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Healthy pregnancy after 35

Chengjie SHEN, OBGYN Physician, Associate Chief Physician

With China’s relaxed family planning policy, more Chinese women are expected to give birth to two or three babies, which may lead to an increase of expecting mothers aged over 35. In many other countries without family planning policies, a lot of women also have multiple children and bear babies at an older age. Today our Obstetrics & Gynecology physician Jane Shen will talk about the risks of pregnancy after 35 and give us some suggestions on proper preparation and care for a healthy pregnancy even if mothers have had previous successful experiences.

Q: How will women’s physical condition change after they are 35 years old? What kind of risks will they face if they bear babies after 35?

A: More and more women are now having babies after the age of 35, given factors influencing career development, family planning choices or other reasons. I’ve served expecting mothers older than 40.

Many women think that if they had no problems in delivering previous babies, they would not have problems in bearing new ones over 35 either. But actually, there are some risks that become more discussion-worthy when they reach this age threshold, as their physical conditions will naturally change. Here are some of the risks they may face.

  1. Chromosome abnormalities

Their eggs may not be in the best condition any longer and clinical research has found that babies born to older mothers have a higher risk of certain chromosomal abnormalities, such as Down’s Syndrome.

Here is a chart to see how the incidence of Down’s Syndrome among babies grows with the expecting mothers’ age.

Incidence of Down syndrome for babies Age of mothers
1:1,250 25
1:952 30
1:385 35
1:106 40
1:35 45

Therefore, we always suggest expecting mothers have pre-pregnancy check-ups and regular antenatal care at a hospital. If they have had a history of miscarriage or embryo growth arrest, they should receive pre-pregnancy genetic tests together with their husbands to give their baby the best start.

  1. Gestational diabetes

Meanwhile, women aged older than 35 also face a higher risk of developing gestational diabetes. This type of diabetes, which occurs only during pregnancy, is more common as women get older. Gestational diabetes can cause a baby to grow significantly larger than average, which may cause difficulty in delivery. And those who have suffered gestational diabetes also have a 30 percent risk of developing Stage-II Diabetes after 40 years old. Their children are also at a higher risk for diabetes as their pancreatic islets would have been overused when they were foetuses.

  1. Reproductive difficulties

Older women’s eggs aren’t fertilised as easily as younger women’s eggs and they might need assisted reproductive technologies, such as in vitro fertilization (IVF). Some women with a history of induced abortion are also at a higher risk of problems, such as placenta praevia and postpartum haemorrhage.

Q: What kind of preparations should couples make to have multiple babies?

A: We have several basic suggestions for them:

  1. Pre-pregnancy check-up

It would be best to have a general pre-pregnancy check-up for possible problems, such as hypothyroidism, a condition resulting from decreased production of thyroid hormones. Untreated hypothyroidism can cause several health problems including infertility.

  1. Early folic acid supplements

Women older than 35 had best take folic acid three months before conception to prevent neural tube birth defects.

  1. A healthy diet and regular physical activity

Women who prepare to bear babies should maintain a healthy and well-balanced diet and do regular physical activities to improve their health. During pregnancy, it will be more difficult for expecting mothers to keep their weight constant, which might cause gestational diabetes and high blood pressure. So, starting with a reasonable weight level and health condition is a better choice.

  1. No smoking or drinking

Both parents are advised to stop smoking or drinking at least three months before conception as these substances can easily cause maldevelopment or malformation of babies.

Q: What is the appropriate pregnancy spacing?

A: The World Health Organization (WHO) suggests mothers wait at least 18 months after giving birth before trying to get pregnant again. It is believed to be helpful to reduce the risks of complications in subsequent pregnancy such as miscarriage, preterm labour, gestational hypertension, or preeclampsia, etc.

Q: What should be done during the pregnancy to ensure healthy growth of babies and the health of expectant mothers older than 35?

A: Like other pregnant women, they should eat a healthy diet, stay active and seek regular prenatal care.

During pregnancy, women need more folic acid, calcium, iron, vitamin D and other essential nutrients. So, it’s necessary to eat a healthy diet to ensure the supply of these nutrients.

Pregnant women still need to keep doing proper physical activities to help ease or even prevent discomfort and improve overall health to support the healthy growth of babies. It can also help prepare for childbirth by increasing your stamina and muscle strength.

We suggest exercises two or three times a week, without the risk of falling or overdoing it, such as quick walking, swimming, and yoga. Women can consult their doctors for a list of recommended activities.

Prenatal check-ups are also crucial. Many mothers with experiences in bearing babies might think they can handle the condition themselves, but many problems can only be found in medical examinations, such as placenta previa and gestational diabetes.

Placenta previa is a condition where the placenta covers the opening of the cervix and can cause severe bleeding during pregnancy and foetal deaths.

Some of the expectant women with gestational diabetes might need insulin if their blood sugar can’t be well controlled by diet and exercise.

Q: How to take care of mothers aged above 35 and their babies after delivery?

A: Mothers should continue taking vitamins and additional calcium, as they did during their pregnancy.

Besides the loss of these nutrients in feeding babies, women older than 35 also face problems such as bone aging and need more supplements to fill in the gaps. Some women who suffered from postnatal haemorrhage may also need an iron supplement. Therefore, food alone can’t provide enough nutrients for nursing mothers and additional supplements are necessary.

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