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LATE CHILDBEARING GUIDE

 

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A Little Background

Today, more and more couples are starting families later in life.  Most women in their mid-30s and older have healthy pregnancies and healthy babies.  However, there are still concerns as to whether their health will affect their ability to become pregnant, their own health as well as the health of their babies.

By the year 2000, it is thought that about 1 in 12 babies will be born to women aged 30 years and older.  There is no absolute age that is unsafe for women who want to become pregnant.  

People age physiologically bit by bit, not all at once.  Some people are very unhealthy at age 30 and some people are very healthy at age 40.  

In fact, with the added help of advances in obstetrics and genetics, this has further opened the door for women to have safer pregnancies in their late thirties.

Everyone of us has a different aging process.  However, with the current interest in health, nutrition and fitness, many men and women may find themselves in better shape than they were at a younger age.

Fertility

There is no exact age at which women become less fertile.  All women experience some decrease in fertility.  However, at the age 35, there is a precipitous drop in the ovarian reserve of good eggs. Men also have a decrease in fertility as they age.  

One reason where women become less fertile is that ovulation or the release of an egg from one of the ovaries, occurs less often as a woman gets older.  Also, the older woman’s eggs are not as good or easily fertilized as a younger woman’s egg.   There may be a host of other problems of infertility which may crop up, one of which is infection or endometriosis affecting the fallopian tubes.  

In 1% of couples, there are no known cause of infertility.  So if you are young and have been trying for more than one year, no matter your age, it is best to see a doctor as soon as possible.  However, if you are a bit older, you do not have the luxury of time to wait until the one year is up.  

The earlier you see the doctor or if you have had a gynaecological problem before you get married, for example, a surgery in the pelvic area, an appendix operation, infection of the Fallopian tube or urine/hormonal problems, you might want to see a doctor even earlier than the usual one year of self-attempt.  

The earlier you see the doctor, the earlier your solution will be solved.  If after the age of 40, even if we find a solution we may not be able to solve the problem due to the inherent poor ovarian function.

Health Problems

As women age, they may encounter certain medical and gynaecological problems.  Hence, it is advisable for them to start a family at a younger age.   Some women have pre-existing conditions such as high blood pressure or diabetes.  These pre-existing conditions before the pregnancy will put greater demands on the woman during her pregnancy and the complications are much higher for these women.  

They are likely to require more frequent hospital visits, more shared medical management, more longer stays in hospitals and more special tests.   High blood pressure per se will pose higher risk to both mother and child.  These include problems with the placenta and the growth of the baby.  

Women above 35 are also more likely to have had diabetes before the pregnancy or they may develop diabetes during pregnancy (gestational diabetes).  They are at a greater risk of the baby growing too large (macrosomia).  They are also more likely to develop high blood pressure and miscarriages.  They may have to be delivered by Caesarean Section.

Miscarriage

Miscarriage is a loss of the pregnancy which occurs in about 15-20% of all pregnancies.  It is often the body’s way of dealing with the pregnancy that is not going on developing normally.    It is again more common in the older women.

Still Birth

Stillbirth, that is, the birth of a baby who has died before birth also occurs more common in women over the age of 35.   Older women are also more likely to have infants of low birth weight.  

Caesarean Birth

Again Caesarean birth is more common in women who have had their first child after 35. Doctors rely on taking a good history from the couple. We need to perform a thorough physical examination, as well as do procedures and tests to help these pregnant ladies. But please note, that couples with risks factors can also have normal healthy children.  They need to be informed of their risks and discuss their plans and problems with their doctor.  This way, proper care can be given before they get pregnant.  These include patients with epilepsy, blood disorders, cancer and thyroid disease.  

Being Prepared

It is important to have a full gynaecological examination before pregnancy, including a pap spear and an ultrasound scan to exclude any organic womb problem.  It is also important to complete all the vaccinations including Rubella, Hepatitis-B, Varicella and HPV vaccination.  

Those who are planning to have a baby should not take any unnecessary herbal medication or any x-rays for whatever reason without informing the doctor.  Any time you see a doctor for any reason, please inform your doctor that you are planning to have a baby and the doctor will take the necessary precaution to give you the drugs that are safe for early pregnancy cases.  It is also important to start taking folic acid as soon as you are planning to have a baby.  Dental checkup is also crucial in the prenatal preparation for pregnancy. 

Pre-pregnancy care is always a good idea, especially if you have underlying medical problem like diabetes, hypertension, thyroid disease or blood disorders.  It can prepare a couple emotionally and physically to become parents.  Genetic counselling can also give parents an idea of the risks involved if they are indeed having a genetic problem.

