What does having a baby later in life really mean for the both of you, healthwise?
WORDS SUNUJA NAIDU
Doctors say that late pregnancies pose higher risks for both mother and baby. “Older women have higher risks of having abnormal babies like Down syndrome,” says Dr Chee Jing Jye, medical director & specialist in Obstetrics and Gynaecology of The Obstetrics & Gynaecology Centre, a Singapore Medical Group (SMG) Clinic.
There is also a higher chance of growth restriction, smaller babies and premature births. In addition, older mothers have a higher risk of developing complications during pregnancy like pre-eclampsia and gestational diabetes.
“While most of these complications will not have any impact beyond pregnancy, very rarely it may,” says Dr Chee, pointing out that a pregnant woman with severe pre-eclampsia may rarely have kidney failure, brain haemorrhage and liver failure. When these complications set in, the effects may last even after delivery.
Moreover, she points out that every pregnancy takes a toll on the mother’s body. For example, the mother may be susceptible to iron and calcium deficiency after each pregnancy if she does not take adequate supplements during pregnancy.
An older mother may already have lower levels of iron and calcium,
to begin with; so she may end up with even lower levels
after pregnancy. Low iron levels may lead to anaemia while
low calcium levels may lead to osteoporosis.
Another issue with being older is difficulty conceiving in the first place. Says Dr Kelly Loi of the Health and Fertility Centre for Women, “Studies have found that women are born with a fixed number of eggs, and the number and quality decline with time, regardless of how healthy we are.”
If you are in your forties and would like to have a child, both doctors advise that you optimise your pre-pregnancy status. “Achieve and maintain an ideal weight, have a well-balanced diet, adopt an active lifestyle which involves an adequate amount of exercise and take a folate supplement,” says Dr Chee. In addition, she advises women in their forties to go for a gynaecological check to look for relatively common gynaecological conditions in older women like fibroids and cysts as these may negatively impact conception and pregnancy. If need be, the woman may need treatment for these conditions before trying to conceive.
If the woman has any pre-existing medical condition like thyroid dysfunction, diabetes and hypertension, ensure it is well-controlled first before conceiving. In fact, she should consult her obstetrician before trying to check if the medications she is currently on are safe for pregnancy. If not, it is better to change to a safe alternative before conceiving, advises Dr Chee.
Start trying as soon as possible, urges Dr Loi, adding that women should take prenatal and folic acid supplements to prevent neural tube defects which lead to problems like spina bifida. They should also schedule a preconception appointment to assess overall gynaecological health and fertility status.
If not pregnant after six months of trying, Dr Chee encourages the woman and her partner to consult a gynaecologist sooner rather than later.
“Do not wait for years before checking. In the event she should need assistance in fertility like in-vitro fertilisation (IVF), the success rate is inversely proportional to the woman’s age,” she says.
The woman should consult an obstetrician as soon as she is pregnant. Regular prenatal visits are important to monitor the well-being of both mother and baby, says Dr Loi. A variety of prenatal tests is now available to screen for conditions such as Down syndrome. These include a nuchal translucency ultrasound scan at about 12 weeks gestation, as well as non-invasive prenatal testing which involves a blood test that examines foetal DNA in the mother’s bloodstream. Diagnostic tests such as chorionic villus sampling and amniocentesis provide the most reliable information about baby’s chromosomes or the risk of specific chromosomal abnormalities but also carry a slight risk of miscarriage. A discussion with the doctor will be necessary to determine which tests are most suitable.
While late pregnancies are a growing phenomenon, where possible, both doctors feel that it is better to plan for pregnancy as soon as possible, and as early as possible as fertility success is higher and pregnancy risks lower the younger one is.