Many married couples put off having babies until they feel that they are financially stable to give their kids the best. Career is the other commonly cited reason. Given advanced medical and prenatal care, most women can have a healthy pregnancy and a healthy baby even at an *advanced maternal age.

However, delaying motherhood has significant implications to women planning a late pregnancy, which impacts their spouses and their families.

AGE AND CHANCES OF CONCEIVING
There are approximately two million cells in the ovaries at birth. Only about 400,000 of the cells survive till puberty and only about 400 of those that survive until puberty will be released at ovulation during a woman’s lifetime. The rest will degenerate. Another point to remember is that the quality of the cells that survive also deteriorates with age which will increase the risk of a child having Down’s syndrome.

HEALTH RISKS
Complications of pregnancy
From the previous factors mentioned, the chance of a spontaneous miscarriage (foetal loss before 24 weeks of pregnancy) and stillbirth (foetal loss after 24 weeks of pregnancy) are increased. The risk of having an abnormal foetus is also higher. A significant proportion of the increased risk is due to abnormal genetic makeup in the foetus. Excessive nausea and vomiting in pregnancy, hyperemesis gravidarum, is also more common in an older mother. The condition is often attributed to the patient’s increased anxiety.

There is also increased incidence of pre-eclampsia, gestational diabetes mellitus and preterm labour. The risk of low placenta or placenta previa is also increased, although there is no ready explanation for this.

Complications of labour
The duration of labour tends to be longer in an older mother. In one study, the duration was reported to be 25% longer than in younger women due to:

• Reduced functional activity of the uterus
• Less elasticity of the soft tissues of the birth canal, and
• Reduced muscular and joint mobility

Abnormal position of the foetus often necessitates the use of assisted/ instrumental vaginal delivery and Caesarean section (also known as C-Section) delivery.

Signs of maternal distress and foetal distress also tend to occur more often than expected in the older woman. Close monitoring of the maternal and foetal conditions is necessary.

As the perineum and lower vagina do not stretch as well, episiotomy is often performed and extensive perineal tears are more common.

The net result of all this is that assisted/ instrumental delivery is required about two to three times more often than in younger women and the Caesarean section rate is increased fourfold.

Complications after birth
Postpartum haemorrhage is increased in older mothers. It may be a result of greater instrumentation and operation required during birth. Coupled with decreased elasticity of the organ and the blood vessels, it can result in greater blood loss.

It appears that postpartum depression is slightly more common among older mothers as well. However the condition may be due to multiple reasons with age playing only a small part.

However, as long as the woman is in good health before pregnancy, she can reasonably be expected to have a smooth and healthy pregnancy.

*The term ‘advanced maternal age’ is universally used to describe pregnancies in women aged 35 and older.

Article is extracted from Mother & Child guidebook. For information on Obstetrics & Gynaecology
health care, treatment and services, please visit https://mtalvernia.sg/specialties/women-obstetrics-gynaecology/.