What is more risky, advanced maternal age or obesity?

[jennica]

I am 34, and my BMI falls in the obese category. I need to loose 15 pounds just to be overweight, and last pregnancy I gained 20, so if I lost 35 I would probably be able to stay out of the obese range while pregnant. But, if I try to lose the weight, it would probably take me until I'm 35 or longer, since weight loss is a very slow process for me. As it is, if I got pregnant now, I would deliver after I turn 35. I desperately want a homebirth and do not want to be risked out for any reason. So, what is more of an overall risk? I am thinking it is weight, but as I approach 35 I am also concerned with whatever risks that may bring. Does anyone have any info that would give me the basics about what kind of risks I face? Opinions are appreciated too Also, I don't know if this is relevant, but I conceived Ds when was 29, and he was born a month after I turned 30. I was 5 pounds lighter then I am right now, and like I said, I gained about 20 pounds overall (lost 5, then gained 26). I conceived the very first month we tried with him. We did try for a couple months recently though and I didn't conceive, but I was not charting or trying super hard, just stopped using protection.

[cileag]

I think that you should check out this blog for information on women of size and pregnancy. There's actually quite a bit of misinformation about the risks of pregnancy and "obesity."

http://wellroundedmama.blogspot.com/

I would say with your history of a vaginal delivery, with no other risk factors---I'd be more concerned with diet, exercise, and life style choices rather than a number on the scale.

I'm firmly in the overweight catagory myself and am having a lovely, low risk pregnancy now with a planned home birth.

[texmati]

very anecdotal... but I am extremely over weight (yes obese), and was very worried about weight when I started this pregnancy.

I joke that this is the most boring pregnancy ever. I have no problems-- not even vericose veins (knock on wood!!!) . I think that neither advanced. mat. age or obesity is an automatic high risk pregnancy. I would interview a few hcp, and see how they feel about each one.

[Vespertina]

I've been obese with all of my pregnancies and never dealt with complications related to me. I was actually 50 lbs lighter when I got pregnant with DD1. My weight has never really been an issue, though it is often assumed that because I'm fluffy that I must have complicated pregnancies complete with impaired blood glucose and high BP. Nope. I'm actually about 19 lbs below pre-pregnancy weight and everything is going smoothly.

[fwlady]

I don't have personal experience, but my friend was very obese when she had her son, and was advanced age. She had no problems whatsoever during the PG. No GD, no BP issues. She did have her 1st by csec 18 yrs earlier, so a RCS was done. And, personally, I am not sure which would have been the safest mode of delivery for her. She did have HUGE infection issues after the csection, but by going vaginal, you shouldn't have any issues with that. But, her PG went great. And, they did all the bells and whistles with her, including the amnio thing. Kymberli

[jennica]

So you're all saying just go for it and stop worrying so much?

My last pregnancy went pretty smoothly, and I am only a bit heavier right now. I would prefer to be thinner to start out with, because I did find being heavy and pregnant to be a bit difficult, but I guess maybe that was just being pregnant itself since I don't know what it is like to be thinner and pregnant. I did start to swell a bit towards the end, and my blood pressure rose during the last week before I delivered. Nothing was ever in the risky zone, but I do worry about that happening again to a more severe degree. I do eat nutritiously and I exercise more now than ever before in my life.

I am wondering though what the risks actually are in either area? Is there any way to mitigate those risks?

[Storm Bride]

I've had all c-sections, for a variety of bogus and semi-bogus reasons. (By "semi-bogus", I mean things like breech with a provider who didn't have a clue how to handle that.)

However, my pregnancies - all five of the term ones - have been easy-peasy. I've never had a blood pressure problem or a blood sugar problem or any trace of anything in my urine, or anything. I don't even get morning sickness.

My pregnancies were as follows, re: AMA and obesity:

#1: I was 24 at both conception and birth. Pre-pregnancy weight was 180lbs.

