Part #4 Babies After 40: The Hidden Health Risks of Mid-Life Pregnancy
Posted Jul 29 2009 12:27am
Information sharing is key to making a solid decision regarding your health and pregnency. Although many women want to be surrogates well into their 40's these issues that Open Arms has been posting about are very real concerns to Intended Parents and Clinical staff. These are just some of the reasons that older women are often passed over when IP's are searching for a surrogate.
The risk to your heart
By Hallie Levine Sklar
The strain of pregnancy, experts say, can be likened to the stress of running a marathon—and the older a woman is, the more likely she is to have complications from it.
Doctors of women in the 40-plus set are most concerned about pregnancy-induced preeclampsia, which generally surfaces in the third trimester. While the incidence of preeclampsia among all moms-to-be is 3 to 4%, that risk increases to 5 to 10% if you’re older than 40 and jumps up to 35% if you’re past 50. Most reputable fertility clinics require patients over the age of 45, especially those with borderline cholesterol or high blood pressure, to undergo more extensive cardiology screening, like an electrocardiogram (EKG) or a stress test, but “these tests can miss women who have borderline heart disease,” Dr. Stillman says. “Sure, they may be fine playing tennis. But the stress of nine months of pregnancy? That’s the equivalent of climbing Mt. Kilimanjaro.”
In addition, pregnancy can prompt an earlier onset of health problems that would have otherwise developed later in life. “A 50-year-old woman with borderline high blood pressure who might not develop hypertension until she’s 60 may start to have it during her pregnancy,” explains Errol Norwitz, MD, a high-risk OB-GYN at the Yale School of Medicine. And this can set her and her baby up for a host of complications.
Deborah Lake, 50, developed preeclampisa seven years ago (she was 43) while carrying twins, prompting her physician to induce labor. “My blood pressure had always been quite low, but toward the end it began to creep up to the point where my doctor decided to induce me at 36 1/2 weeks,” she recalls. Lake delivered her first daughter, Savannah, vaginally. But her second daughter, Courtney, got stuck in the birth canal, prompting an emergency C-section. Lake was discharged after three days, only to return a few days later when her blood pressure shot up and her whole body swelled, both signs of preeclampsia. “They gave me diuretics, and I peed out about 50 pounds of water weight in three days,” she recalls.
Lake had been trying to get pregnant for almost a decade and finally conceived via donor eggs. “Because of my age and the fact that I was carrying twins, I was so careful—I ate perfectly, I didn’t gain too much weight,” she says. “But even that, ultimately, wasn’t enough to stave off problems.”
There are also heart concerns after pregnancy. “Most women tend to gain weight with each pregnancy and keep those extra 10 pounds around for a while,” Dr. Minkin says. “That extra weight increases an older woman’s risk of developing heart disease.”
Progesterone, a reproductive hormone that’s given to women during IVF and is also present at high levels during pregnancy, causes both blood pressure and cholesterol to temporarily go up, adds Nieca Goldberg, MD, director of the New York University Women’s Heart Center. “This isn’t an issue for a healthy woman with no risk factors for heart disease.
But if you’re going into pregnancy with borderline high blood pressure or cholesterol, which many older women have, it can pose a serious problem,” she says.
Peripartum cardiomyopathy, which Joanna Brody had, is also a potential danger among this group of moms. While Brody emerged unscathed, this condition can cause heart failure—which leads to death in 25 to 50% of cases, according to the National Institutes of Health. Another huge worry: gestational diabetes, a temporary form of diabetes that occurs during pregnancy. It almost always goes away after delivery, but it can be a harbinger of diabetes later in life and puts women at risk for delivering a too-large baby (macrosomia).
Though the overall rate of gestational diabetes is 3%, it rises to 7% in women older than 40 and 20% in women older than 50. But while risk factors like a family history of diabetes, borderline blood sugars, being overweight, or having had gestational diabetes in an earlier pregnancy all increase your chances of getting it, many older women with none of these end up developing this dangerous condition.
Not surprisingly, because over-40 women are more at risk for a variety of health problems, their C-section rate is significantly higher than that of younger moms. Almost a third of all women in the United States deliver via C-section, but almost 50% of women having their first child between 40 to 45 and almost 80% in women ages 50 to 63 undergo the procedure. “Older women have older uteruses, which tend to not contract as well, which can result in abnormal labor” and lead to a C-section, explains Robin Kalish, MD, director of clinical maternal-fetal medicine at Weill Cornell Medical Center in New York City.