40+ and Pregnant

By Drs Shah & Pretorius

by Tia

“I feel so stressed about my pregnancy! What if something goes wrong? I am not young anymore. Will my baby be ok? What risks are there?” These are questions that gynaecologists face every day. And the answers to these questions are not always straight forward.

Your pregnancy journey should be a very exciting time in your life. But it can be a very daunting time, especially if you are older. Data from the USA confirms that the average age when women have their first baby, continues to increase.

Women are more career oriented and therefore tend to delay pregnancy and parenthood. Other reasons for delaying pregnancy include effective contraception, gender equity, economic uncertainty and absence of supportive family structures.

A woman’s peak reproductive years are between late teens and late 20s. By the age of 30, the ability to conceive starts to decline; this decline becomes more rapid once you have reached mid-30s. Although it is not impossible to conceive above the age of 40, it does get more difficult.

Any pregnancy in women above the age of 35 is considered a high risk pregnancy. These pregnancies are at risk of potential complications. The most common complications are miscarriages, development of pre-eclampsia (high blood pressure and protein in urine), diabetes, as well as premature labour and birth, and stillbirths. It is important to note that your pregnancy will be closely monitored throughout for the development of complications.

1. Expect close foetal surveillance
You can expect more frequent visits during your pregnancy as well as close foetal surveillance (with ultrasound). During the first trimester, your gynaecologist will discuss potential chromosomal (genetic) abnormalities with you.

All women begin life with a fixed number of oocytes (eggs) in their ovaries. The number of oocytes decreases with age and are also more likely to have abnormal chromosomes. Certain tests can be offered (blood tests and a 12 week ultrasound) that can be done to assess the risk of a chromosomal/genetic abnormality. These tests involve screening tests (assess the risks that a pregnancy is affected) and diagnostic tests (can detect if a pregnancy is affected). The most common chromosomal abnormality is Trisomy 21 or Down Syndrome. Testing for Down Syndrome can be offered, and these tests have a 99,9% accuracy.

2. Expect growth scans
In the second trimester, a detailed anatomy ultrasound (between 18-22 weeks) of your baby will be done to detect potential physical abnormalities. By 20 weeks, your baby has formed, and he/she should just grow from there. The detailed anatomy scan assess baby from top-to-toe to ensure normal development of their organs.

A glucose test will be performed to exclude diabetes of pregnancy. Diabetes of pregnancy is more prevalent in older patients, and it is important to exclude this, to minimise the risk of a stillbirth. If it is present, this will be managed and monitored carefully.

You will also have more growth scans, to ensure that your baby’s growth and development is adequate.

You will be counselled on what symptoms you should be on the lookout for, eg. foetal movements, bleeding, severe headaches and blurry vision.

Your pregnancy and delivery of your baby should always be one of the best times of your life. With advanced technology and tests, your pregnancy should result in a healthy mother, giving birth to a healthy newborn baby.

Drs Shah & Pretorius are both very passionate about women’s health and they are situated at Netcare Blaauwberg Hospital in Cape Town, South Africa. Both are specialist Obstetricians and Gynaecologists with special interest in pregnancy, female fertility and are dedicated to supporting women achieve optimal health. www.blouberggynaecologist.co.za

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