This is really not that uncommon of a scenario; fortunately most patients that I see in this situation generally are pleased and happy, much to their amazement. It usually takes the couple a little while to get to this point though. Shortly, however, the focus changes to the safety issues and risk. There are certain risks that are common to all women who get pregnant later in life and risks that are particular to each individual. It is very important to see your doctor early in the course of a pregnancy in this circumstance to review your particular risks and risks in general. Individual risks relate to your overall general health. Pregnancy in the face of diabetes, heart disease, hypertension, etc. all increase the risk for pregnancy in older women, but this is also true of women in their twenties and thirties. As always, the better a woman’s overall health prior to pregnancy, the safer pregnancy will be at any age.

The concern most women have with a late pregnancy is related to birth defects and chromosomal abnormalities. Down syndrome is the most common chromosomal abnormality seen in later pregnancies. Children affected with this syndrome are affected by varying degrees of mental retardation and physical birth defects such as heart anomalies. Every pregnancy, no matter the age of the mother at conception, has a chance to result in a baby with Down syndrome or some other chromosomal anomaly. The risk steadily increases with age. At age 25 the risk is 1 in 1250, at age 30 it is 1 in 1000, at age 35 it increases to 1 in 400, and at age 40 it is 1 in a 100.  What is important to realize, however, is that the odds always favor the birth of a baby without Down syndrome or any other chromosomal anomaly. The reason is that most pregnancies with a chromosomal problem end in a miscarriage. First and second trimester screening tests are available that recalculate the risk levels noted above. Diagnostic tests in the first trimester (chorionic villus sampling) and second trimester (amniocentesis) are also available. The diagnostic tests have an associated risk of causing a miscarriage, in a normal pregnancy, in the range of 1 in 100 to 1 in 500. Many women who choose to do testing will do the screening test first to see if their risk is significantly lowered. If it is lower, many will forego the diagnostic test to avoid the possibility of causing a miscarriage.

Another risk of pregnancy later in life is the higher chance of miscarriages. Miscarriage in women age 35 to 45 occurs much more frequently, ranging from 20% to 35%, as compared to only 10% in women in their twenties. Other conditions with higher rates include gestational diabetes (twice as high in woman after 35,) high blood pressure and pre-eclampsia, premature delivery, low-birth weight babies, twins, and stillbirth. When risks like this are put in print, it exaggerates their likelihood. The fact is most pregnancies in women after forty proceed normally and safely. These complications, if they do occur, can most often be managed and controlled in a safe manner. Certainly a woman pregnant after forty can expect to be followed more closely during the pregnancy with serial ultrasounds to monitor the baby’s growth and well-being. The mother will also be closely monitored to identify any developing health problems.

Often, I have patients ask me if a late in life pregnancy is too risky or too dangerous. Risk tolerance is an individual decision. The role of your obstetrician is to clearly explain what the risks are and to explain what the likelihood is of those complications occurring. But it is also extremely important to consider all the positives associated with the pregnancy, the joy and happiness this child can offer to your life. Too often we focus on the negatives and not the positives. If the positives outweigh the negatives then the risk is worth it. There are no guarantees in life. Whether we think about it or not, as soon as our feet hit the floor in the morning we are exposed to risk. Some risks are just worth it.

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