Pregnancy is generally a time of joy and anticipation for growing families. And this is true no matter your age. Due to changes in the workplace and society as well as advances in reproductive technology, American women are delaying childbearing. Making women wary about having a baby is not helpful, but informing them is. Women planning a pregnancy over 35, also called advanced maternal age (AMA), are at increased risk for several issues in pregnancy such as gestational diabetes, high blood pressure, preterm birth, cesarean section, and pregnancy loss. Fortunately, most women over 35 have healthy babies! A cornerstone of Thrive is to treat women as individuals instead of statistics. So, let’s move on to how you can optimize your health in pregnancy regardless of your age.
Being as healthy as possible prior to conception is crucial
At Thrive, we offer comprehensive pre-conception visits that focus on creating a personalized plan for you to optimize fertility and health before pregnancy. We recommend specific supplements and nutrition based on your health and lifestyle. It is preferable that you start with a normal weight (BMI<30), avoid environmental toxins, minimize caffeine consumption, exercise regularly, and avoid nicotine, marijuana, and alcohol use both prior to and after conception. It also might be smart to check a couple labs depending on your current health status. Contact us today for a preconception visit. https://thrivemidwives.com/contact/
If you are already pregnant and 35 or older?
- Due to the progressive aging of a woman’s eggs, the risk of miscarriage increases as they grow older. Watch for concerns such as spotting (blood), abdominal pain, pink/brown vaginal discharge, or menstrual-like cramping. If you experience any of these symptoms, notify your provider promptly.
- Consider whether noninvasive prenatal testing—a simple maternal blood test taken between 10-13 weeks—is something you want done. Maternal age increases the risk of having a pregnancy affected by a chromosomal issue, such as Down Syndrome.
- Get a level 2 ultrasound at 20 weeks, which is more detailed than a conventional ultrasound. Extra attention is paid to your baby’s heart, brain, and bony structures.
- Gain the recommended weight in pregnancy based on your pre-pregnancy weight. Unfortunately about 48% of American women gain too much, putting them at increased risk for complications in pregnancy. Focus on healthy fats, lean proteins (including fish twice a week), bountiful vegetables, dark, leafy greens, and minimal sugar.
- Get 20-30 minutes of brisk exercise most days of the week. It will help you navigate your weight gain, increase physical comfort, and give you strength for your labor and birth.
- Women over 35 have slightly higher rates of gestational diabetes and high blood pressure than younger mothers. Screening for both is important! If you have had a prior pregnancy affected by one of these issues, discuss this with your midwife either prior to conception or during your first trimester. You can take evidence-based steps to reduce these risks.
- Many providers increasingly offer weekly fetal monitoring beginning at 38-39 weeks pregnancy over 35. This is due to the slight increase in stillbirth after 39 weeks. This recommendation is stronger if it is your first baby, you are African-American, or have a BMI >30. While this approach might decrease the rates of stillbirth by identifying babies who are showing signs of compromise, the actual advantages are still being debated. “[There] are no large randomized trials that have examined the efficacy of routine antepartum testing in women age 35 and older, there remains no consensus on the management of late pregnancy for these women.” (UTD 2018)
- More providers also offer an induction of labor at 39-40wks to prevent the small, increased risk of stillbirth due to pregnancy over 35. According to a study, 1 in 1000 healthy women under 35 will have a stillbirth between 39-40 weeks, compared to 1.4 out of 1000 women between 35-39 years old, and 2 per 1000 women 40 and older. (EBB, 2018). It is not until women get to 41 to 42 weeks that those risks increase more significantly.
Evidence Informed Resources
Take home message about pregnancy over 35
While this can be taxing to wade through, it is crucial that women understand the evidence around recommendations they are receiving from care providers. Labeling women as “high risk” without first looking thoroughly at the individual’s health and medical history, as well as lifestyle. At Thrive, we believe that women over 35 can optimize their health before and during pregnancy, thereby decreasing their risks and having a birth on their own terms.