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LoneRider
04-08-2014, 03:27 AM
I'm curious about what medical concerns an otherwise healthy, active and athletic woman who is pregnant at the age of about 35-37 would be?

I've got a female character who's a weekend warrior hiker/rock climber type character who would find out she's pregnant after a bout of nausea at her office. Would she, who's never been pregnant before, have any special medical concerns?

Wilde_at_heart
04-08-2014, 03:48 AM
I cannot count the number of friends I've had who've had their first kids over 35 - some, more than one.

Apart from the odd doctor 'suggesting' an amnio, next to none. Becoming pregnant is more of an issue at that age than being pregnant.

Perks
04-08-2014, 03:54 AM
Not really. I mean, not as far as how she would feel at that age. If she's been an active woman like you say, she might even handle it better than someone a good bit younger, but not as fit.

On the other hand, if she's used to high energy, she might feel quite frustrated with the very special exhaustion that comes in those first few months. (Think unable to keep your eyes open at 7pm.) This usually resolves about 3 to 4 months in.

The primary concern with later pregnancies is an increasing likelihood of a few types of birth defects and a higher incidence of multiple, and therefore slightly riskier, pregnancies.

Here's an article about elevated risk (and some lowered!) in later pregnancies.

http://www.webmd.com/baby/news/20140203/babies-born-to-moms-over-35-may-have-lower-risk-for-certain-birth-defects

LoneRider
04-08-2014, 03:58 AM
Thanks, guys. I've also heard of physicians who specialize in pregnancies and older mothers. Is this the case? Or would she be ok to see any OBGYN for matters like this.

Perks
04-08-2014, 04:10 AM
At that age and health, most regular obs or midwives would be happy to help her, unless something in the prenatal testing indicated she needed special monitoring.

Cranky
04-08-2014, 04:11 AM
Speaking as someone who had a baby when I was 36...I was treated mostly the same. However, since I was AMA, I was watched more closely and offered more screening tests. There was also a slightly higher risk of delivering prematurely (which did, in fact, happen). I was referred to a perinatologist, but that was because I developed some pretty severe pre-e symptoms fairly early on and had to be watched closely. I had two visits per week from 30 weeks on. One with my regular OB, and one with the peri, where I had 3D ultrasounds done to make sure my peanut was growing appropriately, etc.

So. Overall higher risk of birth defects and other complications, and you will probably be watched more closely than a younger mother, particularly if it's your first pregnancy. (First time mothers are at a higher risk for pre-eclampsia, as well) Unless she develops complications like pre-e or gestational diabetes, or unless there is a problem with the baby, she would be fine being seen by an OB, though, AFAIK and in my experience. I wasn't referred to the peri until I started getting sick.

Lauram6123
04-08-2014, 04:14 AM
Thanks, guys. I've also heard of physicians who specialize in pregnancies and older mothers. Is this the case? Or would she be ok to see any OBGYN for matters like this.

Speaking as someone who had my second baby at 35, I didn't need to see anyone special. Just my regular doctor. I was a bit horrified to see Advanced Maternal Age printed out on my files, however. I think moms over 35 get more visits than younger ones do.

ap123
04-08-2014, 04:58 AM
I'm pretty sure the risk of miscarriage is higher for women over 35.

shakeysix
04-08-2014, 05:16 AM
My 41 year old daughter, Hannah, had a totally unexpected surprise just about a year ago. She is mother to a 12 year old and step-grandmother to a 4 year old. She had a couple of miscarriages 0ver the years so she and her 43 year old husband were told that with birth control the chances of conception were nil. She missed a period while visiting me last year for spring break. She figured it was the beginning of menopause. We talked about it. The pregnancy was a shock, although my goofy sister had been dreaming about babies. She was sure the dreams were a sign that her 25 year old married daughter was going to break down and give her the grandbaby she craves. My sister was so confident of the dreams that she started a baby afghan. In yellow. I told her that if she were really second sighted she would have made it blue!

