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35 and Pregnant
Once considered taboo, pregnancy over 35 years of age has become a common occurrence. Doctors face this reality every day in our terminology ... we use enviable terms such as elderly gravida (pregnant lady) and advanced maternal age to describe our 35-and-over crew. I am reluctant, however, to mark such a diagnosis on my patients' charts. I don't even call them "mature" women. Instead, I call them pregnant, just like the rest of my patients. In fact, there isn't a day that goes by that I don't see many women over 35 enjoying their nine-month pregnancy adventure.

There are some extra considerations and precautions suggested for women as they conceive and carry babies in their mid-30s and beyond, the first of which is their general health. As we age, medical conditions such as high blood pressure, diabetes and heart disease become more common. Although these are treatable conditions, they do place an added burden on the expectant mother and may cause obstetrical complications for the mom and her unborn child.

Being 35 and over is commonly associated with a higher chance of having a child with altered DNA. These changes are unpredictable and can't be prevented. With each passing year, the odds of a problem increase (see my answer to another question for the statistics). However, the chances are still quite small if you take a moment to think about it. A 35-year-old woman has a 199/200 chance of having a healthy baby. With such good odds, many of my patients are willing to take their chances. They also have the opportunity to do a test (amniocentesis) in order to establish the baby's chromosomes. The risk of losing the baby associated with an amniocentesis is also 1/200. Therefore, the risk and benefits are equal. Hence, we have created a magic barrier at 35 years of age.

The following table gives you an idea of the gradual increased risk of having a baby with a chromosome problem.

Once we get beyond health issues and the DNA, women over 35 seem to do quite well. They have healthy babies but seem to require a bit more obstetrical assistance at delivery. Several research studies have found that this group of women has more forceps, vacuum and cesarean section deliveries than their younger counterparts. I am not sure of the exact reason for this trend. It might relate to doctor bias, worrying a bit more about older women and their limited opportunities to have more children. Perhaps our bodies don't stretch as well as we age and it is harder to fit the baby through the birth canal. Regardless of the means, the end is terrific: a beautiful baby coming into the world.

I don't want to give the impression that one can conceive indefinitely without some increased risk of problems. After age 40, pregnancy does become more complicated and there is a reasonable increase in the health risks to the mom and baby.

As always, it is so important to speak with your doctor about your specific health concerns, especially if you are considering pregnancy.
Craig L. Bissinger M.D.