FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

HEALTH RISKS GREATER FOR OLDER EXPECTANT MOMS;

BUT CHANCE OF HAVING A HEALTHY BABY STILL VERY HIGH

Question: My 40-year-old sister is trying to get pregnant, and if this happens, it will be her first child. I know that there are many older women who have babies, and I also know that the health risks are higher for older moms and their babies. How great are these risks?

Answer: Pregnancy and childbirth place significant demands upon a woman's health. These physiological stresses often reveal health problems that are potentially detrimental to the mother or baby, and these problems occur with greater frequency in women who are 35 or older. I think it is important to emphasize that even though the absolute risk of problems increases with these "older" mothers, the chances of having good health and a healthy baby are still very high.

During the last two decades, there has been a persistent trend for women to delay having children until their 30s or 40s. Those who delay childbearing, particularly for their first child, are disproportionately well educated. Forty-seven percent of those having their first child after age 40 are college educated as compared to 7 percent of all mothers.

Pregnancy-induced high blood pressure and pregnancy-induced diabetes are two examples of common maladies that are more frequently seen in older mothers. High blood pressure during pregnancy is present in 15 to 20 percent of women over 35, but only in 2 percent of the general population. Diabetes in pregnancy occurs in about 7 percent of those in their 20s and in 14 percent of those 30 and over. Fortunately, proper treatment of these problems almost always results in a healthy mother and baby.

Miscarriage, bleeding, heart conditions, and many other additional problems of pregnancy happen more often to women over 35. These conditions are, in part, responsible for the higher rate of Cesarean section. This delivery procedure is necessary for about 27 percent of women over 40.

Problems that directly affect the baby's health such as Down's Syndrome, prematurity, low birth weight for age, congenital malformations and higher infant mortality are a concern for parents over 40. These occur in about 12 out of every 1,000 babies with mothers in their 20s and in about 20 per 1,000 for those 40 and older.

In an ideal world, the chance of having a healthy baby should always be a topic for thoughtful discussion between the parents and their physician before a baby is planned regardless of the parents' ages. This type of planning is much more common in "older" couples while, unfortunately, it is almost non-existent in those in their teens and 20s.

I'm happy to report that despite all these concerns, the chances of a 40-year-old woman, like your sister, having a healthy child are quite good. Support and encourage her, but don't remind her of how much fun it will be parenting a teenager when she is in her late 50s!

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.