Hannah is in very good shape, eats sensibly and bikes and swims. Although things went smoothly there were more than a couple of concerns and more doctor visits and tests.
Because of her age the doctors did a complete analysis of the fetus. There were several tests. We knew early that he was a good sized boy, most likely blue eyed. All checked out but they stopped short with the test for Downs. They knew they were going to have the baby regardless, so did not want to know. That one really shook me up. We are a family of teachers. My sister is a special ed. teacher so we knew the joys and the challenges and were ready for them. Still, that test was something I dreaded. It was not an option in my day.

The delivery was tough. The doctor induced labor because Hannah was four days over her due date. The women in our family deliver late. I thought it was a mistake not to let it happen naturally but then I am old school so no one listens to me. The labor was almost twelve hours and finally ended in an emergency C-section. Quite a stressful day. The good news is that in Florida they make the incision low so that it won't interfere with bikini wearing. Swear to God. Hannah was thrilled. How is the baby? Check him out. He's my avatar--s6

shaldna
04-08-2014, 04:38 PM
One thing to note is that, increasingly, women are waiting longer to have babies, and now it's incredibly common for women to wait until their mid-30's or early forties before considering starting a family.

Generally fertility starts to decline at around 35, but equally, you could have a 25 year old with the same issues.

Statically speaking older mothers have an increased risk of miscarriage or having a baby with Down's Syndrome. If she's had a history of miscarriage etc and is now pregnant at that age then she may well be monitored more carefully, but from my friends and family that I've seen have babies at that age, there doesn't seem to be too much difference in care.

arcan
04-08-2014, 04:47 PM
35-37 poses no probelm for pregnancy. Too much sports can, though. My sister had to stop doing sports because her a dominals were too strong and it could have caused problems. (She hust does ski, tennis and cycling, so a normal figure not the hormon-boosted one)...

eparadysz
04-08-2014, 05:28 PM
I had my two kids at age 38 and 42. Regular OB, no issues during pregnancy. I had several early ultrasounds, partly because I opted for CVS (genetic testing that has a narrow window so they have to be sure your dates are accurate). Both unmedicated vaginal deliveries, and both went past their due dates.

sassandgroove
04-08-2014, 05:36 PM
I'm still not sure we will have a baby. But I asked my doctor because I'm not getting any younger, and she said age isn't as much of an issue as it used to be, and that it was better to have a stable marriage and be sure than to just have a baby "before I get to old."

Mutive
04-08-2014, 05:56 PM
FWIW, I'm currently attending a step class taught by a woman who's about two weeks from her due date. (She also teaches a toning class.)

She does have to alter some of her moves (no crunches, although she does do a side plank, she's lowered her step a bit, she can't raise her knees as high during knee lifts), but she's still VERY active.

So it's definitely possible to remain super active during pregnancy. (Although likely not for all women.)

Perks
04-08-2014, 06:02 PM
I was 32 when I had my last baby and worked out until the day before delivery. You don't really want to have your character doing any ab work because it can exacerbate diastasis recti, which is a condition that pregnant women are susceptible to involving separation of the abdominal muscles, leaving basically a gap in the middle. (Not really a serious thing, but kind of wild looking.)

Lindy
04-08-2014, 06:43 PM
I'm 36 and just had a little one just over 4 months ago. Instead of jumping right to amnios nowadays, they have 2 separate blood screens that are able to identify potential problems. If a possible abnormality is detected in one test, you have the option of having the second blood test...if that is also abnormal, that's when amniocentesis will be discussed.

Other than maybe a few extra ultrasound appointments, things went pretty much the way I remembered when I had my daughter 11 years ago. This little guy did try coming at 30 weeks, though. I was put on bed rest and had to take meds every 2 hours to stop contractions. Bed rest is *awful*, especially for someone who's used to an active lifestyle.

jaksen
04-08-2014, 06:58 PM
I had my Down Syndrome son at age 39. I didn't have amnio due to the way he was positioned, but even so, I knew if he had Down S., I'd still have him. Perhaps if the birth defect were more severe, and I had amnio, I might have considered not having him.

