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It probably wouldn’t surprise most people that the older women get, the harder it may be to get pregnant, stay pregnant and deliver a healthy baby while maintaining your own health.

The risks of getting pregnant in forties

Many women have delayed starting their families for a wide variety of reasons.  And, while it would be nice to say that the choice should be easy, for many women in their 40’s, deciding—or even being able to—have a baby is not an easy choice at all.

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There are a number of risks associated with having a baby over the age of 40.  That is the hard reality that women have to deal with.  The best way to make a difficult choice is to have all the information available, talk with your partner and your health care provider and see what seems to be the best path for you.

Having a baby in your 40’s can increase the risk of:

• Midlife Pregnancy and Hidden Health Risks of Having a Baby in Your 40s
- as women get older, their risk of breast cancer increases. While the relationships between how old a woman is, her history of pregnancies, her history of breast feeding, her use of hormonal contraceptives and other variables are complex, it is unknown if the exposure of breast tissue to the high hormone levels of pregnancy may increase the risks of some types of breast cancer.

•  Stillbirths - a stillbirth is defined as the death of a fetus anytime after the 20th week of pregnancy.  (A miscarriage technically happens before the 20th week.)  The rate of stillbirths and miscarriages both increase past the age of 35. Other factors that increase these risks are smoking, poor nutrition, poor prenatal care, alcohol and drug abuse as well as diabetes, pre-eclampsia or birth defects in the baby. About one-third of stillbirths have no known cause.

•  Hypertension (high blood pressure) and pre-eclampsia/eclampsia.   Pre-eclampsia/eclampsia is a condition in pregnancy characterized by increased blood pressure and kidney problems.  It is also known as the toxemia of pregnancy.  It can be life-threatening for both mother and child.

•   Gestational diabetes –this is often a temporary problem of pregnancy, but it can put the mother at a higher risk of diabetes after pregnancy. The overall rate of gestational diabetes is 3%. It rises, however, to 7% in women older than 40 and to over 20% in those women older than 50. There are risk factors for all these—family or personal history, for example, but many older women with none of the risk factors still get gestational diabetes.

•   Cesarean (C-) sections. Over the last ten years, the rate of C-sections in the US has climbed dramatically—almost a third of all births in 2006 were by C-section. The rate goes up to almost half of the women between the ages of 40-45 having their first baby and to almost 80% of women from the ages of 50-63 will have a C-section. The problem with that may be best left for another article, but the problem for older mothers is the same as with any surgical procedure—the older a person is, the greater the risks of any surgery. Also, C-sections are associated with scarring and increased risks for abnormal placentas in future pregnancies.

•  Heart disease,  Even excluding pre-eclampsia and eclampsia, the risk of certain types of heart conditions increase in perfectly healthy women over 40.  Some of these, including a condition called peripartum cardiomyopathy6 can occur a few days to a few weeks after the baby is born.  Also, since it is often harder to lose weight the older women get, that can contribute to heart disease and high blood pressure.

•   Having a baby with birth defects.  Some birth defects are very minor and never cause any serious problem.  Others can be much more severe and even fatal. Often, if the birth defect is very severe, the baby may miscarry or be a stillbirth.  Other birth defects, such as cleft palate, spina bifida (where the spinal cord does not seal properly), or heart defects don’t necessarily cause a miscarriage, but may cause problems for the baby after they are born—sometime immediately, but sometimes not for years.

So what can women do?  The first thing is to get all the information possible.  Talk with as many people as you can and find out the risks that are unique to your situation. You can get screened and tested for a variety of heart diseases, diabetes, hormonal disorders and high blood pressure.  You may need to work with a team of health care providers that provide high risk care. You can also ensure that you are doing all you can for yourself—look at your diet, your nutrition, your exercise plan—for areas that could be improved.  No one can make this decision for you—or should!  But, the more you know, the more prepared you are and the more prepared you are for any event—the better you will be able to deal with it.  And, if you decide the risks are something you are willing to take on, the joys of a child are many!  Ask your mom!