PREGNANCY OVER 40
To wait or not to wait? It sounds like a simple enough question, but to women wanting children it's not simple at all. More and more women now are challenging traditional thinking and letting that biological clock tick.
25, 21, 30, 19, 23, 34
Are you wondering what all these women are talking about? They're confessing their magic age - how old they were when they had their first baby. Many women become mom's in their twenties and thirties. But there's an increasing trend to save those diaper days for a little later.
ANN SHUMAN: "The thought of having kids never crossed my mind, it would have interfered with everything that I was doing. When I met my husband I realized this was the person I would want to raise a family with."
Ann Shuman had her first child, Natalie, when she was forty, and her second child, Daniel, when she was forty three. A demanding nursing career and love of travel and adventure pushed motherhood to the back burner. And she's not alone - the number of women having babies after forty has doubled in the last ten years. But having kids later in life can impact you and your baby's health. Knowing this, many women look to their doctor for answers.
DR. BILL GILBERT (Dr Gilbert is chief of Maternal Fetal Medicine at the UC Davis School of Medicine and Medical Center): "I went to the literature and found that there really wasn't much there describing women over forty having babies."
He wanted nitty-gritty details about pregnancy over forty so he conducted a study that looked at over 24,000 women over forty who were delivering their first child.
DR. BILL GILBERT: "There was a dramatic increase in the cesarean section rate as well as an increase in the operative vaginal delivery rate which is forceps or vacuum."
Dr. Gilbert also found that first-time older mothers had an 80% increased risk of having high blood pressure during pregnancy, and that they were at a higher risk for gestational diabetes and other complications linked to labor and pregnancy.
DR. BILL GILBERT: "If you compare as a group of women in their twenties to a group of women in their forties pregnant or non-pregnant, the older group is going to have a higher incidence of hypertension, diabetes and so forth."
And those are the risks if you can get pregnant in the first place. That biological clock is alive and ticking, and many women over forty have to fight mother nature. Females are born with about 2-million eggs in their ovaries, but as they age that number decreases.
DR. BILL GILBERT: "By the age of forty you have about five or ten thousand eggs, so the sheer number of eggs that can ovulate and therefore cause a pregnancy are dramatically decreased."
But Ann Shuman and her husband Brad beat those odds. Ann found herself pregnant past the crucial age of 35, and she knew that there could be problems.
ANN SHUMAN: "The genetic risks were the things I was kind of worried about as far as having a pregnancy and carrying it through, and the side effects I didn't worry about any of that. I didn't worry about labor and delivery."
Ann did end up having a complicated delivery with her first child, but her second delivery went smoothly. She feels that other women over forty shouldn't let fear hold them back if they want children.
ANN SHUMAN: "I did have a C-section, but again the outcome was a perfectly healthy baby. And I think that's what women need to hear, that you know pregnancy can be fine. Mine were great, they can be fine. Delivery can be fine, but there's that increased risk, but they're watching for it."
Dr. Gilbert's study highlighted those risks, but he still encourages women over forty who really want children to get pregnant.
DR. BILL GILBERT: "The most important thing I think is that although there was the significant increase risk in the pregnancy, the vast majority of the pregnancies did very well."
Medical facts aside, some people feel that there are benefits to pursuing other life goals before having children. Older moms offer a different perspective on motherhood.
DR. BILL GILBERT: "A lot of times earlier in our lives we are not quite as mature, maybe not quite as ready to deal with the pregnancy issues. We haven't worked out our own issues. Of course in the forties a family makes a conscious choice to have a baby. They're usually pretty well set financially, they're pretty well set emotionally, this is really a wanted pregnancy."
ANN SHUMAN: "I have a lot of friends who when they were younger had there kids and now, they're grandmothers, and now they're going traveling, they're doing all the things that I did younger. I also have equally as many friends that are waiting until they're older and more mature and ready and that is comforting."
Ann mentioned one more bonus to having kids later in life: no matter what her age is, her little bundles of joy will keep her young at heart. If you are over 40 doctors recommend that you get your own health under control first, and this getting your blood pressure under control, that your exercising and eating right, and getting plenty of rest.
Some Women Are Genetically Programmed for Later Fertility
Spontaneous conception occurs in women over 45 who have a certain genetic profile, an Israeli scientist told the 21st annual conference of the European Society of Human Reproduction and Embryology today.
Dr. Neri Laufer of the Haddassah University Hospital, Jerusalem, said that his team's work to identify a specific gene expression profile linked to later fertility would help understanding of the aging process, as well as enable the development of better treatments for infertility in older patients.
Dr. Laufer and colleagues studied 250 women over 45 who conceived spontaneously. Women generally are not fertile at this time of life, due to aging of the ovaries, so the scientists thought that there might be some special factor that was allowing these women to conceive.
Longevity Link?
"Mostly, they had had a large number of children and also a low miscarriage rate," he said, "and these two factors indicated to us that they had a natural ability to escape the aging process of the ovaries. We decided to see if we could find any differences in gene expression between 8 such women and another 6 women of the same age group who had finished their families at the age of 30."
Using gene chip technology, the scientists found that blood samples from the 8 women had a unique pattern of gene expression that did not exist in the control group. The two main groups of genes expressed in these women were involved in apoptosis (cell death) and in DNA repair mechanisms.
"These women appear to differ from the normal population due to a unique genetic predisposition that protects them from the DNA damage and cellular aging that helps age the ovary," said Dr. Laufer.
"What we do not yet know is whether this reproductive success is linked with potential longevity," he noted.
Delicate Issue
The women were all Ashkenazi Jews, but Dr. Laufer's team does not believe that the gene profile is unique to this group. "We already have preliminary results demonstrating similar results from another group", he said. The team intends to study women from different ethnic -- and, hence, genetic -- groups and study their genetic fingerprints against those of the first group.
Identifying women with these genetic fingerprints will enable doctors to know which women are still fertile at an advanced age and may determine the counseling they require, said Dr. Laufer.
"However, the question of motherhood over the age of 45 is a delicate and complex one," he pointed out. "It is very dependent on the religious and cultural background of the women in question. Our first study group came from an ultra-religious sector which encourages natural conception and discourages contraceptive use. These women would, in any event, continue to challenge their reproductive system until menopause.
"But for other groups, the ethical implications may be different," Dr. Laufer said, "and counseling on all the aspects of late motherhood will play an important part in determining what is best for the individual woman."
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