More women are giving birth at an older age; based on the statistics in the Registry of Births and Deaths in Singapore, the median age of mothers increased from 29.4 years in 2006 to 30.5 years in 2015 for first births. For third birth, the median age of mothers has increased to 34.1 years in 2015. About 1,750 births or 4% of babies born in 2015 were to mothers 40 years and above. Moreover, there have been several news of celebrities giving birth over 40, such as Halle Berry at the age of 47, Geena Davis and Kelly Preston at 48 years old. What are the risks of giving birth at an older age and is it really getting easier?

Let’s explore some of the issues for giving birth after 40!

Risks

Even though the likelihood of pregnancy increases with medical advancements, the risks of giving birth at an older age remain significant. There are risks associated with getting pregnant, during pregnancy and postpartum delivery.

#1 Harder to get pregnant at an older age

This is due to a woman’s egg supply which decreases significantly with age. Research figures have indicated that women being treated for infertility at 40 years old had a 25% chance of pregnancy (with own eggs) but this percentage dropped to 1.6% by 44 years old. While celebrity news may give an impression that it is common to give birth after 40, it is not always reported whether the birth is from her own eggs or donor eggs. Apart from fewer eggs, the quality of eggs also deteriorate with age.

#2 Higher risk of chromosomal problems and miscarriage

The risk of chromosomal problems such as Down Syndrome increases with age. The risk of miscarriage increases more than proportionately after 40 years old, and can be more than 50% for women who are 44 years old. The risks are not only associated with the quality of the egg, but also the quality of the sperm. The sperm quality deteriorates with age, and babies born to older fathers are associated with higher risks of Down Syndrome and autism.

#3 Higher risk of low birth weight/ premature baby

The statistics also showed that the rates of stillbirth, low birth weight and preterm delivery increase for older mothers. The health of the mother also plays a role – the risks appear to be higher for mothers who have or at risk of diabetes and high blood pressure.

#4 Higher risk of C-section births

Due to higher pregnancy risks, there are higher incidences of C-section delivery for women who are above 40 years old. C-section delivery is at times planned as doctors may advise an earlier birth given the increased risks. The uterus of an older woman is also less able to contract well, thus also increasing the chances of C-section.

#5 Health risks to mother

Pregnancy and delivery are very taxing on a woman’s body; the risks of a late pregnancy are sometimes related to undetected health issues with the mother. For instance, with older age, there may already be an inherent risk of diabetes, high blood pressure or high cholesterol that are not detected. It is also not known how the increase of hormones (or hormone therapy) will do to a woman’s body. Some reports suggest higher risks of breast cancer for women who give birth at an older age.

#6 Higher risks of pregnancy complications

For older women, the risks of preeclampsia and gestational diabetes increase. Although gestational diabetes is temporary during pregnancy, it increases the risk of diabetes later in life and also increases the risk of baby being born too large (and in turn, increases the risk of C-section).

#7 Challenges on finances and lifestyle

This would depend on individual; but if an older couple has not saved up in the early career years, the rising costs of education may outstripped the savings earned prior to the baby’s birth. There may be less energy for an older couple to raise a child, but this really depends on one’s priority and lifestyle.

Benefits

There are however benefits of being a mother at an older age. There would have been more time to focus on career in 20s and 30s, which are also the crucial years to increase one’s income level. Being older usually comes with being wiser, and being able to sort one’s priorities better. When the baby comes, it is more likely that an older mother, and also a stronger marriage (as opposed to newlyweds), can take on the challenges of juggling a baby with other responsibilities better. Some studies also show that children born to older mothers are more likely to be healthier, have better language development, factors which could be related to an older mother’s education and income level.

Precautions

Given the increased risks of pregnancy in 40s, it is important to take precautions. First of all, you may want to have a doctor who is experienced with high-risk pregnancies who would have more experience to advise you on your options. Screening for Down Syndrome and gestational diabetes are important, as well as ensuring that you have regular ultrasound scans. You also have to discuss with your doctor on your nutritional supplements/ diet and also exercise during pregnancy. After birth, your body may take a longer time to recover or there are more health risks to monitor depending on your health before and during pregnancy.

Fertility options

If you want to get pregnant, you may have to see a fertility specialist and be advised on your options. In-vitro fertilization (“IVF”) is a common method, which involves the fertilization of the egg by the sperm outside of the body and then implanted into the body. This can be done with fresh embryos or embryos which are frozen-thawed. The number of couples seeking IVF has increased as there is higher awareness and also subsidies available in public hospitals.

In Singapore, freezing of eggs without medical reasons is not allowed; this has led to an increase in women who went overseas to freeze their eggs for use later when they want to get pregnant. As the quality of one’s eggs become lower with age, some couples may find that they have to use donor eggs. There is however no licensed egg bank in Singapore and altruistic donation rates are very low. This can be in part due to payment to the egg donor is not allowed, except for reimbursement of expenses. The egg donor, however, has to go through daily hormone injections and also anesthesia when retrieving her eggs.

It is therefore more common and more likely to be pregnant in your 40s; however, the risks remain significant and it is important not to take for granted that giving birth in your 40s is going to be the same as during your 20s or early 30s.

Written by Mei