Past 40 lies fertile ground
Is 40 the new 30? If you keep up with this country’s childbirth trends, you might think so. Britney Spears’ headlong rush into young motherhood aside, the face of the American mother is beginning to look increasingly middle-aged.
“Advanced maternal age” is the medical terminology applied to any woman who is 35 or older when she gives birth. Because women’s fertility lessens with age, and the incidence of pregnancy complications and birth defects increases, waiting to start a family can be a risky proposition, and one that grows more precarious with each passing year.
Still, the American Society for Reproductive Medicine reports that approximately 20 percent of American women are waiting until after age 35 to have children. And despite the risks, more and more women are giving birth on the far other side of the 40-year milestone.
Though the numbers are still relatively small, data from the Centers for Disease Control and Prevention indicate that the number of mothers giving birth after 40 has increased by almost 70 percent in the last 15 years.
This isn’t news to Dr. Karen Lee, a reproductive endocrinologist with Presbyterian Hospital’s ARTS (Assisted Reproductive Technology Services) Program, who has noticed the trend in her own practice.
“People can certainly be pregnant after 40, but there are two major issues to contend with,” she notes. “The first is trouble getting pregnant. Female fertility is largely age-based, and we are born with all the eggs we’ll ever have. … There’s a much higher incidence of eggs that are genetically not capable of either fertilizing or implanting” as women age, she says. “There’s also a higher risk of miscarriage: 50 percent if you’re 40.” Frankie Branham of Dallas had her only child, 10-year-old daughter Leta, when she was 40. “I never worried about what I might have been missing in terms of my social life,” Ms. Branham says.
Older moms-to-be who sustain their pregnancies can expect a slightly harder nine months than younger women, she adds. “The second issue is a higher incidence of complications such as diabetes and high blood pressure, as well as smaller babies and higher need for a C-section. But I tell my patients that for most women who are healthy, there’s no reason why they can’t be pregnant. It just takes more luck.”
Count Melissa Finn among the lucky. The Lake Highlands mother of four had her first child at 34 and delivered her youngest three years ago, when she was 40.
“I had no trouble conceiving ever,” she says. “My last two children are 20 months apart. I keep waiting for this decreased fertility to kick in. I read these stories about plummeting fertility and how these people over 35 better watch it or their clock is going to run out, and I think I’m ready for my clock to beep, you know?”
Though she knew about the increased risks of a post-40 pregnancy, she says she didn’t let the worries consume her. “I guess in the back of your mind, you know that the statistics are worse for you in terms of birth defects and gene problems the older you get. But since I started late and had good luck three other times … I was hopeful that was a good indicator for me.”
Under the best of circumstances, pregnancy is a stressful time, notes Dr. Jorge Saldivar, an OBGYNat Methodist Charlton Medical Center. Add advanced age into the mix and the normal physical issues are compounded.
“Pregnancy is tough physiologically,” he says. “It’s a big stress on the heart, the kidneys, everything. And as you get older, you’re less resistant, so you’re not able to tolerate it as well. You’re more prone to diabetes, to hypertension, to placenta previa,” where the placenta covers the cervix, “placental abruption,” when the placenta separates from the wall of the cervix, “and Caesarian delivery.”
Older moms are also more likely to give birth to multiples, whether conceived with assisted reproductive technology or naturally, and advanced maternal age