The 10 risks associated with advanced maternal age (geriatric pregnancy)

Posted on 5 March 2019

Worldwide, many women are choosing to have children later in life in order to study, start a career or to pursue personal goals. Many couples also strive for financial security before having a family.

What is ‘Elderly primagravida’?

If a woman is having her first child at 35 or older, she’s considered ‘advanced maternal age’, or elderly primigravida – commonly referred to as a ‘geriatric’ pregnancy. The risks of later pregnancy depend very much on the individual woman’s health. Women who become pregnant in their thirties and forties shouldn’t be stigmatised or grouped into statistically high-risk categories that are not necessarily applicable as chronological and biological age aren’t necessarily related.

While in South Africa the average age for first-time mothers ranges from 20-29, globally this has shifted to 30+ as many women choose to pursue studies or a career before starting a family.

Thanks to medical advances, women are having babies well into their 40s. But while we tend to hear success stories about many celebrity ‘older moms’, we don’t tend to read about the failures, miscarriages and age-related complications.

INFOGRAPHIC: Fertility treatment options

Main risks

According to Dr Malikah Van Der Schyff, a gynaecologist at Mediclinic Constantiaberg, the main risks associated with a geriatric pregnancy are:

Genetic abnormalities. For example, Down Syndrome, which happens when there is an extra copy of chromosome 21, increases with age. Studies show that at 10 weeks, embryos have a risk of one in 1,064 at age 25, one in 240 at 35 and one in 19 at age 45.

Miscarriage. Spontaneous miscarriage occurs more with age as a result of egg quality or defects.  Research published in the BMJ showed that women aged 20-24 had an 8.9% risk and 74.7% for women aged 45+.

Multiple pregnancy. The incidence of having multiples increases with advanced maternal age. This is most likely due to fertility treatment.

Stillbirth. According to comparative studies, if you’re over 35, there’s an increased risk of stillbirth in most developed countries.

Emergency Caesarean section. Older mothers are more likely to have complications, such as placenta previa, where the placenta blocks the cervix, or breech position of the baby. Studies have found that physiological and cellular changes associated with age result in labour dysfunction.

Low birth weight; or preterm birth (early labour). A study found that women over 40 were more likely to have many risk factors for prematurity such as obesity, pregnancy-related diabetes or high blood pressure, and a complication known as placenta previa.

Co-morbid medical conditions are the most significant contributor to maternal deaths. These include asthma, autoimmune diseases, mental health problems, inflammatory/atopic disorders, essential hypertension, haematological disorders, musculoskeletal disorders and infections.

Gestational diabetes. This is more common in older women so it’s important to control blood sugar with diet and by being active.

Hypertension. The risk of gestational hypertension has previously been found to be 1.22 times higher in mothers between the ages of 35 and 39, and 1.63 times higher in mothers aged 40 to 44 compared to mothers in their 20s.

Greater risk of stroke and heart disease. Pregnant women over 40 are at greater risk of death from cardiovascular disease later in life.

Endometriosis is not the end of your fertility

Are there any benefits of an older pregnancy?

  • Many consider age as a bonus because older women may be in a better position to take a sabbatical – or break altogether – from a career. “They take time to enjoy them (babies),” writes Dr Northrup, adding that women should celebrate the miracle of pregnancy.
  • There may be higher levels of emotional maturity and patience.
  • Breastfeeding rates are higher in older mothers.
  • Older mothers may be in a more comfortable financial position.

Stay informed and talk to your doctor about ways to improve your chances of conception and maintain a healthy pregnancy.

Published in Pregnancy

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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