Preconception and Prenatal Care

Good health before you become pregnant, sometimes called preconception care, will help you through your pregnancy.  Because your health is so important at this time, you could discuss your plans of pregnancy with your doctor.  This provides a chance to find any risks and treat any medical problem that you may have.  The doctor may also make suggestions for any special tests you may need.  Medical problems such as diabetes, high blood pressure, renal failure and epilepsy should be under control before a woman becomes pregnant.

Many women do not know they are pregnant until several weeks after they have conceived.   These early weeks are some of the most important for the babies because it is at this time that the organs are formed.  Cigarettes, alcohol and drugs can interfere with normal growth whereas good nutrition and healthy habits can help promote it.

Early and regular prenatal care, that is, care before the baby is born may increase a woman’s chances of having a healthy baby.  If you have any medical problems or genetic defects that might affect your baby, this should be found early.  If you start prenatal care early and visit your doctor regularly many problems can be prevented or controlled.

Birth Defects

Many children are born healthy.  Some women though have a greater chance of having a baby with a birth defect.  These include women aged 35 and older and those who have had a close relative or child with a birth defect.  The cause of the birth defect is not always known.  Some are passed on from the parents (inherited), some may be caused by factors in the environment but most are caused by an error in the growth of the egg or sperm.  

Having extra or missing part of chromosomes usually cause serious problems.  Most children born with chromosomal disorders such as Down’s syndrome are mentally retarded in addition to having physical defects.  The chance of birth defects increases with age but still it remains low well into the late thirties.

Genetic Counselling

Genetic counselling can help couples be aware of their chances of having a child with a birth defect.  It can also help to show a pattern of inherited genetic orders if one exists.  

Genetic counselling involves a detailed family history, along with a physical examination and some lab tests.  The results will help the counsellor determine the couple’s chances of having a baby with a birth defect.  

Counselling is done by doctors, nurses or health educators with special training in genetics.   Genetic counselling is advised for women above the age of 35 or older or couples who already have a child with a birth defect and couples with a family history of genetic problems, birth defect or mental retardation.  

If your doctor feels that your chance of having a child with birth defect is greater than average, he or she may advise genetic counselling.  This allows you to assess your risks and make an informed choice before having a child.

TESTS

Various tests can help detect disorders before, during and after pregnancy.   Advances in medicine have made having a child safer, reducing the risk of women with problems in pregnancy.  Because older women are more likely to have certain problems, they are more likely to have tests done to detect them.  Testing for genetic problems are offered to women who are 35 and above when the baby is due.  You may want to discuss the pros and cons of having these tests done with your doctor.

1) Amniocentesis

In amniocentesis, a small sample of amniotic fluid (the fluid in the sac that surrounds the fetus) is withdrawn from the mother’s uterus for testing.  This procedure can help detect certain birth defects in the fetus during pregnancy, such as Down Syndrome and many other genetic conditions.  Amniocentesis is usually done at 16-18 weeks of pregnancy.  It may be done even earlier in some cases.

2) Chorionic villus sampling (CVS)

With CVS, a small sample of cells is taken from the placenta.  It is tested in a lab for abnormalities.  CVS is done earlier in pregnancy than amniocentesis.

3) NICC (non-invasive chromosomal check)

This is a simple blood test taken from the mother whereby chromosomal abnormalities in the baby can be detected.

Types of Genetic Testing

1. Preconception Genetic Testing This tests will detect whether parents are carrying genes that can be transmitted to a baby causing the child to develop a genetic disorder. 

2. Pre-Implantation Genetic Screening A sample of cells is carefully extracted from a fetus in early pregnancy to determine if there is any genetic abnormality present. 3. Pre-Natal Genetic Screening This is a test to see if the baby itself has a genetic disorder.  More recent methods such as non-invasive prenatal diagnosis (NIPD) allow for less invasive screening with

3. Pre-Natal Genetic Screening This is a test to see if the baby itself has a genetic disorder.  More recent methods such as non-invasive prenatal diagnosis (NIPD) allow for less invasive screening with lower risk of the pregnancy. Each type of screening is not 100% accurate.  So there is a possibility that the baby can be born with a genetic disorder despite the negative result.

Personal Issues

A woman having her first child in her mid-30s or older may be faced with issues besides her health and that of her child.  She may be used to having control of her life but complete control of a pregnancy is not possible.  It may take longer to become pregnant than she thought.  When the baby arrives, her life will change.  

She will have to make choices in order to balance career and family and make room for the time the baby demands. On the other hand, an older woman may feel sure that she is ready to have a child.  She may be secure in her career, have more personal and financial resources, and be more prepared to meet the demands of raising a child.

Finally …

Most women have healthy pregnancies and normal babies.  Many older women show no greater signs of problems than younger woman.  If you want to have a baby, discuss any concerns you might have with your doctor. Pregnancy and childbirth can be exciting, rewarding events.  Age need not be a barrier to the enjoyment of a safe, happy experience for both new mother and new father.

 

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