The internationally famous singer and dancer Janet Jackson was in news recently for giving birth to her first child, a son, at the age of 50.

While pregnancy after 40 is fraught with many risks to the child and the mother, the increasing availability of modern medical technology is making it easier for many older women to make the decision on whether or not they should become pregnant.

The internationally famous singer and dancer Janet Jackson was in news recently for giving birth to her first child, a son, at the age of 50. The fact that she became a mother at that age gives a whole new meaning to her song “That’s the Way Loves Goes.”

Nowadays, many women who would like to give birth to a child often wait to concentrate on their career, or simply because they still have not found the right person. It may also be that they have been trying for a while, but haven’t simply been able to conceive, and they are all already in their 40s. The one question such women often ask is, “Can I try to have a baby now?” The answer, unfortunately, is both yes and no: yes, it is possible (many 40-plus women do conceive), but that rate declines dramatically with age and is fraught with medical complications. I recently met Dr. Dipti Shrestha, Gynecologist at Kathmandu Medical College and Teaching Hospital, Sinamagal, Kathmandu, to talk about issues related to pregnancy after 40. The information below is primarily based upon that conversation.

 

The chances of a woman getting pregnant after 40 years of age

Dr. Dipti Shrestha said that it depends on how far into 40s the woman is. After 45, it is less likely for the woman to get pregnant naturally. She further added that the reduced fertility is not just because of the low number of eggs, but it is also because of their low quality. By 40s, the eggs released by ovaries each month are more likely to have structural problems (chromosomal abnormalities) which can cause high risk of miscarriage. 

But there’s never been a better time to get pregnant as an older mother, given the range of new Assisted Reproductive Technologies (ART) methods that are now available. Treatment such as Intra Uterine Insemination (IUI) and In Vitro Fertilization (IVF) are often used to get pregnant if a woman is not able to conceive naturally.

 

Complication in pregnancy after 40

Dr. Dipti said that pregnancy is still possible for a woman in her 40s, but pregnancy in 40s (or after) poses major risks and complications to the mother and the baby.

 

Likely to have a difficult pregnancy

Pregnancy complications are another concern. Women in their 40s are far more likely to develop problems such as high blood pressure and Gestational Diabetes Mellitus (GDM) during pregnancy, and placental and other complications when giving birth. In addition, the birth experience for women over 40 may be harder. They are also more likely to need increased operative interference (usually through cesarean section, C-section) due to the baby being in an awkward position.

 

Higher risk of a small or preterm baby

Older women who are more than 40 are more likely to deliver a low-birth-weight or preterm baby. Furthermore, in the first trimester, there is higher risk of spontaneous death which is also known as Intra Uterine Fetal Death (IUFD). In the second and third trimesters there might be fetal anomalies which could very difficult to detect. Stillbirth rates are also higher, and studies show that children born to older mothers may be at increased risk of type 1 diabetes and high blood pressure (though this association isn't strong).

 

Partner's sperm is older too

Don't forget about your partner. Although men are physically capable of fathering children in their 60s and even their 70s, their sperm quality deteriorates with age. An older man's sperms have a higher rate of genetic defects than those of a younger man. In recent years, studies have suggested links between the father's age and genetically related conditions such as Down syndrome, schizophrenia, and autism spectrum disorder.

It may appear that there’s a long list of things a 40-plus mother-to-be needs to worry about. But also keep in mind that there are also plenty of women in their 40s who have trouble-free pregnancies and perfectly healthy babies.

 

Risk to the child

Babies born to women over 40 years of age are not only more likely to be born early, but also more likely to have birth defects. “It could have something to do with egg quality or with the fact that older women may have undiagnosed and untreated diabetes or hypertension, which could affect the baby’s growth and contribute to birth defects,” explains Dr. Shrestha.

 

How to get pregnant

While modern medical technology is available to help a woman get pregnant even after 40, it cannot guarantee a smooth and safe road to delivery. There are undeniable health risks from pregnancy in the peri- and postmenopausal years, risks that aren’t often revealed to the plus-40 women hoping to get pregnant. It is therefore very important for them to prepare themselves, and plan ahead in order to have a successful pregnancy. If you are also in your 40s, here is how you can do that.

