Past 40 lies fer­tile ground

The Dallas Morning News - - Small Business Report - By KIM HAR­WELL Spe­cial Con­trib­u­tor

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.

The odds

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.”

Com­pli­ca­tions

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

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