> SECOND OPINION

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Dr. Ealena Callender is a graduate of the University of Maryland Medical School. She completed her residency at Wright State University in Dayton, Ohio, before joining the Center for Womens Health, a Newport News practice, in November 2006. Her specialty is obstetrics and gynecology.

What are the risks associated with having a child after age 35?
Most women do not think of themselves as elderly when they
tissuethe only way to accurately determine whether the babys chromosomes are normal. Hypertension Chronic hypertension is almost twice as prevalent in pregnant women who are of AMA, and the complications associated with this condition may include preeclampsia in the mother, inadequate growth of the fetus, placental abruption and fetal death. Pregnant women under treatment for hypertension may have to adjust their medicine intake because certain medications can be harmful to the fetus. These women will be closely monitored for rising blood pressure, severe headaches or protein in the urineall of which may indicate the development of preeclampsia. In its mildest form, a woman with this condition may be restricted to bed rest late in her pregnancy. When it becomes severe, however, the only treatment for preeclampsia is deliveryeven if the baby is premature. Diabetes While only two to three percent of pregnant women are diabetic, diabetes complicates some eight percent of pregnancies among AMA patients. Like those with hypertension, pregnant women who have diabetes are at increased risk for miscarriage, preeclampsia, and stillbirth. They are also more likely to have large babies, increasing the chance of injury during vaginal delivery or requiring a cesarean section. Maintaining tight control over blood sugar levels can help decrease the risk of complications. Blood sugars should be checked up to four times a day and reported to the obstetrician/gynecologist. Even those whose condition was previously wellcontrolled may require significantly increased doses of insulin during pregnancy. Women who are newly diagnosed with diabetes may be offered nutrition counseling. For some, diabetes may be controlled by diet alone. Others will require pills or insulin injections to control their blood sugar. If a woman has a history of a chronic illness such as diabetes or hypertension, further testing may be required to establish whether she has suffered any damage to her liver or kidneys. Due to the increased risk of stillbirth, AMA patients may require weekly monitoring of the babys heart rate, or a nonstress test, starting at around 34 weeks into the pregnancy. Labor may be induced at 39 weeks if by then the patient hasnt gone into labor on her own. Often, the decision to delay pregnancy is a wellinformed one. Having reached a point when they may be more financially secure, in a stable relationship and feeling more confident about themselves, many women believe they are better equipped to start a family of their own later in life. But because of the increased risks, women of AMA can expect more frequent doctors visits as well as additional testing, monitoring and counseling. By knowing the risks, women can make informed decisions about their care, and the health of their baby. HJ

turn 35, but as far as pregnancy goes, once a woman reaches that age, terms such as elderly, geriatric and postmature start to apply. Pregnant women over 35 years of age are said to be of advanced maternal age, or AMA. It is the age at which the risk of pregnancy complications increasesyet more and more American women are choosing to consider pregnancy in their 30s and 40s. Approximately 20 percent of women are waiting until after age 35 to begin childbearing, and according to the Centers for Disease Control and Prevention, the number of births among women 35 to 44 rose by as much as 51 percent between 1990 and 2002. By 2004, the birth rate for women 35 to 39 had reached its highest since 1965. For women 45 to 49, the birth rate more than doubled between 1990 and 2000. Some women have postponed marriage and childbearing to pursue their education and career goals; others are simply choosing to continue childbearing later in life. Moreover, medical advances in the field of assisted reproduction have made it possible for women to

Even a perfectly healthy 40-year-old woman will be considered highrisk during pregnancy.
overcome fertility problems and pursue pregnancy much later. But women of AMA are at increased risk for complications during pregnancy. These women, on average, tend to have a higher prevalence of medical conditions such as hypertension, diabetes and obesityall of which can cause complications. AMA is also an independent risk factor for complications including gestational diabetes, preeclampsia (which can lead to seizures in the mother), placental abruption (separation of the placenta from the uterus), cesarean delivery and stillbirth. Even a perfectly healthy 40yearold woman will be considered highrisk during pregnancy. Chromosomal Abnormalities The risk of a newborn having chromosomal abnormalities, such as Down syndrome, also increases for women of AMA. Down syndrome occurs in approximately one in every 800 births in the United States, but when a mother reaches AMA, that risk becomes one in 400 (for women 31 to 35 years of age; the risk grows substantially with each fiveyear increase in age). Women of AMA may be offered specific genetic tests as early as 10 weeks into the pregnancy. These include an ultrasound (to measure nuchal translucency, or the thickness of the back of the fetuss neck, a sign of possible chromosomal defects) and blood tests, which together can help determine the risk for chromosomal abnormalities. Women of AMA may also be offered a chance to speak with a genetic counselor to outline their individual risks. Once fully informed, they may opt for testing that obtains fetal