Pregnancy after 40. What to expect?

Although birth rates (in Europe) are regularly falling and experts predict a demographic collapse, there is a trend that is still gaining strength. This is an increasing number of women who decide to get pregnant after the age of 40. In the European Union, the number of mothers over 40 doubled between 2001 and 2020 - from 2.4% in 2001 to 5.5% in 2020 ¹ . Similar conclusions come from the analysis of data in the United States. Here, as in Europe, there is a clear upward trend in this respect. Data from the CDC (Centers for Disease Control and Prevention) show that the number of women who give birth after the age of forty doubled between 1990 and 2012. ² .

More and more women are deciding to get pregnant later.

We keep hearing that the best time to get pregnant, especially the first one, is between the ages of 20 and 30. Certainly - before the age of 35. It happens - not uncommon - that pregnancies of women who are over 35 years of age are called "geriatric" . This is because fertility declines after the age of 30 , and pregnancies for women at this age are more likely to involve many health risks. However, the development of medicine, greater (in Poland: at least theoretically) availability of prenatal tests and a high level of this type of diagnostics mean that more and more women decide to have later pregnancies . The reasons are various: fertility problems, family and professional stability, or fear of responsibility. It sometimes happens that a woman feels ready to have a child only around the age of 40.

This is a frequently discussed issue in the media, both mainstream and parenting media. When the news reaches them that one of the mature, famous women is expecting a child , the pregnancy is closely monitored and opinions vary. This was the case of American actress Cameron Diaz, who gave birth to her first child at the age of 47.

On the one hand, texts on this subject emphasize that after the age of 40, many changes occur in the body , there is less strength, and a child requires huge outlays in every sense. There are also voices that it is simply too late and parents will be perceived as "grandparents". Fortunately, this is changing, because such comments are nothing more than another version of ageism .

Gynecologist and author of books, including: best-selling book "Calm down your hormones", Dr. Tadeusz Oleszczuk, believes that criticizing pregnancies after 40 is unjustified: "More and more women over 40 are deciding to get pregnant, I can clearly see it in the office - and that's a very good thing! Yes, fertility is declining, but it is there, so what is the problem? It is worth emphasizing that statistically more children with genetic disorders/abnormalities are born to younger women because there are simply more such pregnancies . He adds that the most important thing is "research" and preparation.

What do you need to know about pregnancy after 40?

Dr. Tadeusz Oleszczuk recommends that women over 40 who are planning a child be well prepared : “I recommend that patients undergo a number of blood tests, including the so-called oncopackage , i.e. checking the level of 6 minerals: zinc, selenium, lead, copper, cadmium and arsenic . The results give us a picture of the body's condition and the risk of cancer . If the tests are optimal, the practical risk of cancer is zero, but if the results exceed the norm, we act. We do a complete blood count, we can test the genes to see where we are overall with a holistic health assessment . We supplement identified vitamin and mineral deficiencies. You need to enter pregnancy with the best possible parameters . Let's also remember that a lot depends on the quality of sperm - the risk of genetic disorders depends on the man in 40%.

At least a few months before pregnancy, it is worth starting to take folic acid (preferably its active form) and other ingredients recommended when trying to conceive (read more about what you should supplement when planning a pregnancy in this article ). Dr. Tadeusz Oleszczuk draws attention to the fact that in many situations a woman over 40 is better prepared for pregnancy than a 20-year-old who suddenly finds out that she is already pregnant.

“It is important to remember that in a 40-year-old woman, ovulation does not occur every month , but every 2-3 months. Sometimes – 2-3 times a year. But I repeat: you can prepare for anything. I have patients who give birth at the age of 47 and are planning another child. Let's dispel this stupid superstition that it is too late to get pregnant after the age of 40," she adds.

Pregnancy after 40 – what are the benefits?

Sometimes the benefits of late pregnancy outweigh them. The most obvious of them are - often - a stable professional situation and the related good financial position , as well as the ability to devote more time to the child compared to parents (mainly mothers, of course) on their own work. There are also other benefits that are rarely talked about. These include primarily health benefits - a lower risk of rapid loss of cognitive abilities by the mother ³ , longer life and better educational opportunities for children who achieve better results, for example in school tests (compared to children of younger mothers ⁴ ). Research shows that there is a clear relationship between late pregnancy and the mother's greater chances of living to an exceptionally old age ⁵ .

Risks associated with pregnancy after 40.

However, there are also risks - not small ones. Still, from a medical point of view, pregnancy after the age of 40 is considered risky and therefore should be managed very carefully . This is due to, among other things, an increased risk of high blood pressure and preeclampsia, diabetes, miscarriage, low birth weight and the risk of fetal defects . Down syndrome is the most common chromosomal aberration. The average incidence worldwide is 1/700 births, and one of the risk factors is maternal age. In the case of a pregnant woman aged 36, the risk is 1/300, in her 40s - 1/100, and after the age of 45 - 1/20 ⁶ .

Despite medical progress, greater availability and popularity of in vitro procedures and the possibility of using sperm banks or freezing eggs, it must be remembered that a woman's fertility declines significantly after the age of 35. According to data from the American Association of Obstetricians and Gynecologists, the number of eggs drops from 27,000 at the age of 37 to just 1,000 at the age of 51. ⁷ . For this reason, many couples who decide to have a child later have problems getting pregnant .

If successful, the pregnancy itself can also be a challenge , although there are many women over 40 who said that for 9 months, apart from standard ailments, they felt good. However, it is important to remember that bones and joints change at this age , and extra weight during pregnancy may make women in their 40s and older feel more uncomfortable . Because the risk of preeclampsia increases, doctors recommend a cesarean section in such situations. 

So there are risks and many inconveniences. There are also advantages that more and more mature mothers around the world notice. It is important that when planning a pregnancy after the age of 40, you evaluate all the pros and cons individually and approach the issue consciously.

Bibliography:

1. “Older mothers”, Eurostat, accessed August 4, 2022, ec.europa.eu.
2. T.J. Mathews, M.S.; and Brady E. Hamilton, Ph.D., First Births to Older Women Continue to Rise, NCHS Data Brief No. 152, May 2014, www.cdc.gov.
3. Roksana Karim PhD, MBBS, Ha Dang PhD, Victor W. Henderson MD et al, “Effect of Reproductive History and Exogenous Hormone Use on Cognitive Function in Mid- and Late Life”, J Am Geriatr Soc 64: 2448- 2456, 2016.
4. Barclay, K. and Myrskylä, M. (2016), Advanced Maternal Age and Offspring Outcomes: Reproductive Aging and Counterbalancing Period Trends. Population and Development Review, 42: 69-94.
5. Sun F, Sebastiani P, Schupf N, Bae H, Andersen SL, McIntosh A, Abel H, Elo IT, Perls TT. Extended maternal age at birth of last child and women's longevity in the Long Life Family Study. Menopause. 2015 Jan;22(1):26-31.
6. Dorota Gieruszczak-Białek, MD, PhD, "What is Down Syndrome and what are its causes?", Medycyna Practical dla Patients, mp.pl., November 17, 2016
7. “Female Age-Related Fertility Decline,” The Practice Committee of the American Society for Reproductive Medicine, The American College of Obstetricians and Gynecologists, March 2014, acog.org.