#2: I was 34 at conception and birth. Pre-pregnancy weight was about 200lbs.
#3: I was 36 at conception and 37 at birth. Pre-pregnancy weight was about 220lbs.
#4: I was 38 at conception and 39 at birth. Pre-pregnancy weight was about 225lbs. (Son was stillborn, but I was also attempting HBA3C, and I believe I had also caught a nasty stomach bug during labour.)
#5: I was 40 at conception and 41 at birth. Pre-pregnancy weight was about 230lbs.

So...take it for what it is. I think that AMA and obesity are both frequently markers of declining health (eg. if you don't have a healthy lifestyle your entire adult life, your body can still cope with it at 25, but it's getting harder at 35 or 40 and in some/many people, obesity is a sign of lack of exercise and really crappy eating habits), not health problems, or pregnancy problems, in and of themselves. But, that's just my two bits. I'm not an expert - just a fat old lady with four kids.

[tireesix]

I am just going to give my evidence lol.

Pregnancy 1 and 2 I was 18 stone, not sure how many lbs that is, hang on : 252ish lbs.

Labour was hard going, moving around in labour was hard going, 12 hour labours, just generally uncomfortable and difficult.

3rd baby I was 14 stone by the end (196ish lbs) and labour was easy, 6 hours long.

Of course, thats just anecdotal and I know for a fact that FOR ME, I simply function a whole lot better at a lower weight (I am currently close to 11 stone but work much better at the lower end of my ideal weight at about 9 stone 5ish so that my goal once I stop eating all the biscuits in the world).

I don't think being 35 is going to cause you many issues, I reckon losing a few lbs might be the better option. It might be worth talking to a MW and seeing what they have to say about it.

[mwherbs]

go in and get a physical including a glucose tolerance test, thyroid function this way you are ruling out many of the basic health concerns including borderline-to- high BP- if you have none of these things going on take a prenatal vitamin or atleast the increased folate and do some daily exercise, like walking or swimming or bike riding or dancing do something that will support your endurance so you would be able to physically be up to being active in labor and try to get pregnant sooner than later- because the other thing that happens is a decline in fertility as you get older- the issues with weight and age often have to do with baseline health concerns things that are not ok before pregnancy and haven't been detected before hand or that get worse in pregnancy --- if you have a basic health concern figure out how do address it

[MegBoz]

Well, first and foremost, you have to just ASK the MWs you're interested in using what would officially risk you out. Here in Maryland, the CPM designation is actually flat out illegal. Luckily for us mamas, we have a few 'rebels' who practice here anyway. (Some are licensed in VA or PA where it IS legal.) I know some of them attend HBACs, twins, and I think even HB Breech. But they have no legal limitations on their practice here in Maryland - so you would just have to ask them personally how they'd feel.

Originally Posted by cileag

I'd be more concerned with diet, exercise, and life style choices rather than a number on the scale.

:
I'm actually a fitness instructor, & I was going to say that it's actually worse for your health to be sedentary & slim than to be overweight & active! Number on the scale is really not that crucial!

[kcparker]

Originally Posted by jennica

I am 34, and my BMI falls in the obese category. I need to loose 15 pounds just to be overweight, and last pregnancy I gained 20, so if I lost 35 I would probably be able to stay out of the obese range while pregnant. But, if I try to lose the weight, it would probably take me until I'm 35 or longer, since weight loss is a very slow process for me. As it is, if I got pregnant now, I would deliver after I turn 35. I desperately want a homebirth and do not want to be risked out for any reason. So, what is more of an overall risk? I am thinking it is weight, but as I approach 35 I am also concerned with whatever risks that may bring. Does anyone have any info that would give me the basics about what kind of risks I face?

35 is the beginning of 'advanced maternal age,' and I think it's the cusp because A) fertility taking a noticeable decline at around 35, and B) that's the age at which, statistically, your risk of carrying a Down Syndrome baby is greater than your risk of amniocentesis causing a miscarriage. My midwife said 35, 36, 37, not such a big deal...but if you compare 35 to 40, 42, 44, then risks for maternal and fetal morbidity and mortality as well as increased risk of birth defects are statistically significant.

