Cindy is a glowing new mom. On January 15, she gave birth to her first child at the University of Utah Hospital. In many ways, Cindy is no different than the average mother; she's excited and nervous about what the future holds for her tiny arrival. Cindy is also unlike most new mothers in one significant way. She is 51.
Cindy is proof that women her age are often capable — with help from donor eggs and in vitro fertilization — of carrying and giving birth to a child.
"I have people come to my office and say, 'At age 40, am I crazy from a medical standpoint to even think about getting pregnant?'" said Erin Clark, MD, a maternal fetal medicine physician at University of Utah Health who treated Cindy during her pregnancy. "The conversation that we have is 'While your risks are going to be a little bit higher than somebody who is younger, your most likely outcome is that you're going to have a healthy pregnancy. So I try to reassure them that if the timing's right for them, and they want a family, it's not an unreasonable journey to embark upon."
At 35, women reach "advanced maternal age," but this doesn't mean there's a line in the sand with low risks for pregnancy complications on one side and a sudden spike in risk when a woman crosses the line. Instead, risks increase gradually until menopause. Some women are able to conceive naturally in their 40s while others need infertility treatments or donor eggs to become pregnant. At age 20, the risk of miscarriage is about 10 percent; the risk at age 40 is about 50 percent. Likewise, the probability of having a baby with Down syndrome at age 20 is about one in 1,400 while at age 40, the odds are one in 80, Clark said.
It's important to note that these statistics become a nonfactor when, like in Cindy's case, an older woman uses donor eggs from a younger woman. At 50, it's nearly impossible for women who want children to go the natural route. Utilizing donor eggs allows them to carry a child since it's the older eggs themselves that are often the cause of complications, Clark said.
Still, even with donor eggs, older women have increased risks of preeclampsia, early delivery, gestational diabetes and Caesarean section, Clark said, but it's really the fact that they can't conceive on their own that is the biggest issue.
One reason risks of complications are higher for older pregnant women is that they are more likely to have chronic diseases such as hypothyroidism, chronic hypertension and diabetes.
"We say, 'Look, if you've got these chronic diseases, you need to make sure they're as controlled as possible before you get pregnant," Clark said. "It ends up being a discussion about balance. How healthy can we get you without delaying your pregnancy an inordinate amount of time?"
When it comes to advice for staying healthy while pregnant, the guidance isn't much different whether a woman is 22 or 47.
"We always tell people to try to achieve an optimal weight before pregnancy and to eat a generally healthy diet and to try to get at least 30 minutes of exercise a day," Clark said. "That counseling is the same across the board."
Open communication with a health care provider is key in all pregnancies and even more so when the patient isn't far from menopause. A doctor can assess a woman's unique medical circumstances and determine if she's healthy enough for pregnancy. It's also vital for patients and their doctors to candidly discuss the personal, financial and social issues of having a child later in life.
"I try to get a sense from them that they've really thought about these issues and that they understand they're going to be having children who are graduating high school potentially when they're 70 years old," Clark said. "If I get a sense that they have carefully thought about those issues, that's enough for me."
In Cindy's case, her doctor determined, after tests, that she was medically healthy enough for pregnancy. Regarding the social factors, Cindy and her husband decided that the timing was right. It helped too that she's surrounded by an amazing support system.
"I have a friend who's a nurse and she was very insistent that I stay healthy," Cindy said. "So, even if I didn't feel like it, she would be like 'Get up and get out of bed and let's go walking.' I'm sure I wouldn't be doing as well if she hadn't kept me active like that."
The pregnancy wasn't all smooth sailing for Cindy. Her water broke early, and her baby was delivered six weeks preterm by Caesarean section. Cindy had to spend the final two and a half weeks leading up to the birth in the hospital, and Clark said the infant will likely need to spend about six weeks in the Newborn Intensive Care Unit. But Clark said the baby will likely be healthy when it's time to leave.
Cindy said she's thought about how she'll be in her late 60s when her child graduates high school, but she has friends who are grandparents who act as the primary caregivers for their grandchildren. There are all kinds of different ways to do things in this world, Cindy said.
Said Clark, "I tell my patients that parenthood is always a leap of faith. Becoming pregnant when you are older is just a little bigger leap."