Special considerations: I saw my doctor more often, at his insistence. I had gestational diabetes and also saw an internist/endocrinologist. (But ges. diabetes is more likely if a previous baby was very large, say eight pounds or over.)

I understood the risk of having a Down Syndrome child at my age. However, in my early childhood group, which the state of MA encourages women to join shortly after the child is born, there was an 18 year old and a 28 year old mother, both who had Down Syndrome children. Age matters, but Down Syndrome can happen at any age.

With my son, at age 39, I worked up until two weeks before his birth. I am not a super active person, but I was a teacher who 'taught on her feet' as I taught science which was a very active subject. (Well, the way I taught it.) But pregnant with my son, I needed more sleep and more 'sit-down time.' I did corridor duty sitting on a lab stool, though my principal told me to go sit at my desk and 'skip' corridor duty. Skip it? It was one of the few times I got to talk to the teachers in my corridor.

So, compared to the pregnancies I had at a younger age: more tired, sitting down more. (Once I got home I sat on the couch and held that position 'til bedtime. I had two daughters, ages 7 and 11 who ran around the house doing errands for me.) No morning sickness though, and a very uncomplicated, vaginal delivery.

My most difficult pregnancy was my first at age 26. Baby came early, was a frank breech and a C-section. My second two babies were HUGE and I managed a vaginal birth on each. And I am not huge myself, five foot, two inches and about 120 pounds.

Probably tmi here. :D

usuallycountingbats
04-08-2014, 07:43 PM
Most of my friends who have children, had them in the 34-38 age range. It's incredibly normal these days. Heck, my mum was 35 when she had me (an only child) back in 1979! As far as I know, none of them had any issues, and they are all as you describe (we met mainly in the university mountaineering club, so we're an active bunch). They tended to stop doing the more extreme end of what we do, and restricted themselves to running, climbing on toprope, mountain biking known man-made trails, road cycling, that kind of thing. They all stayed active right up until the birth. One (who admittedly is 33 so slightly younger) is a very good climber - her abs were so strong she still wasn't visibly pregnant at 6 months, and she continued to bench press weights right up until she gave birth.

This article might be useful info for your research (if you haven't seen it already!) http://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/

Fallen
04-08-2014, 08:06 PM
I had my youngest at 37. I had the normal extra tests for high blood pressure and gestational diabetes (had both in all my pregnancies).

The only difference was afterwards and the injections I had to take to prevent blood clotting. That was something new and, from someone who's used to injections, those particular ones hurt like hell. I ended up with a bruise the size of a tennis ball on my arm.

Myrealana
04-08-2014, 08:44 PM
In my experience, the majority opinion above is accurate.

Nowadays, a nominally healthy woman in that age range would not automatically be classified as high risk. There would only be need for special concern if she had a pre-existing condition or some warning signs early on to warrant it - like a woman of any age.

However, if your story is taking place in another time, the situation could be different. In 1981, when my mom got pregnant at age 34, we repeatedly heard about the risks of such a late pregnancy. Her doctor had her take every possible test and eventually ordered her to stop working and take home bed rest with pre-eclampsia symptoms that today would only be considered mild.

MDSchafer
04-08-2014, 09:06 PM
Just a short list
Greater risk for high blood pressure, gestational diabetes, pre-term labor, eclampsia, higher chance of chromosomal defects, which are still thankfully very rare
Greater likelihood of birth via cesarean
Greater chance of having multiple births

skylark
04-08-2014, 10:32 PM
The good news is that in Florida they make the incision low so that it won't interfere with bikini wearing. Swear to God.

That's normal - the standard C-section incision worldwide is called a bikini incision. It's also used for some other pelvic operations.

35 is late enough that your character will be at slightly increased risk of a baby with Downs syndrome, but not significantly.

