It is logical to want to wait to be ‘ready’ (that could mean being in a committed relationship or having financial stability, among other things) to have a baby. However, doctors warn that childbirth after the age of 35 comes with complications that many women are not aware of.
Health experts say that as a woman approaches her mid-to-late 30s, the eggs decrease in quantity and quality. Also, older women’s eggs aren’t fertilised as easily as younger women’s eggs. If a woman above the age of 35 is trying to have a baby but hasn’t been able to conceive for six months, it’s advisable to talk to a healthcare provider for advice.
According to Dr Kenneth Ruzindana, a consultant at Kigali University Teaching Hospital of Kigali (CHUK), says the age cut off for advanced maternal age pregnancy is not uniformly defined. But historically, advanced maternal age was defined at the age of 35 based on the convergence of risk for chromosomal abnormalities among this group of women.
He says that older women are at risk for the same pregnancy complications as younger women, but their risk is not for some conditions. Older women are at an increased risk for spontaneous abortion. These losses are both primarily due to trisomic disorders and they result from chromosomal abnormalities.
The result is mainly from the decline from egg quality or changes in uterine and hormonal functions which may play a role, he adds.
“The majority of spontaneous abortions are between six and 14 weeks of gestation. For example, if we have 80 women hospitalised for abortion, the calculated risk for spontaneous abortion in each age group is about 12 per cent if the women are less than 30 years of age.
“But it increases to about 15 per cent if the women are 30 to 34 years, and it increases to 25 per cent if the women are between 35 to 40 years. Above 40 years, the risk for spontaneous abortion is almost 51 per cent,” he says.
Ruzindana says that if a woman is 45 years old, the risk increases by double to almost 93 per cent. So, as maternal age increases, the rate of spontaneous abortion significantly increases as well.
Also, advanced maternal age significantly increases the risk of a woman to an ectopic pregnancy (pregnancy occurs when a fertilised egg implants and grows outside the main cavity of the uterus), he says.
According Ruzindana, ectopic pregnancy is the major source of maternal mortality and mobility in early pregnancy. Women who are above 35 years of age are associated with four to eight increased risk for ectopic pregnancy compared to younger women.
He adds that the risk of ectopic pregnancy likely reflects an accumulation of risk factors overtime, such as, multiple sexual partners, pelvic infection, or any other conditions that may affect the quality of the fallopian tubes.
Ruzindana explains that when analysis from spontaneous abortion is done, it’s called carrier type analysis. It is found that there is always a steady increased risk of aneuploidy as a woman ages. (Aneuploidy is a chromosomal abnormality, most common is trisomy).
He says that the other complications associated with advanced maternal age is congenital malformations, the risk of having a child with a congenital anomaly increases with increasing maternal age.
Ruzindana adds that historically, an increase in congenital anomalies with advanced maternal age has been attributed to the recognised increase of an aneuploidy in advancing maternal age, and the association of aneuploidy foetuses with structural abnormalities.
He says, there are also late pregnancy issues, some pregnancy complications in older women appear to be related to the ageing process alone, while others are largely related to co-existing factors such as, multiple gestation or multiple pregnancy or having gotten pregnant so many times, and other chronic medical conditions which are less likely to be observed in younger women. So both may contribute to increased pregnancy-related poor maternal outcomes that are reported in older women.
For example, he notes that hypertension—the most common medical condition encountered in pregnancy—is prevalent in older women. The odds of being diagnosed with chronic hypertension are two to three or even four times higher in women above the age of 35, than in women below that age.
Ruzindana says that other conditions, including diabetes mellitus, increase with maternal ageing. So the rate of both pre-existing diabetes mellitus and pregnancy induced diabetes, increase by almost six-fold in women who get pregnant at the age of 35 and above, compared to women who are younger. Late in pregnancy, there is a higher prevalence of placental problems like early detachment of the placenta before the baby is born, or low lying placenta which is called placenta previa.
“I must say that there are many higher studies conducted worldwide which consistently report that older women, above 35 years of age, are significantly at higher levels of risk of stillbirth as compared to younger women,” he says.
He adds that the excess risk for stillbirth as experienced by older women is largely due to non-anomalous foetal death which is often explained after controlling other risk factors like hypertension, diabetes, and smoking.