When I was pregnant with my son, I was 33 years old. Now that I am pregnant with my second child, I have aged into the category of “Advanced Maternal Age”. This used to be known as a geriatric pregnancy. Doesn’t that sound terrible? The semantics changed to advanced maternal age, which I’m not entirely sure is better. In just a few short years, my age became a risk factor. This caused me a lot of anxiety at the beginning of my pregnancy. I started to look more at the research and what this actually meant for me. I used Evidence Based Birth website and the ACOG guidelines for guidance.
What’s the Risk of Miscarriage?
During my first trimester, I found I worried about the increased risk of miscarriage and genetic abnormalities with advanced maternal age. According to a Norwegian study, the risk of miscarriage before 20 weeks is 17% at the ages of 35-39 years of age. This is a jump from 11% between the ages of 30-34 years old. This pregnancy had a 6% increase in risk of miscarriage based on my age. This was scary to me. I know a lot of people who have had a miscarriage and I feared joining this statistic. I continued to count each week that went by as a win and used the website miscarriage odds reassurer daily to ease my anxiety.
There is also an increase in multiples with older moms. A woman is more likely to ovulate more than one egg each cycle, as she gets older. The American College of Obstetricians and Gynecologists (ACOG) recommends a first trimester ultrasound because of this. I had my first ultrasound at around 10 weeks. I admit that I was happy to only see one in there. Props to parents of multiples, but I struggled with one newborn my first time around.
What’s the Risk of Genetic Conditions?
Another thing often brought up with aging pregnant moms is the risk of genetic conditions. The most common being Down’s Syndrome or Trisomy 21. A live birth of a baby with Down’s Syndrome is 1 in 353 at the age of 35 compared to 1 in 939 at the age of 30. That does seem to be a pretty significant jump, but comparatively the risk really increases past the age of 40 with a 1 in 85 chance of having a baby born with Down’s Syndrome.
Other genetic conditions include Trisomy 18 or Edward’s Syndrome (1 in 3,000 live births), Trisomy 13 or Patau Syndrome (1 in 6,000 live births) and the most common sex chromosome syndrome XXY, Klinefelter’s Syndrome (1 in 500 live births). Due to this increased risk with age, the ACOG recommends genetic testing be offered to those >35 years old.
We decided to have the Non-Invasive Prenatal Testing testing done using the Maternity21 blood testing. We were excited to find the sex of the baby earlier than 20 weeks, but more relieved the genetic testing came back as unlikely to have any of the conditions it tested for. The ACOG also reccommends a detailed fetal anatomic ultrasound around 20 weeks. I am scheduled with Maternal Fetal Medicine for a detailed ultrasound next week. Hopefully, another milestone of good health is checked off next Friday.
What’s the Risk of Still Birth?
Still births are defined as a pregnancy loss after 20 weeks. One study from the Netherlands found that the rate of still birth in ages 18-34 was 0.17%. Between the ages of 35-39, it increased to 0.22%. The risk jumped to 0.81% in ages 40 and older. The risk was highest in those giving birth for the first time over the age of 40. With all pregnant people grouped together the highest risk of stillbirth occurs after 41 weeks gestation. Those 35 and older had the highest risk after 39 weeks gestation.
How does this relate to how older moms are managed? It probably won’t affect me as it would someone over 40 years of age. The ACOG recommends a third trimester growth assessment, fetal surveillance, and induction between 39-40 weeks, if labor does not start spontaneously in women over 40 years old. These decisions are not black and white. It may depend more on the individual and the medical provider.
What About Daily Baby Aspirin for Preventing Preeclampsia?
At my first prenatal visit, I was told that the ACOG recommended a daily low dose Aspirin for women over the age of 35 to prevent Preeclampsia. My midwife told me I didn’t have any other risk factors, so I could decide what I wanted to do. I decided to look up the risks and benefits of this.
The ACOG guideline criteria reccomends a Low-dose aspirin (81 mg/day) prophylaxis in women at high risk of preeclampsia. It should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks) and continued daily until delivery. Low-dose aspirin prophylaxis should be considered for women with more than one of the moderate risk factors for preeclampsia.
High Risk Factors for Preeclampsia:
- History of preeclampsia, especially when accompanied by an adverse outcome
- Multifetal gestation
- Chronic hypertension
- Pregestational type 1 or 2 diabetes
- Kidney disease
- Autoimmune disease (ie, systemic lupus erythematous, antiphospholipid syndrome)
- Combinations of multiple moderate-risk factors
Moderate Risk Factors for Preeclampsia:
- First Pregnancy
- Obesity (ie, body mass index > 30)
- Family history of preeclampsia (ie, mother or sister)
- Black race (as a proxy for underlying racism)
- Lower income
- Age 35 years or older
- Personal history factors (eg, low birth weight or small for gestational age, previous adverse pregnancy outcome, >10-year pregnancy interval)
- In vitro fertilization
When I read more into this, the only other moderate risk factor besides my age would be low birth weight of my first born. My son weighed 6 lbs, 5 ounces when birthed at 41 weeks and 3 days. I decided to look into if this was considered small for gestational age. According to the Merck Manual, boys weighing less than 6 lbs 9 ounces at 40 weeks are considered small for gestational age. I remember the doctor telling me at his birth that he was small and it could be due to placental insufficiency from being overdue.
With all of this in mind, I made my decision to start taking the daily aspirin. There is no known risk to taking the Aspirin and if it can help prevent possible issues, I felt like it was worth it for me.
How This Will Continue to Affect My Pregnancy
Overall, being over 35 hasn’t changed much in my prenatal care. I will continue to have some anxiety, because that is how I am by nature. There is not a lot of consensus on the treatment of women 35 and older. Talking to other women, I have found that decisions vary from one provider to the next.
I’m hoping that with the history of my previous birth experience, I will not require an induction if I go past my due date. I will be doing yoga and Spinning Babies exercises to try to get the baby into the most optimal position. I will get the more detailed ultrasound and I’ll take my daily baby Aspirin. I’m hoping that being a “geriatric pregnancy” will not affect my birth preferences. Daily meditations and wearing my Dainty Moon Healthy Pregnancy Bracelet has helped my anxiety.
I hope that this post was not triggering for anyone to read. Doing research and looking at the studies, helps me to make informed decisions and understand risks vs. benefits. At this point, I’m just taking it one week at a time and recognizing that people of all ages can have struggles. At the same time, statistics show that the majority of births are healthy and safe, despite the age of the birthing person. I’m going to stick with that statistic.