Random fact: in 1969 my mum was considered AMA to be having her first baby at 26. In 1996 I was considered relatively young to be having my first baby at 26 - I was the youngest in my antenatal classes. So it's going to be very dependent on exactly when and where your story is set as to how a 35 year old expectant mum is viewed.

The standard advice is that you shouldn't take up vigorous exercise in pregnancy, but if your body's already used to it, it's fine to carry on for as long as it's comfortable.

shaldna
04-08-2014, 10:55 PM
I have to say that I'm a little mistrusting of ultrasounds, or maybe just the skills required to read them. A couple of days before my daughter was born she stopped moving, so in a panic I went to the maternity hospital where I was given a scan and put on a heartbeat monitor. Baby was fine, just playing the still game.

However, the staff were very concerned because, although I was 9 days over my due date, the baby was, apparently very small and I was told that she probably wouldn't make six pounds and that they'd be ready incase she had to go for special care.

2 days and 8lbs 10 later she was born fit as an ox.

Bit of a difference.

Foolonthehill
04-09-2014, 04:46 PM
35 is basically a normal starting age for a modern woman living in the city. I know many women who are starting families in their late thirties and early forties. She would have to give up "hard" sports (but that applies to every age), she can speed walk, swim, do yoga, but no running or exercising too hard. She would probably get an amnio, but that would ultimately be up to her.

jaksen
04-09-2014, 08:04 PM
That's normal - the standard C-section incision worldwide is called a bikini incision. It's also used for some other pelvic operations.

35 is late enough that your character will be at slightly increased risk of a baby with Downs syndrome, but not significantly.

Random fact: in 1969 my mum was considered AMA to be having her first baby at 26. In 1996 I was considered relatively young to be having my first baby at 26 - I was the youngest in my antenatal classes. So it's going to be very dependent on exactly when and where your story is set as to how a 35 year old expectant mum is viewed.

The standard advice is that you shouldn't take up vigorous exercise in pregnancy, but if your body's already used to it, it's fine to carry on for as long as it's comfortable.


Totally correct in that the time period of the pregnancy makes a difference. I had my first child at age 26 and was the oldest woman on the ward. I felt ANCIENT.

Second child at age 32, and there were several women around the same age as me.

Last child at age 39, and before labor I said to a nurse, I bet I'm the oldest woman here having a baby. She said, nope, we have a 45 year old woman in labor with twins right now.

Time periods: 1980, 1985, 1992.

So by 1992 seeing 'older women' in labor/pregnant was becoming more common.

One more fact. When I had my second child at age 32, my grandmother said to me: 'In my day, by the time a woman was 32, she already had most of the children she was going to have. And, you're no spring chicken, so if you want another one, have it soon!'

My grandmother was born in 1903.

Hilary1
04-10-2014, 04:23 PM
The main issue of conception at 35 would be the lowered fertility rate. However, there is also an increased risk of the child experiencing genetic and birth defects.

sheadakota
04-10-2014, 04:38 PM
Thanks, guys. I've also heard of physicians who specialize in pregnancies and older mothers. Is this the case? Or would she be ok to see any OBGYN for matters like this.

I had both my kids over the age of 35- ummm- OLDER MOTHER???? REALLY? Kind of don't like that description at all- nope not one little bit-

I was not considered special or high risk- I had normal pregnancies- only thing was an increased risk (SMALL) for down syndrome-

I mean Im a nurse- 35 is not considered an old mother- used to be when women died at forty but today- umm- no.

wendymarlowe
04-10-2014, 07:10 PM
I had both my kids over the age of 35- ummm- OLDER MOTHER???? REALLY? Kind of don't like that description at all- nope not one little bit-

I was not considered special or high risk- I had normal pregnancies- only thing was an increased risk (SMALL) for down syndrome-

I mean Im a nurse- 35 is not considered an old mother- used to be when women died at forty but today- umm- no.

