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Sunday, December 8, 2013

Older Moms, How old is too old?

Advanced maternal age is a term we have applied to women over age35, advanced paternal age is men over 45. Moms in the US are getting older, and surprisingly to many, this has proved wiser in ways as well. Women over 35 are more likely to have a career, to have had a planned pregnancy, to be in a social and psychological frame for pregnancy and there in lie the primary advantages.This is leading to all time log pregnancy rates for this group, and the rates of getting pregnant overall have been dropping from 2000-2009 have dropped 12% according to a CNN Article.
Now that we track other diseases there is some evidence increased risk for autism, schizophrenia and learning disabilities in children born to older fathers, so in the discussion has to be the age of dad, so 'advanced parental' age meaning either parent,  Advanced parental age may prompt mental disorders in the offspring via de novo mutations in the male germline or chromosomal abnormalities in the female gamete.[2] On the other hand, the children of young parents more frequently display conduct disorders and poor outcomes, such as substance use or academic problems, a finding that has been attributed to the socioeconomic deprivation and mental health difficulties affecting teenage mothers as
There are challenges, so one has to be wiser when approaching this decision. Miscarriage rates, already relatively high (1/6) climb to ½ for the mid forty pregnant mom. While the scientific approach to age related fertility is to assess a woman’s ovarian age, rather than their chronological age, there is a fairly direct association between aging and conception rates. We are still researching the basics of reproduction as you can read in this report from the Population Council. About 8% of all cycles in your early 30s have a defected second half, and about 36% of cycles in women over 40 will have abnormal second half of the menstrual cycle progesterone levels. For more reproductive facts link to ASRM. Women in their 30s and older are more likely to have uterine fibroids, endometriosis or other gynecologic conditions that if remain untreated can affect fertility. Fertility testing and treatments are usually covered by insurance after “year of trying” but physicians caution that women over the age of 35 trying to have a baby start their infertility testing if they aren’t pregnant within 6 months of trying as about a third of women over 35 will have fertility issues, and over half over 40 will have difficulty conceiving. All fertility treatments, including insemination and in vitro fertilization (IVF), decrease in effectiveness as moms get older. For IVF for instance the percent of embryo transfers leading to births decreases from almost 50% in women under the age of 35 to 15% for women of 41 to 42 and only 6% for women aged 43-44.

The association with age and chromosomal birth defects is relatively well recognized, and the statistics are fairly dramatic. A woman’s statistical risk of having a trisomy 21 (Down’s Syndrome) child if delivering at age 20 is about 1/2000, by age 25 that climbs to 1.1250, by age 35 about 1/400, by age 45 1/30 and by age 49: 1/10. AMA mothers (physician initials for Advanced Maternal Age), have increased risks of structural defects in their children as well, and congenital anomalies including heart, lung and other organ defects are the leading cause of infant death in the US. Once a woman conceives she may be offered a variety of tests to determine whether any of these birth defects exist in the pregnancy. There are many new tests, here's a discussion about some of the tests that have been around the longest.

Older moms are more likely to have twins. They are also more likely to have triplets, but that’s mostly due to fertility treatment. The increased rates of twinning is specifically due to age related double ovulations. Other pregnancy problems are common as well, including gestational diabetes, which AMAs are twice as likely to develop, and having a thromboembolism (blood clot), already a serious problem, accounting for 15% of all maternal deaths, is more common in women over 35. Direct pregnancy effects on the fetus as mothers get older include placental problems like placenta previa (placenta is implanted over the cervix), is twice as likely when you are pregnant in your thirties and about three times as likely as in your forties,. Prematurity (babies born prior to 37 weeks) and stillbirth which is the direct consequence of poor placental feeding of the developing fetus.For links to information regarding preterm infants, check this information on the CDC site.

There is also a concern that older mothers are penalized in their general health care when pregnant. They less likely to have mammograms (concerns regarding radiation to the fetus if already pregnant and not current on tests) so less likely to have a breast cancer diagnosed early, less likely to receive effective medical or surgical treatment of their condition, in spite of the well meaning care of some of their health care providers.

So how old is too old, like everything in medicine, the adage is, it’s all relative. Risks are greater. Definitely physicians don’t advise waiting if you can make your mind up earlier, as you can see risks go up fairly rapidly. And what do we advise, well, not so much more or less than what we advise for younger women planning to get pregnant. And lastly, have sex, age related decline in sexual activity leads to part of the decreased conception rates, now that’s a prescription that might even be more popular than an apple a day!

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Thank you for your comments and questions. This blog is not intended to replace medical care, but is informational only. We hope you will become a follower or visit Womens Health Practice. We offer a variety of unique services including MonaLisa Touch, Coolsculpting, Labiaplasty, and Gynecoloigic Clinical Research Trials. For more information on menopause see http://www.amazon.com/Menopause-Make-Peace-Change

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