We don’t see many patients at UT Southwestern who are pregnant in their mid-40s, but it’s becoming more common to see patients who are 35 or older. Many of them have some level of anxiety about the increased risks during pregnancy at that age.
I tell these patients that pregnancy after age 35 is not as scary as it may seem. Certainly, there are some inherent risks, but those risks increase throughout a woman’s childbearing years. For example, a woman who is 26 has a greater risk for some conditions than a woman who is 25.There isn’t a magical line at age 35, where risks dramatically increase.
One of my patients, Lesley Thompson, is currently pregnant with her second child. Because her pregnancies have been after age 35, I invited Lesley to share her story, in her own words:
John and I got married in 2010. I was almost 34 and he was 40. We were both very focused on our careers and education, but we were ready to start a family.
We thought it would take some time to conceive, since we were older, but 5 months into our marriage, we found out we were pregnant. We were overjoyed and felt very fortunate that we didn’t struggle in conceiving.
My age was never really the focus of my appointments with Dr. Lo. She explained the realities of the situation and what to expect but didn’t blow things out of proportion. We connected quickly because of her open and honest personality, as well as the fact that she could relate to being a working mother who had children in her 30s.
Because of my age, I knew there were increased risks to having a baby, but each time I got positive news from Dr. Lo, my confidence grew. Her humor and knowledge really shined through – my appointments usually included at least a couple of laughs.
We were initially labeled as “high-risk,” due to my age and a procedure I had done 10 years earlier. Six weeks into my pregnancy I had some significant bleeding. I went into the office for an ultrasound and was diagnosed with a subchorionic hemorrhage. In addition, we learned there were initially two gestational sacs but one was not viable.
Overall, it was a very healthy pregnancy. I worked up until the day I went into labor and did not have any restrictions. It was February 16, 2012, when I felt the first contractions and decided to leave work. Of course, I got my car washed and went home for a shower before heading to the hospital! After some convincing from my husband, we left for the hospital and learned I was already 5.5 centimeters dilated upon arrival.
At that point, we still didn’t know whether we were having a boy or a girl. About 9 hours later, we met Lily for the first time. Lily came into this world on her own terms, and the words “Catch the baby!” may have been uttered in the delivery room. Her personality as a toddler is the same today!
Lily had some minor complications after delivery but nothing serious. The nursing staff and the physicians at University Hospital were phenomenal.
My second pregnancy has been completely different. It took a bit longer to conceive, and we had a miscarriage in June 2014. It was a very emotional time. Dr. Lo and others in her office were amazing at guiding us through that process.
We were shocked when we found out we were pregnant again in August 2014. With the still very recent miscarriage, I had more apprehension than during my first pregnancy. For 12 weeks, I held my breath, knowing that was a critical time.
Because I was over 35 years old, we were offered genetic screening at my 10-week appointment. One screening option we considered was a cell-free fetal DNA test, a non-invasive test that helps the obstetrician identify the women at risk for carrying a baby that may be affected by Trisomy 13, Trisomy 18, and Trisomy 21 (Down Syndrome).
This decision weighed on us. We had to balance the desire to know the increased risks against the fact that the test was not fully covered by our insurance. We decided results of the test would not change our decision to proceed with the pregnancy, so we chose to have a different first-trimester screening performed. This test measures the space behind the baby’s neck. That measurement and additional blood work from the mother helps the obstetrician identify risks for Trisomy 13, 18, and 21. Fortunately, the results were within normal range.
I was relieved a bit after my first trimester and then finally became comfortable in the pregnancy after the anatomy scan at 18 weeks. We learned our little boy was perfectly healthy. However, I was diagnosed with complete placenta previa. My placenta was covering the cervix, and if it did not migrate during the pregnancy, a vaginal birth would not be an option due to bleeding risks.
We chose to monitor the situation and hope that the placenta moved so it no longer covered the cervix, which happens in about half of all cases. We tried to stay positive and said many prayers. To avoid further complications, I was placed on several restrictions, including limiting exercise to low-impact methods such as light walking and not lifting anything heavier than our toddler. This was tough for me because I’ve always been an active person.
Over the next several weeks, I had two bouts of minor bleeding and lots of cramping, likely but not definitively caused by my condition.
At 31 weeks, we got great news. The placenta was no longer covering the cervix. This meant that my restrictions were lifted and the possibility of bed rest later on was erased. Most importantly, it meant a natural birth was possible.
Our little boy is due in about a month, and we could not be more excited to become a family of four!
I’ve truly enjoyed both my pregnancies. During the second pregnancy, I was certainly more fatigued. Was it because I was older? Or was it because I have a toddler at home? You definitely don’t take as much time for yourself the second time around.
If you are over 35 and considering pregnancy, I’ll give two pieces of advice (which I should take more often): One. Relax. It will all be OK. Enjoy your pregnancy and try not to let your age be the focus of it. Make choices that make you happy as a family. Two. It’s about balance and acceptance, especially if you work outside the home. Accept that you will not always be on your “A” game. It is near impossible to be an “A” mom, an “A” wife and an “A” at work at the same time. Some days you will have to settle for being a “B” in any given category and that’s OK. A hard pill to swallow for us Type A personalities!
The latter is the best piece of advice I’ve received, and I credit Dr. Lo for helping me put life in perspective!
Naturally, my age and my husband’s age do cross our minds occasionally as it relates to our daughter and the son we are about to meet. We certainly hope and pray that we are able to enjoy all of the milestones our children will celebrate.
But age is really just a number. It’s a cliché, but when it comes to being a mother, there’s a common bond formed among women who have the privilege of calling themselves “mommy,” regardless of age. I am fortunate to have fellow moms who serve as coaches, mentors, and most importantly, friends on the days you need a little encouragement.
We don’t know for sure that Lesley’s age was the primary cause of her complications. It’s normal for women of any age to experience some light bleeding (or spotting) during pregnancy. Age does not seem to make a difference.
Placenta previa, however, is more common as women get older. That said, it’s not unusual for a woman’s placenta be near or covering her cervix, no matter her age. So while studies have shown that placenta previa is more common for women like Lesley who are over age 35, we can’t say for sure that she developed the condition because of her age.
With any pregnancy, you are as young as you feel. If you are younger than 40, don’t let your age dissuade you from having a baby. If you are already pregnant, find an Ob/Gyn you are comfortable with so you can understand the risks and tests that are available.
Being over 35 is just a state of being. It’s important to have that attitude. As Lesley said, embrace it, and enjoy your pregnancy.