It is, actually. In the US it's "advanced maternal age" but in the UK you get the tag "elderly" :-\

usuallycountingbats
04-10-2014, 07:33 PM
Could be worse, when my mother had me (she was 35), they put 'geriatric mother' on her notes! :D

sheadakota
04-10-2014, 08:21 PM
It is, actually. In the US it's "advanced maternal age" but in the UK you get the tag "elderly" :-\

LOL that's just wrong ( shea who is now figuring out how to hack into her medical records to erase all mentions of OLD)

KarmaPolice
04-12-2014, 11:23 AM
Hah... I can beat that. My Mum was 45 when she had me - if 35 got 'old' on their medical records, what did she get? Ancient? It's a little freaky having your nephew in the year above you at primary school. (And even freakier that we look almost identical!)

*Amel*
04-19-2014, 07:23 PM
Women are at higher risk for placenta previa after age 35. I experienced this during my last pregnancy when I was 36. If you have this condition, you cannot move around much (bed-rest is often ordered). Fortunately, my condition corrected itself, but it can be dangerous and life-threatening to both the mother and baby. For more information, see:

http://www.mayoclinic.org/diseases-conditions/placenta-previa/basics/definition/con-20032219

Antonin
04-19-2014, 07:49 PM
I can't find anything to back this up atm, but I know the medical community is upping the "safe" age to 38 now/soonish.

Updrifting
04-19-2014, 09:31 PM
I'm 36 and just had a little one just over 4 months ago. Instead of jumping right to amnios nowadays, they have 2 separate blood screens that are able to identify potential problems. If a possible abnormality is detected in one test, you have the option of having the second blood test...if that is also abnormal, that's when amniocentesis will be discussed.

Yes! I had our only child a week shy of my 38th birthday and my doctors did watch me more closely because of "advanced maternal age" (my file actually said this) and the increased risk for downs. They recommended a "triple screen" that included amniocentesis, which we elected not to do because of the risks an amnio has, although we did do an ultrasound with the intention of determining genetic abnormalities we could see - these included the amount of space between the big toe and others, as well as some other indicators I can no longer recall. Our son is now 10 yrs old.

If you're looking for complications for your character, some options for you might be hyper emesis or pitting edema/gestational diabetes. I had a good friend who suffered with hyper emesis through all three of her pregnancies, to the point she had to be on a Zofran drip (this is an anti-nausea medication used in chemotherapy patients.). Good luck!

crunchyblanket
04-19-2014, 10:21 PM
I'm curious about what medical concerns an otherwise healthy, active and athletic woman who is pregnant at the age of about 35-37 would be?

I've got a female character who's a weekend warrior hiker/rock climber type character who would find out she's pregnant after a bout of nausea at her office. Would she, who's never been pregnant before, have any special medical concerns?

Pre-natal screening lab assistant here! The risk of Down's syndrome increases rather a lot after 35 - by the stats we use in the lab, the baseline risk for a 25 year old woman is roughly 1/1300. At 35 this rises to approx. 1/350, and at 45 it increases to 1/30 (for reference, we consider 1/150 the threshold for 'at increased risk', and usually amnio or CVS would be offered.)

It's worth noting that we don't calculate risks based on maternal age alone - other factors including N.T (nuchal translucency) biochemistry (in first trimester, PAPP-A and Free Beta HCG) and other maternal factors such as weight, whether or not she smokes and previous history of chromosomal anomalies are all considered when we calculate the 'adjusted risk'

Advanced maternal age, in my hospital at least, is considered as >35 years old. Nowadays the risk of complications is greatly reduced but there are some. Older mothers are statistically more likely to suffer with gestational diabetes, and breech presentation is more likely in older mothers, as is postpartum haemorrhage. The risk of stillbirth and premature birth is also slightly higher in older mothers. This study (http://humrep.oxfordjournals.org/content/15/11/2433.full) gives some interesting stats on the above.

(Of course, just because these complications are possible doesn't mean they'll happen - my mum had my brother and I aged 21 and suffered pre-eclampsia, hypertension and delivered prematurely. She had my sister aged 36 and had a relatively easy time. So it's always possible to have a completely normal, event-free pregnancy!)