Hospital News

2006 Press Releases

Older and Pregnant
More Women 35-plus Are Having Babies. Doctors say there are risks, but screenings can make a difference.

LONG BRANCH, NJ, April 25, 2006 - On April 3, Lorene Walters gave birth to Brooklynn Marie — 6 pounds, 13 ounces of beauty — at CentraState Medical Center in Freehold.

Walters did something else that day, too. At 44, she joined the ranks of a growing number of older women who are having babies.

The baby, whom they call Brooke, was a surprise addition to the family, says the Keyport woman, who has a 21-year-old son, Greg. Her fiance, Steve Rinck, has daughters Tiffany, 12, and Stephanie, 15.

She and Rinck are thrilled with Brooke's arrival, she says.

"But I do sometimes think at this point in my life, I should be a grandmother, not starting over," Walters says, laughing.

Like Walters, Kelly Rainford, 37, is an "older woman" when it comes to pregnancies. John Luke, her son with husband, John, 39, is 5 months old. McKenzie, 3, completes the Ocean Township family.

Because of their ages, both women's obstetricians referred them to the Monmouth Medical Group in Long Branch, perinatologists affiliated with Monmouth Medical Center, Long Branch. The group specializes in high-risk obstetrics and maternal-fetal medicine and sees 4,000 to 5,000 patients a year, says Dr. David M. Wallace, one of four doctors in the group.

"Older women" are defined medically as age 35 and up, he says, and the older the age, the greater the chance of problems.

"You have to look at it as a continuum of risk," Wallace says.

Yet the number of older women having babies is increasing.

"Prior to World War II, the incidence of older women giving birth was about 14 percent," he says. "There was a continuous drop up to the 1970s, down to around 5 percent in the mid-'70s. It's back to about 14 percent of the 4 million births in the country each year."

One reason is careers

"The more educated women are, the more career-oriented, the more they delay childbearing," Wallace says.

"I think women are waiting longer because they need to get established in their careers," agrees Rainford, an ultrasound technician who works for Wallace's group and who built a career before marrying and having children.

Another reason is the availability of assisted reproductive technologies, such as in vitro fertilization or ovulating-inducing medication. This helps older women, who may have fertility problems, to become pregnant but can lead to multiple births, Wallace says.

"When you get to triplets and above, you have a whole set of other risks — low birth weight and preterm births," Wallace says. Preterm babies are born before a pregnancy, usually about 40 weeks, is completed.

"The 24-week baby has a 25 (percent) to 50 percent chance of minor and major lifelong handicaps. That number goes markedly down when you have a 28-week baby. Maybe they only have a 25 percent chance. That's compared to 1 percent for a term baby," Wallace says.

Additional concerns

Older women also are at risk of high blood pressure, diabetes, miscarriage, problems with the placenta and genetic disorders, according to the March of Dimes. The nonprofit national agency works to prevent birth defects, premature births and infant deaths through research, education and advocacy.

Other risks are low or very low birth weight and ectopic pregnancies, Wallace says.

"Most of these risks are doubled or tripled over the baseline (risk) of anyone who's less than 35 years old," he says.

Fetal screenings are used at 18 to 20 weeks to examine the fetal anatomy, which he advises women of all ages to have done.

"It's terrible to go through a pregnancy and not know if the baby has early developing hydrocephalus or kidney, spine, brain or heart problems," he says.

Tests are done for chromosomal problems. "All older mothers have a chance of having a fetus with a chromosomal problem such as Down syndrome. But a 43-year-old certainly has higher risk for a miscarriage or a fetus with Down," Wallace says, pointing to that age-based continuum of risk.

Along with specific blood tests, a nuchal translucency test is done at 11 to 14 weeks.

"It measures the thickness of the skin on the back of the fetal neck to see if there's swelling. There's a greater chance of chromosomal problems with babies with that," he says.

The screenings yield an age-related risk.

"If the risk is that of a 35-year-old mom or older, she's a candidate for invasive testing," he says, which may include amniocentesis — removing amniotic fluid from the uterus and analyzing it.

"Screenings, however, pick up about 90 percent of Down fetuses. We probably do about half as many invasive tests and pick up about 50 percent more Down fetuses," he says.

Older women also face labor and delivery difficulties.

"The chance of a Caesarean delivery increases for women in their late 30s. When you're in your late 40s, there's a 50 (percent) to 80 percent chance," he says. "Clearly, we are better built to have babies in our early 20s."

Four thumbs up

Walters and Rainford both had screenings, both had their children by Caesarean section and both say they'd tell women it's OK to be older and pregnant.

"Absolutely! Why not?" Rainford says, adding that she felt fine and worked longer during her second pregnancy. "We have such great testing now. I think you need to see your doctor, take your prenatal vitamins and take care of yourself."

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