What you need to know:
- Many studies concur that the risk of pregnancy induced diabetes, hypertensive disorders on pregnancy, caesarian delivery, post-partum haemorrhage and small for gestational age babies (babies that are smaller than usual for the number of weeks of pregnancy) markedly rises for mothers above the age of 35, more so for those above 40.
- This has been more investigated among first time mothers but the risk appears to apply even for those having their subsequent babies after 35.
My colleague sat across the table, her hands wrapped around the coffee cup to keep warm. It was a cold July morning and we were keeping a long overdue date. We laughed and talked about life in general, catching up with each other’s lives.
I asked about her little ones, no longer so little, and her eyes lit up as she regaled me with the new developments in their lives. Suddenly her demeanour changed and she leaned forward, grabbing my hand. She narrated how she had attended a workshop on infertility for the past two days and all she heard was how we had gotten too old to bear children!
Though I was giggling uncontrollably at how visibly upset she was, it was worth noting that this is a conversation that is taking centre stage with most women in their 30s and beyond who are considering having babies but haven’t yet dipped their toes in the waters.
Despite one in five babies being born to adolescent mothers in Kenya, for many women planning for motherhood, the age of first pregnancy is steadily rising as education, career and other life interests take precedence. Many women are now starting their motherhood career after the age of 35 years.
For over seven decades, the age of 35 has been steadfastly used to make reference to advanced maternal age. Any woman delivering her baby after crossing this age is deemed a high-risk mother. Over the years, this cut-off has been contested but what remains factual is that the risk of pregnancy, childbirth and neonatal complications has been documented to significantly increase with age in a linear fashion.
Many studies concur that the risk of pregnancy induced diabetes, hypertensive disorders on pregnancy, caesarian delivery, post-partum haemorrhage and small for gestational age babies (babies that are smaller than usual for the number of weeks of pregnancy) markedly rises for mothers above the age of 35, more so for those above 40. This has been more investigated among first time mothers but the risk appears to apply even for those having their subsequent babies after 35.
While the focus has been on the mother, with due attention to her health during the maternity period, there is also a significant spotlight on the baby being born. It is worth noting that advancing maternal age does increase the risk for chromosomal abnormalities in the unborn baby.
Take for instance Down’s Syndrome. The risk steadily increases with age, from approximately 1:1250 at the age of 25, to 1:40 above the age of 45. Despite this, many babies with Down’s syndrome are born to younger women currently because there is only a small number of women above 40 having babies.
The older mum is more likely to deliver a pre-term baby as a result of the expected pregnancy complications necessitating early delivery of the newborn, not necessarily because spontaneous prematurity is more common in older women. These interpretations of the statistics are important so as not to give older mums undue anxiety over their offspring.
As a result of the high risk of chromosomal anomalies in the unborn babies, antenatal screening is becoming more relevant in our antenatal clinics as part of service provision. In the more advanced countries, antenatal screening for chromosomal abnormalities is offered to every pregnant woman above the age of 35. Back home, we are a far cry from achieving basic antenatal care, let alone advanced screening!
For this reason, even availability of these screens is dismal at best. Very few facilities offer these screening tests and for those that do, the costs are prohibitive to a majority of the population! Even more appalling is the fact that many antenatal care providers are not even aware of their existence, hence they would hardly recommend them, even when caring for women above the age of 40.
While considering the hurdles involved, the end point of the screening also remains hazy. Screening for chromosomal abnormalities is intended to offer the pregnant woman options regarding her unborn baby. The woman and the care team are better prepared to expect the abnormalities at birth, hence there is early preparation for the baby. This may involve referral to deliver in more advanced facility with better level of care for the unborn baby.
The family is also able to psychologically prepare to raise a baby with special needs, not just to be slapped with the unplanned demands when the baby is already here. Furthermore, this also offers the woman the choice to opt out of the pregnancy early through termination.
It is clear that diagnosing foetal abnormalities in pregnancy does not make the journey any easier, hence the constant reminder to caregivers that it is important for the mother to always have the final say on whether she wants to get screened or not. For some, not knowing is a safer bet than knowing and having to deal with the reality of it before the baby arrives.
For what it is worth, let us strive to educate our mothers and always offer them a choice!
Dr Bosire is an obstetrician/gynaecologist