Pregnant at 40

Many years ago, it would have been unusual for women to get pregnant at the age of 40. In recent years, this has become more common.  

One of the reasons for this is related to modern-day technologies, especially in infertility treatment, that allow women to conceive at this age. The other major reason is related to the technological advances in imaging the foetus (ultrasound) safely, as well as the genetic tests that can be carried out to ensure that the foetus is normal. 

Famous celebritieswho became mumsat a later ageinclude OscarwinningactressEmma Thompson,who had her baby at40. – AP Photo

The problems faced by women pregnant at 40 years of age are best addressed by a series of questions and answers: 

How easy is it to conceive at this age? 

Fertility steadily declines with age especially from the 30s onwards. Certainly after 35 years of age pregnancy becomes uncommon.  

This decline is related to a decrease in the number of eggs and the compromised quality of such eggs. The frequency of intercourse generally decreases with age and this could be a contributory factor. Finally, associated gynaecological conditions like fibroids and endometriosis can contribute to difficulty in conceiving. Most of these problems can be addressed nowadays by infertility experts. 

 

Is it safe to get pregnant after the age of 40? 

This depends on your underlying medical, surgical or gynaecological problems. If you have none of these pre-existing problems, the risks are negligible.  

If you have significant medical problems, like diabetes or high blood pressure, then you should consult your physician as well as your obstetrician before you embark on pregnancy. If these are well controlled, your chances of a successful pregnancy are good. 

What are the risks to the baby when one conceives at this age? 

The risks of chromosomal abnormalities like Down Syndrome rise with age. This is usually related to abnormal division of the egg called non-disjunction. The incidence is around one in 1,400 deliveries in women in their 20s and around one in 100 at 40 years of age.  

Structural defects occur in all age groups and are generally not age-related. Chromosomal abnormalities are the major reason for miscarriages, which are higher at this age. 

 

What other health problems can occur? 

Besides chronic health problems, the incidence of stillbirth (delivery of a viable baby who died before birth) is higher. Some of these are related to medical problems like uncontrolled diabetes and high blood pressure.  

In labour, there may be problems like slow progress. The incidence of Caesarean section delivery is higher especially in women having their first birth. 

 

What can I do to have a healthy pregnancy at this age? 

Good health before and during pregnancy is an important asset. Some of the recommendations are as follows: 

Maintain a well-balanced healthy diet of 2,200 to 2,400 calories, which contains all the necessary nutrients as well as carbohydrates and protein. This can be modified if you have a medical condition and a dietician can provide the necessary advice for you. Folic acid is important even before pregnancy to prevent birth defects in the brain and spinal cord. 

Caffeine consumption should be limited to 300mg per day. Certainly alcohol consumption is not recommended. 

Any medications prescribed should be checked with your obstetrician. 

Do not smoke as this has serious consequences for your baby. 

It is good to exercise regularly but the type of exercise that can be done needs to be checked with your doctor. 

 

What about prenatal tests for the baby? 

Your doctor can counsel you on your risks of chromosomal abnormalities based on your age, ultrasound between 11 and 14 weeks of pregnancy as well as blood tests (Papp-A , free B HCG, double/triple tests).  

At the age of 40 years and above, invasive tests are the most sensitive for chromosomal disorders as well as certain blood disorders like thalassaemia. These carry certain risks of miscarriage and this fact needs to be considered before these tests are carried out.  

In the first trimester, the test is called chorionic villus sampling (placental biopsy). In the second trimester, the test most commonly done is amniocentesis. Occasionally, blood can be taken from the baby’s umbilical cord but this is not commonly done. These tests combined with high-resolution ultrasound at 18-22 weeks can detect most of the problems in the baby. 

With modern-day technological advances and expertise, the possibility of seeing a pregnant woman in her 40s successfully through her pregnancy is very high. In Malaysia, such expertise is available widely in both the government and the private sectors.  

Proper pre-pregnancy counselling should be done in women with medical, surgical as well as gynaecological problems and the risks should be assessed before pregnancy is embarked upon. The religious, ethnic and medico-legal aspects must be considered before invasive procedures are carried out. 

 

This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are opinion leaders in their respective fields of medical expertise and have wide experience in medical health education. 

The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician. For more information, e-mail starhealth@ thestar.com.my 

The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as medical advice. The information published is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. 

The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.