Experts highlight pregnancy risks and complications for women as they age

Posted January 17, 2012

Women over 35 have an increased risk of pregnancy complications.Featured in the January edition of the Journal of Obstetrics and Gynaecology Canada is an article which suggests that delayed child-bearing is associated with an increased risk of infertility, pregnancy complications, and adverse pregnancy outcomes.

Women should be aware that fertility begins to decline significantly after 32 years of age. Biologically, the optimum period for child-bearing is between the ages of 20 and 35. Women over 35 have an increased risk of pregnancy complications including ectopic pregnancy, miscarriage, fetal chromosomal abnormalities, congenital anomalies, placenta previa, stillbirth, multiple birth, and cesarean section as well as coexisting medical disorders such as hypertension and diabetes. These may in turn, be associated with an increased risk of preterm birth, as well as serious conditions, long-term disability or death for the mother and/or baby before, during, or shortly after birth.

“While most women have some awareness of the “biological clock” and realize that conception difficulties increase with age, many are unaware of the limitations of fertility treatments and of the impact of maternal age on pregnancy outcome,” said Dr. Jo-Ann Johnson, principal co-author of the guideline and professor at the University of Calgary Faculty of Medicine. 
“This document reviews the obstetric and medical risks of delayed child-bearing, and provides specific practice guidelines for maternity care providers to help optimize maternal and obstetric outcome in this growing population”.

Not only are more women over thirty giving birth, but the proportion of first births occurring among women over thirty has been increasing steadily over the past 20 years and has now reached 11%. While the Society of Obstetricians and Gynaecologists of Canada (SOGC) acknowledges that many women successfully bear children beyond the age of 35, the Society also feels that the public should fully understand the reproductive lifecycle as well as the potential implications of choosing to have children later in life.
 
Canadians must consider the potential medical, social, emotional, and economic consequences of child-bearing across the reproductive years. If the trend to delay pregnancy continues, society can anticipate an increased demand for reproductive assistance, and associated increases in the need for more sophisticated prenatal, post partum and early development care.

“While a short delay in age at parenting may pose little absolute risk for the individual woman, shifts in population distribution curves towards later child-bearing affect large numbers of women, which has important implications for the health-care system,” added Suzanne Tough, PhD, principal co-author of the guideline and professor at the University of Calgary Faculty of Medicine.

Given the gaps in reproductive knowledge and awareness, the SOGC feels strongly that preconception counseling and education needs to occur at a population level, and needs to be implemented early enough so that the 95% of Canadians who anticipate parenting at some point can make informed decisions that will affect the likelihood of healthy pregnancies and the impact on the health-care system.

Johnson and Tough are also members the University’s  Alberta Children's Hospital Research Institute for Child and Maternal Health.