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Advanced Maternal Age: "What Do You Mean I'm Old?"

Pregnancy Journal

Birthdays are special. Most people celebrate them every year. They represent new life being brought into the world. But for some women, birthdays may also mark their entrance to the world of high-risk pregnancy.

One of the first conversations between an expectant mother and her health care provider includes the significance of her age. The topic has even sparked a national conversation through high-profile individuals like Carrie Underwood, who recently shared her thoughts on having a big family at the age of 35 in an interview with Redbook Magazine.

It comes with controversy, but it warrants discussion. Advanced maternal age is one of the most common reasons a woman’s pregnancy might be considered high-risk.


What’s considered advanced maternal age?

Advanced maternal age is basically a fancy way of saying pregnant at 35 or older. Keep in mind, though, that even if you’re not 35, you may still be considered of an “advanced” age by the standards associated with various pregnancy risks.

By definition, if you turn 35 on or before your due date, you’re considered of advanced maternal age. So let’s say your baby is due on your 35th birthday. And let’s say you deliver before that date. Yep, you meet the criteria.


How was advanced maternal age determined anyway?

Let’s clear the air here. You’re not “old” if you’re over 35. You’re not automatically doomed if you’re over 35 and pregnant. You’re just at a higher risk for maternal and fetal complications. While your risk steadily increases with age, it’s not a sharp spike once you reach the big 3-5.

So where did that number come from? Antiquated data suggests that it’s the age when a woman’s chance of having a baby with Down syndrome is the same as having a complication from amniocentesis – a test for chromosomal issues like Down syndrome. That’s it.

But a lot has happened in the world of obstetrics over the last 50 years. There are a lot of resources and information now available to those looking to grow a family in their mid- to late-30s

While there are risks associated with advanced maternal age, know this: It is possible to have a healthy pregnancy if you’re 35 or older.
 

Risks associated with age

Unfortunately, when you’re expecting a child or trying to conceive, age does matter. Again, while there is nothing magical about 35, it’s the age at which your doctor will want to discuss three types of risks with you.
 

Genetic risks

Genetic risks are more common in pregnancies of older women. One of the biggest risks we talk about with mothers 35 and older is the chance of carrying a baby with Down syndrome. As mentioned, that risk increases as a mother ages.

If you’re considered of advanced maternal age, it’s a good idea to sit down with a genetics counselor early in pregnancy – typically between 11 and 13 weeks.

At the Methodist Perinatal Center, this is the first thing we go over with mothers 35 and older. The goal is to give families as much information as they need to choose the genetic testing plan that best meets their needs.
 

Fetal risks

An ultrasound routinely follows the genetic counseling session. If a family chooses to undergo screening, the ultrasound often makes up a part of that. It’s also used to begin addressing the fetal risks in pregnancy.

Expect your doctor to evaluate early fetal anatomy, as every mother, no matter her age, has a 3 percent risk of giving birth to a baby with a congenital anomaly (birth defect, disorder or malformation). After the ultrasound, labs will be drawn to complete any testing.

Once results are available, the nurses or genetic counselors will follow up to determine what next steps are needed. If your results are normal, your next visit is usually around 20 weeks. If the opposite is true, rest assured that your health care team will work to make sure a plan is in place to meet your specific needs.

Additional fetal risks include:

  • Miscarriage
  • Abnormal growth
  • Stillbirth

Your perinatology team commonly recommends follow-up ultrasound exams to ensure that your baby is growing normally. We usually also recommend targeted stillbirth testing later in pregnancy.
 

Maternal risks

Routine prenatal care is designed to find medical complications of pregnancy, so it’s important that you continue to see your general OB/GYN.

Just as genetic and fetal risks tend to increase with age, so do many maternal risks such as:

  • Preterm birth
  • C-section
  • High blood pressure
  • Gestational diabetes

The specifics of any and all risks are different for every family. A key job of your perinatal team is communicating the one(s) most relevant to you.
 

Addressing all your fears about advanced maternal age

Having a baby can be scary. Having a baby at age 35 or older can be terrifying – especially with all the information, misinformation and headlines out there.

While there’s not much you can do about your egg count and quality, you can still be proactive in achieving the healthiest pregnancy possible.

Focus on what you can control (diet, exercise and avoiding toxins) rather than what you can’t. And consider meeting with a maternal fetal medicine provider. We understand your fears. We appreciate your concerns. And we view your birthday as one more special detail to better help us serve you.

Neil Hamill

About the Author:

Dr. Neil Hamill, a maternal-fetal medicine specialist at Methodist Women's Hospital Perinatal Center, chose medicine because it’s where he thought he could make a positive impact with his skill sets.

He enjoys balancing the maternal needs with those of the fetus in complex situations and specializes in using two, three and four dimensional ultrasound to identify fetuses at risk for genetic conditions, congenital anomalies and complications of growth.

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