to make choices to maintain excellent health throughout their pregnancy, had uncomplicated pregnancies and births. Modern obstetrics could better serve women of advanced maternal age by stressing preventive health measures before and during pregnancy, than the “bandaid” solution of aspirin and frequent testing currently offered. The increased level of stress and fear that accompanies being subjected to frequent testing and pills may cause more problems than it prevents.
Common sense tip for today: Whether you will experience complications during pregnancy has less to do with your age, and more to do with how you take care of yourself before and during your pregnancy.
1. Schutte JM, de Jonge L., Schuitemaker NW, Santema JG, Steegers EA, van Roosmalen J. Indirect maternal mortality increases in the Netherlands. Acta Obstet Gynecol Scand. 2010 Jun;89(6):762-8.