 

See a doctor:

  • You need to have a detailed and in-depth discussion with your doctor on how to increase your chances of conceiving, and what lifestyle changes you would need to make in order to assure a healthy pregnancy. It is equally important to be honest with your doctors about your health problems, if any, before pregnancy.

  • Dr. Shrestha emphasized that getting regular immunizations is important. In addition, other tests also need to be taken if recommended by the doctor to evaluate the eggs, or the ovarian reserve.

  • The stress of giving birth is harder if the woman is older. It is helpful to talk to the doctor about possible birth plan methods, while you are deciding whether or not you would like to be pregnant (or, as the case may be, if you eventually decide not be pregnant).

  • It can be more difficult to conceive after 40, so you may need fertility treatments. It is helpful to talk to the doctor about the possibility of using options such as fertility enhancing drugs, or surgical treatments.

 

Get regular test:

  • “All women in this group need to get their blood pressure, cholesterol, and blood sugar levels checked, before trying to get pregnant. Dr. Shrestha emphases on being proactive and getting a thorough screening to rule out hidden heart disease or condition.

 

Change life style:

  • Dietary changes are especially important during pregnancy as one needs increased amount of certain nutrients. It is important to have a more than usual portion of healthier diet. There are certain food items that need to be avoided as they can be harmful to the fetus. Food such as raw meat, smoked seafood, raw egg, and any food made from unpasteurized milk should be avoided.

  • Maintaining a healthy weight is important. Being overweight during pregnancy increases the risk for gestational diabetes and high blood pressure. On the other hand, being under weight can increase the risk of a premature birth. So you should change your lifestyle to be able to achieve healthy weight.

  • Avoid harmful substances such as tobacco, alcohol, and recreational drugs during pregnancy as well as while trying to conceive. Caffeine intake should be lessened during the first trimester.

  • Exercise is safe and even encouraged during pregnancy. Dr. Shrestha stresses that every pregnancy is different so it is important for you to consult with your doctor before embarking on a new exercise regime. The doctor may recommend more or less of certain exercise depending on your overall health.

 

Understand the risks:

  • The rate of chromosomal birth defects is higher in infants born to women over 40. You should be aware of these risks and be open to testing for chromosomal abnormalities.

  • Pregnancy loss can be very traumatic. The risk of stillbirth or miscarriage increases with age. So you should prepare yourself for the emotional impact in the unfortunate occurrence of a pregnancy loss. Close monitoring of the fetus throughout pregnancy is important if the woman is over 40, so as to reduce the likelihood pregnancy loss.

  • There is a higher likelihood of having twins or triplets, especially if you are using IVF or fertility drugs to increase the chance of conceiving. You should be prepared to be able to support a multiple pregnancy, and educate yourself on the specifics of carrying twins.

  • It is important to be patient. It takes much longer to conceive if you are over 40. Since older women’s eggs are not fertilized easily, it may take over six months to conceive.

It is possible to have a baby in midlife. But before you proceed, it’s essential to understand the potential dangers to you and your baby. “Even if a woman passes all the screening tests with flying colors, she’s still at greater risk for health complications,” stresses Dr. Shrestha. She adds, “If an older woman decides to get pregnant, that is her decision. But she should keep her eyes wide open and make sure she’s fully aware of all the potential risks.”

Don’t be surprised if -- in about a decade’s time -- Janet’s son Eissa Al Mana, who would be 10 years old by then, starts sweetly crooning Janet’s own song “Love Will Never Do (Without You)” to honor her, and to celebrate his own birth as a result of her late pregnancy.

 

Fun Facts:

  • Frieda Birnbaum of Saddle River, New Jersey, set the record for the oldest woman in the US to give birth to twins when she gave birth to them in 2007at age of 60.

  • A 62-year-old, Janise Wulf, gave birth to a singleton in 2006.

  • The oldest documented birth mother in the world is Omkari Panwar, a 70-year-old Indian woman who gave birth to 2-pound twins in 2008 via emergency cesarean section.