The importance of making advanced-age pregnancy safer
More women are now delaying childbirth, so hospitals are focusing on mitigating associated health risks.
By WP BrandStudio
Tracy Pickford used to watch turtles for a living.
In her late 20s, she worked for the National Park Service in Florida, where she made sure turtles and shorebirds had a safe place to lay their eggs. That’s where she met her now-husband, a fellow park employee. By the time she was 33, she and her husband were ready to start a family—the very thing, in a way, she’d been supervising for years.
More and more, women are following this path, delaying childbirth until later in life. Many are spending their 20s prioritizing careers, educations, financial security and other life goals, which leaves less time to start a family. As such, the average age at which women are first having children has been rising steadily since at least 1970. And while birth rates for American women have mostly gone down in the past 10 years, they’ve gone up in one single age group: women over 40.
Responding to this change, hospitals across the nation are putting in hours to develop best practices for treating women who have children later in life—otherwise known as mothers with “advanced maternal age,” which describes pregnant women over age 35. These pregnancies are always considered high-risk and thus require special care.
In Pickford’s case, when she got pregnant for the second time at 40, she was treated by Virginia Hospital Center’s Maternal Fetal Medicine group. MFM physicians provide specialized care for women with high-risk pregnancies, including those with advanced maternal age. In fact, 80 percent of the women who seek care at the VHC MFM group are over 35 years old, said Dr. Kelly Orzechowski, VHC’s Vice Chief Medical Officer for medical subspecialties and a lead physician of the VHC MFM group.
What makes advanced-age pregnancy high risk?
Socially speaking, being in your 30s is hardly “old”; the average person doesn’t buy their first house until 32 or get their master’s degree until 33, and between 24 and 34, most people switch jobs between four and five times. Physically, though, by the time we hit our 30s, our bodies begin to change.
“The older we get, the more likely we are to have conditions like high blood pressure and diabetes. It’s just a function of age,” said Dr. Michael Moxley, Vice Chief Medical Officer of hospital services and Director of OB/GYN Medical Education at VHC. During pregnancy, these medical problems require closer attention, as they can become more serious.
Women are also born with all the eggs they’ll ever have—there’s no regeneration of eggs or reparation of any tissue damage over time. “Thirty-five-year-old genetic material [in eggs] is naturally going to be a little bit less perfect than 22-year-old genetic material,” said Dr. Lynsey Owen, a generalist obstetrician in private practice on the VHC campus.
As a result of these factors, pregnant women over 35 are more likely to develop gestational diabetes, high blood pressure and preeclampsia. They may also have a harder time getting pregnant to begin with, and when they do, their children are at higher risk of preterm birth and chromosomal disorders. Doctors stress, however, that just because they’re at a higher risk doesn’t mean these outcomes are inevitable.
“I think sometimes we actually cause increased stress and anxiety by just saying ‘you’re high risk’ because the translation in a patient’s mind is ‘I’m going to do poorly,’” Orzechowski said. “I tell women, ‘you’re high risk, and that means that you qualify for some extra monitoring to help ensure you have a healthy outcome.’”
What can happen if that risk isn’t managed?
Without that kind of extra monitoring, many women who have children in their 30s face complications. Pickford, for instance, went into labor with her first daughter, Chloe, at just 24 weeks—which happens to less than three percent of mothers—as a result of HELLP syndrome, a variant of preeclampsia.
“My delivery with Chloe was really scary. By the time I finally delivered her, I was close to dying. That’s what they told me,” Pickford said.
Chloe is healthy now, as are Pickford and her second daughter, Beatrix.
Tiffany Bollinger had a similar experience: The mother of two didn’t get pregnant until she was 35. Before then, she’d been focusing on her career in finance and waiting to find the right partner. When she did, they decided to have kids almost immediately. Bollinger’s first two pregnancies were not successful; the first ended in a miscarriage and the second in a stillbirth, both as a result of Antiphospholipid Syndrome (APS), an autoimmune disorder that she didn’t even know she had.
Following her two pregnancy losses, Bollinger was referred to VHC’s MFM group, where she was diagnosed with APS. After Bollinger received proper treatment for her APS, she went on to have two full term pregnancies that gave her healthy babies.
When a woman is adequately tested, screened and treated before and during an advanced-age pregnancy, this kind of outcome is likely, said Orzechowski. That’s why she recommends that mothers of advanced maternal age have conversations with their doctors if they’re even thinking about getting pregnant—something many women don’t know is an option.
“I would have liked to have talked to [Dr. Orzechowski] before I was pregnant to find out options for planning my pregnancies,” said Sarah Ouwerkerk, who was treated by Orzechowski after going into spontaneous preterm labor with her first child in 2016. “I didn’t realize that I could do that. I thought I had to be pregnant before I could see any type of specialist about it.”
The option to delay childbirth gives freedom to many women
When a woman is able to safely put off having children, it can have a major impact on her life. Ouwerkerk, for example, who works as an occupational therapist, believes she would never have been able to reach the professional success she has now if she’d had children in her 20s.
“I’m a manager now because I spent so much time here when I was younger. I didn’t have to go home to [take care of] kids—I could spend time working and working and getting further ahead,” she said.
Research shows that women are often penalized professionally when they have children earlier in their careers. A recent study found that mothers lose the equivalent of about two years’ pay if they have their first children before age 25, whereas those who delay their first children until age 37 add about a half year of salary to lifetime earnings. While there are additional factors that influence these statistics—from inadequate maternity leave policies to lack of childcare support—enabling women to plan their own timelines gives them more control of their futures.
“The immediate benefit that seems clear to me is that women will participate more in policy-making [when they can delay childbirth],” said Elizabeth Gregory, Director of the Women’s Studies Program and Associate Professor of English at the University of Houston. “And a lot of the policies that women are introducing are [benefitting women.] It’s a self-fulfilling prophecy.”
Ultimately, safe advanced-age pregnancy lets women wait to have kids until they’re truly ready—which “generally means some special combination of ‘willing’ and ‘able’ particular to each woman,” Gregory wrote in her book Ready: Why Women Are Embracing the New Later Motherhood. There’s some data that quantifies the ambiguous value of raising children when you feel truly prepared to do so. But for women, that value can’t be measured—just felt.
“I really just wanted to live life a little bit,” Pickford said of her decision to delay childbirth. “I didn’t have a permanent job. I was following my passion and not worrying about money. But then I did get married at 30 and I think there was just a point where we started thinking, ‘Okay. Maybe we could do this.’”
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