Most women over 40 have a healthy pregnancy and healthy baby. However you will be offered increased monitoring during pregnancy as there are some added risks to consider.
***Key Points***
The most common terms used to describe a woman who is pregnant over 40 years are ‘advanced maternal age’, “late or older’ pregnancy. We have elected to use the term ‘pregnant over 40’ instead.
You may have conceived naturally at around 40, 1 in 10 women are likely to be able to, or you may have achieved pregnancy using reproductive technologies, either way congratulations…there is lots to look forward to!
When you are pregnant in your 40s your antenatal care will be much the same as someone younger. However, research suggests that women pregnant over 40 are at a higher risk than younger groups of developing some pregnancy complications.
However there are some things that may occur more commonly in older mothers such as: miscarriage, gestational diabetes, high blood pressure, placenta praevia and premature labour.
There may be an increased chance of miscarriage, your baby having chromosomal changes and interventions such as caesarean section. You will likely be offered more tests and your pregnancy may be more closely monitored.
***Key Points***
***Antenatal care and screening***
Many women pregnant over 40 are in excellent health and most will have a healthy pregnancy and a healthy baby. Your Midwife or Doctor will discuss with you your previous health and any pre-existing illnesses and as with any pregnancy you will be offered regular antenatal visits to monitor the health of you and your baby.
However, research suggests that women pregnant over 40 are at a higher risk than younger groups of developing pregnancy complications.
Your care provider may offer tests for genetic conditions such as Down syndrome, as older mothers have a higher chance of conceiving a baby with Down syndrome , around one in 100 at 40 years of age, and by age 44 the chance of having a baby with Down syndrome is one in 30.
These are tests you can have but none are compulsory – they are a personal choice.
You may be offered screening tests which indicate there is a higher chance your baby may have a condition. The non-invasive prenatal screening test (known as NIPT) is the most accurate screening test for chromosomal changes and involves a blood test after 10 weeks of pregnancy. The results are usually available in 3-5 days, the test costs around $450 AUD and is not covered by Medicare or health insurance.
If a screening test shows you have a higher chance of having a baby with chromosomal changes you may be offered diagnostic testing which can give you a definite answer. A diagnostic test may be chorionic villus sampling (CVS) which is done after 11 weeks of pregnancy. The risk of miscarriage after this procedure is thought to be around 1 in 100 pregnancies. Or if after 15 weeks of pregnancy you may be offered an amniocentisis to confirm whether or not your baby has chromosomal changes or a genetic condition. The risk of miscarriage after amniocentisis is around 1 in 200 pregnancies.
Both procedures are completed by a doctor using ultrasound to guide the insertion of a very fine needle to remove a sample of amniotic fluid [in the amniocentisis] or placenta [in the CVS]. The sample will be sent away for testing and your doctor will give you the results in a couple of days or up to a week or two. Ask your doctor about your individual situation. Each procedure may only take a few minutes and you will feel minimal discomfort afterwards. If the test shows that your baby has a condition you may be offered genetic counselling to discuss your options.
Good antenatal care is essential. There is a an increased risk of placenta praevia, high blood pressure, gestational diabetes and premature labour, therefore your pregnancy and wellbeing will be monitored closely. You nay be offered further ultrasounds to monitor your baby’s growth and wellbeing and the functioning of the placenta.
***Antenatal care and screening***
***Planning for labour***
Your Midwife or Doctor may suggest increased monitoring once you reach 38 weeks pregnant. They may suggest extra ultrasounds or monitoring by listening to your baby’s heart rate over a period of time. While the overall risk for stillbirth is still very low there is a slight increase for women pregnant over 40. The risk of stillbirth at 39-40 weeks is 1 in 1000 pregnancies under 35 years of age and about 2 in 1000 pregnancies for women over 40.
Therefore your Midwife or Doctor may discuss with you the risks and benefits of an induction of labour as you approach 40 weeks. An induction of labour is when labour is started artificially using medications and by breaking the waters surrounding your baby encouraging the uterus to contract.
When discussing an induction of labour your should have a clear understanding of how the benefits of inducing labour outweigh the risks of waiting for labour to begin on its own.
Your Midwife or Doctor will help you understand the risks for your own pregnancy. Different people will make different choices based on their own preferences and values. Remember the choice is yours.
***Planning for labour***
As with pregnancy at any time, surround yourself with a good support network before, during and after the birth.
Resources
https://www.ontariomidwives.ca/pregnancy-and-birth-after-age-40
