Getting pregnant, experiencing the entire course of the pregnancy, going into labour and giving birth can take a toll on the body of any woman.

If you’re an older mum-to-be, things can get even harder. The chances of conceiving falls drastically once you’re 35, and the risk of certain complications is also higher. While 75 per cent at age 30 conceive after trying for a year, only about 45 per cent of women at age 40 do so.

According to figures from the Singapore Department of Statistics, the number of women conceiving over the age of 40 has doubled over the past three decades. It doesn’t mean you can’t deliver a healthy baby though ― celebs like Janet Jackson and Fann Wong are just some examples of older mums who have defied the odds.

While being an older mum has benefits ― you’re likely to be more established in your career and have developed a greater sense of self ― the fact is, that your pregnancy may be more difficult.

Dr Cynthia Kew, obstetrician & gynaecologist at Mount Elizabeth Hospital, advises, “If you plan to have kids, you may need to watch your biological clock.”

So, should you wait any longer before starting a family? To help you decide, Dr Kew lists the risks associated with a later maternal age.

Infographic: Syahirah Maszaid

Risks for the mum:

1. Infertility

Statistics show that the older you are, the more difficult it is to get pregnant, since women have a fixed number of eggs in her reserve. As a woman reaches her mid to late 30s, her eggs will decrease in quality and quantity.

Dr Kew notes that an older woman’s eggs are also not as easily fertilised as that of younger women. Even with assisted reproductive technology like in vitro fertilisation (IVF), success rates of these procedures decline with the woman’s increasing age.

2. Miscarriage

Getting pregnant is just half the battle won. Older mothers are at a high risk of miscarriages. According to Dr Kew, the risk of miscarriage is around 25 per cent in women above 35 years of age compared to 12 per cent in women below 30 years of age. The risk is more than 90 per cent in women who are more than 45 years old.

3. Gestational diabetes

Gestational diabetes is a condition that develops during pregnancy. Women over the age of 40 are three to six times more likely to develop gestational diabetes, compared to women aged 20 to 29.

Gestational diabetes in pregnancy poses a higher risk for potential complications for the mother and the baby during the pregnancy as well as during the delivery process.

An older woman’s eggs are also not as easily fertilised as that of younger women. Even with assisted reproductive technology like in vitro fertilisation (IVF), success rates of these procedures decline with the woman’s increasing age.

4. Ectopic pregnancy

Expectant mums over the age of 35 are four to eight times more likely to have an ectopic pregnancy (pregnancy outside the womb), compared to younger mums. In ectopic pregnancies, the fertilised egg gets implanted outside the uterus, and in most cases, inside the fallopian tube. If not detected or treated, it can rupture the fallopian tube, putting the mum at risk of internal bleeding, and even death.

5. High blood pressure and preeclampsia

Older mums have a high risk of high blood pressure and preeclampsia. Preeclampsia can happen any time after 20 weeks of pregnancy. The condition is marked by high blood pressure in women who have previously not experienced high blood pressure before. The expectant mum will also have a high level of protein in her urine. The mum’s organs may be affected and there is also a higher risk of bleeding in pregnancy, low birthweight, and even death. Left untreated, preeclampsia can be potentially life-threatening to the mother and baby.

6. Multiples

As a woman gets older, she starts seeing hormonal changes ― specifically, higher levels of a hormone called FSH. This increases the chances of developing twins. Of course, as with all multiple pregnancies, there’s a higher chance of complications to both the mother and the baby. This would require close follow-up throughout the pregnancy.

Risks for the baby:

1. Still birth

Because pregnancy complications are more likely to arise when the mum-to-be is over 35, the risk of a still birth is higher, too. According to a British Medical Journal article in 2000, the incidence of stillbirth is about 0.7 per cent in the 40 to 44 age group and 0.4 per cent in the 25to 29 age group.

A 2013 paper from the Royal College of Obstetricians and Gynaecologists in the UK even suggested that pregnant women over the age of 40 should be given the option of being induced early to reduce the risks of a still birth.

The risk of all chromosomal abnormalities increases with age of the woman, especially after 35 years of age.

2. Prematurity

Since multiple pregnancies, preeclampsia and gestational diabetes are more likely to happen among older mums, these may require preterm delivery of the baby.

Most premature babies have a low birthweight, and will need an incubator to keep warm in the first few weeks as they have trouble regulating their body temperature. Their respiratory and digestive systems are also less developed, and they are more susceptible to life-threatening conditions such as bleeding in the brain, and infections. Premature infants are also more likely to develop hearing and vision problems, as well as cerebral palsy, especially if they are born before 32 weeks of gestation.

3. Chromosomal abnormalities

Notes Dr Kew, “The risk of all chromosomal abnormalities increases with age of the woman, especially after 35 years of age.”

The risk of a Down syndrome pregnancy at different maternal ages are:
At age 30: 1 in 950.
At age 35: 1 in 350.
At age 40: 1 in 100.
Ate age 45: 1 in 30.

4. Non-chromosomal conditions

The risk of heart defects in babies of women above 40 is almost four times that of women aged between 20 and 24. The risk of clubfoot (inward turning of the feet at the ankle) and diaphragmatic hernia (a hole in the diaphragm that allows the organs in the abdomen to move into the chest cavity) also increases.

Other health conditions that are more likely to afflict babies born to older mums include cleft lip and other congenital heart diseases.

Main photo: iStock

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