Pregnancy in Your 30s and Beyond
Understanding the challenges and joys of having children later in life
Laura Stennett of Apex met her husband, Bob, when she was 30. They had trouble getting pregnant, so the couple went to see a fertility specialist. Before she could begin treatment, however, Stennett found she was pregnant. Age 33 at the time, Stennett was considered high risk, even though she was physically fit and healthy.
Being labeled “high risk” didn’t overshadow Stennett’s pregnancy experience. “It was amazing,” she recalls. “I loved being pregnant. I loved everything about it.”
Stennett's pregnancy went smoothly, right up until her delivery at 38 weeks when she endured 25 hours of labor. She avoided a cesarean section, however, and delivered a healthy baby boy.
Three years later, as she approached her 37th birthday, Stennett gave birth to her second son. “With my second pregnancy, the labor and delivery was half the time,” Stennett says. “So in terms of being physically pregnant as an older woman, I had no challenges.”
A Rising Trend
Stennett is just one example of the increasing number of women in the U.S. who experience pregnancy later in life. In 2000, the Centers for Disease Control and Prevention reported that the average age for a woman’s first pregnancy in the U.S was 24.9. By 2016, that number had risen to 28.
To explain the higher average age in 2016, experts have pointed to the decreasing rate of teen pregnancies. However, the CDC also found that, for the first time, women in their 30s are having more babies than women in their 20s. The reasons behind why women are waiting longer to start their families varies.
Professor Hans-Peter Kohler of the University of Pennsylvania is a social and economic demographer who focuses on fertility and health. Kohler has concluded that the rise in age for first pregnancies is most likely due to more women participating in higher education and the job market.
The Risks of Late Pregnancy
While few would argue that women increasing their knowledge and influence is anything but positive, Kohler also found that there are unintended consequences. As the average age of first pregnancies rises, the overall fertility rate decreases. This decrease is due in part to the difficulties involved in later pregnancies, which is confirmed by the OB-GYN community.
“Everything gets riskier as women age, with regards to pregnancy,” says Dr. Daniel Breazeale of Atrium Obstetrics & Gynecology in Raleigh. “Although plenty of our clients are pregnant in their late 30s and early 40s, there is age-related decline in the ability to have biological children.”
Reductions in Fertility
According to The American College of Obstetricians and Gynecologists, a woman’s fertility begins to decrease at age 32 and even more rapidly decreases after age 37. The organization says that is because, over time, a woman’s eggs decrease in quantity and quality. Women over age 35 are also more likely to experience health concerns that could affect their fertility, such as endometriosis and fibroids.
Advances in procedures such as artificial insemination and in vitro fertilization have helped many older women overcome infertility. However, a study published in The New England Journal of Medicine indicates that age can also play a factor in decreasing success of fertility treatments like artificial insemination. The study found that women under age 31 who received artificial insemination had a 74 percent chance of becoming pregnant within a year. For women age 35 and older, that chance drops to 54 percent.
Medical Risks to Babies and Mothers
In addition to a decrease in fertility, older mothers also face an increased risk of medical complications such as preterm delivery, diabetes, hypertension and pre-eclampsia, Breazeale says. Older mothers are also more likely to experience miscarriage or stillbirth.
“For some women [pregnancy loss] can be particularly devastating if they delayed childbearing until a later age, and were one of the few whose reproductive options were limited,” Breazeale says.
Babies born to older mothers also face increased risks for chromosomal abnormalities such as Down syndrome. According to The American College of Obstetricians and Gynecologists, the risk of having a baby with a chromosomal abnormality at age 30 is 1 in 385. By age 40, this number rises to 1 in 65.
Diagnostic Screening and Tests
Physicians can provide older mothers with chromosomal abnormality screening and diagnostic tests, including amniocentesis. With amniocentesis, physicians use ultrasound to guide a needle into the amniotic sac to collect fluid. The fluid is analyzed at a laboratory to detect chromosomal abnormalities.
The optional test is 99 percent accurate in detecting chromosomal abnormalities such as Down syndrome, but also carries a small risk of miscarriage, according to Dartmouth-Hitchcock, a nonprofit academic healthy system serving communities in New England. Test results give mothers the opportunity to prepare for caring for a special needs infant or to pursue interventions, such as fetal surgery.
In addition to amniocentesis, many physicians offer mothers of advanced age a series of noninvasive prenatal tests and a detailed anatomy ultrasound. The ultrasound, sometimes called a Level II ultrasound, provides a clearer picture of the baby’s heart and brain.
Chapel Hill Obstetrics and Gynecology, for example, offers patients the option of a 3D or 4D ultrasound, and ensures that an ultrasonographer certified by the American Registry of Diagnostic Medical Sonographers is available five days a week.
Advantages of Delaying Pregnancy
Despite the many medical risks and challenges, women report practical benefits to delaying pregnancy.
“One of the benefits of being an older mom is maturity,” Stennett says. “I was much more patient with my kids than I think I would have been earlier. I already had a career and had traveled and experienced life. We were also established financially, so we didn’t have the worries of finances. But I don’t think any age is the right age or wrong age. It’s really dependent on where you are in life and what it is you’re looking for.”
Breazeale advises his older patients to seek an evaluation from a fertility specialist if they haven’t achieved a desired pregnancy within six months. However, despite the difficulties and the lack of medical advantages to delaying pregnancy, Breazeale agrees with Stennett.
“The social factors associated with [delaying pregnancy] outweigh the medical factors in my opinion.”
Christa C. Hogan is a local freelance journalist and author, and mom of three boys. Learn more about her at christachogan.wordpress.com.