4 min read
Age remains one of the most important factors influencing women's fertility. Research shows that fertility declines steeply after age 35. However, with modern technology and medical knowledge, the likelihood of getting pregnant after 35 is higher than before.
The age at which you conceive or decide to conceive is a very personal decision. In Hong Kong, more and more couples start a family later in life. According to the Census and Statistics Department of Hong Kong (pg.32), the median age at first childbirth rose from 26.6 years in 1986 to 31.6 in 2017.
While today women are delivering healthy babies throughout their 30s and beyond, traditionally 35 and older is considered a high-risk pregnancy. In obstetrics expectant mothers who are 35 or over are referred to as “Elderly Primigravida” for a first pregnancy and “Elderly Multigravida” for having been pregnant more than once. Other terms associated with being pregnant after 35 are “advanced maternal age” and “geriatric pregnancy”.
We take a closer look at prenatal care and childbirth after 35 with Dr. Alexander K. Doo 杜堅能醫生, Obstetrician-Gynecologist from The Women’s Clinic – Dr. Doo discussed the matter in depth back in October 2018 at the Healthy Matters Maternity + Baby Event, as one of our featured speakers.
The number 35 was defined more than 30 years ago and some would argue that age by itself should not be the major criterion for high-risk. For example, a 39-year-old woman could be healthier than a 29-year-old. However, as you get older, you are more likely than younger women to have certain health conditions that can cause complications before and during pregnancy.
Also, the chance of conception declines with age, and at 35 the success rate is halved compared to a woman at her peak fertility. The quality of the eggs also declines, and therefore the risk of chromosome abnormalities is also increased.
Risks or complications that may occur before and during pregnancy for women 35 and over include:
In general, the ante-natal visit is similar to others, provided that all is going well, and no particular risk factors are identified. This means 4 weekly visits until 28 weeks, 2 weekly visits till 36 weeks, and then weekly after that. Should you have particular risk factors, then more frequent monitoring would be advised by your doctor.
Older women are more likely to have a baby with chromosome abnormalities, so you will be advised to have some prenatal tests to check. For example, the rate of an embryo having Down syndrome at the 10-week mark of pregnancy is 1 in 1,064 at age 25, whereas it rises to 1 in 686 at age 30 and 1 in 240 by the age of 35 years. At the age of 40, the Down syndrome rate increases to 1 in 53, and down to 1 in 19 embryos at age 45.
Screening tests, like cell-free fetal DNA screening check for chromosome abnormalities via a blood test from the mother. However, it is still a screening test and if it is positive you would still need to do amniocentesis to confirm.
In the old days, before cell-free DNA testing, a CVS or Amniocentesis would be routinely offered to all mothers over 35 years old as these are diagnostic tests of chromosome problems that the baby may have, but it carries about a 1% risk of miscarriage or damage to the fetus. With the development of NIPT (non-invasive prenatal testing), most people would first be offered this as a screening test and would only proceed to invasive testing if the result is positive, or markers for genetic disease is noted during scanning, as it has no risk to the baby and the mother. However, it must be remembered that this is still a screening test and may have false positive and negative results.
In order to reduce the complications of childbirth, we need to start from pre-conception. Your doctor may suggest lifestyle changes and address any chronic diseases that may affect your pregnancy and the baby’s health.
Other prevention methods include:
Dr. Alexander K. Doo 杜堅能醫生 practiced in Hong Kong for over two decades. He was a member of various international reproductive organizations and the Vice President of the Asian Pacific Fertility Preservation Society. He had also been a Council Member of the Hong Kong Society for Reproductive Medicine for over ten years. He was Honorary Consultant at the Matilda International Hospital as well as the Director of The Women’s Clinic and Director of The IVF Clinic.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
Healthy Matters is Hong Kong’s leading health resource. Our mission is to help you make better health decisions and take control of your health.
Our team of experts is committed to producing reliable health content that is accurate, engaging and relevant, to cover your health & wellness journey from prevention to treatment.
Whether you are looking for trusted information on health conditions, wellbeing or looking for the right doctor or service in Hong Kong, we’re here to help!
Your health matters. Begin your health journey with Healthy Matters today!