So, if you're asking, should I take a year to lose weight or try to get pregnant before I hit that magic 35...if you would personally feel better if you take some time to drop the weight and increase your fitness level before you get pregnant, taking a year to do it would not be a big deal in terms of fertility and pregnancy risk factors. It might make for a healthier, lower-risk pregnancy and easier birth if you are active and strong, whatever your actual weight is. You could always split the difference and start a diet and exercise program but not try to avoid conception. If you get pregnant midway through you just keep exercising to comfort and eating healthy foods.

[GoestoShow]

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Edited by GoestoShow - 12/7/10 at 6:53am

[cristeen]

To be totally honest, neither one is all that risky - definitely not the "high risk" category everyone presumes. Assuming there are no other factors involved (blood pressure, heart problems, lack of mobility, etc.), neither weight nor age should risk you out of HB. But you will want to interview care providers carefully - many still do have the fat-phobic views of our society, and you do not want to be dealing with that during pregnancy.

[jennica]

Originally Posted by Storm Bride

I'm not an expert - just a fat old lady with four kids.

Originally Posted by mwherbs

the issues with weight and age often have to do with baseline health concerns things that are not ok before pregnancy and haven't been detected before hand or that get worse in pregnancy --- if you have a basic health concern figure out how do address it

Thanks, that makes a lot of sense. I think I am overall healthy, just overweight. I may consider getting the things checked you mentioned just to be sure.

Originally Posted by kcparker

35 is the beginning of 'advanced maternal age,' and I think it's the cusp because A) fertility taking a noticeable decline at around 35, and B) that's the age at which, statistically, your risk of carrying a Down Syndrome baby is greater than your risk of amniocentesis causing a miscarriage.

So aside from fertility and a downs baby, are there any other risks? I mean, do all the fetal abnormalities that can occur increase after 35, or just downs? Can downs be detected by any other means then an amnio?

Originally Posted by kcparker

You could always split the difference and start a diet and exercise program but not try to avoid conception. If you get pregnant midway through you just keep exercising to comfort and eating healthy foods.

That is an excellent point, and kind of the direction I was heading it. I just wanted to make sure I was not overlooking anything. Thanks.




Thanks some of you for the links as well, I will look them over as soon as I have the time.

[mamazee]

I don't think either is particularly risky, so I wouldn't use those as my deciding factors for when to conceive. What age difference do you want between your kids? I'd think more about that kind of thing.

[pamamidwife]

Originally Posted by cileag

I think that you should check out this blog for information on women of size and pregnancy. There's actually quite a bit of misinformation about the risks of pregnancy and "obesity."

http://wellroundedmama.blogspot.com/

I would say with your history of a vaginal delivery, with no other risk factors---I'd be more concerned with diet, exercise, and life style choices rather than a number on the scale.

I'm firmly in the overweight catagory myself and am having a lovely, low risk pregnancy now with a planned home birth.

agreed.

[kcparker]

Originally Posted by jennica

So aside from fertility and a downs baby, are there any other risks? I mean, do all the fetal abnormalities that can occur increase after 35, or just downs? Can downs be detected by any other means then an amnio?

Statistically: 1 in 60 chance of a chromosomally abnormal fetus at 40, and 1 in 20 by the time a woman hits 45, looking at all abnormalities outside of Down Syndrome...

With AMA, there are statistically greater chances of placental insufficiency or implantation site issues (older moms have higher rates of previa), premature/low birth weight babies, all sorts of genetic defects (think - old, past their expiration, rotten eggs and sperm coming from a middle-aged man most of the time), some evidence that older dads produce more autistic children, just not being able to get a pregnancy to stick in the first place, higher incidence of gestational diabetes and high BP/preeclampsia, probably more that I am not aware of...

So much depends on the individual though that I wouldn't let statistics scare you into having or not having a child if you are over 35. You can be 25 and have a baby who doesn't make it for one reason or another, or 42 and birth perfectly healthy term twins...

You can do CVS early in the pregnancy to test for Down Syndrome, and maybe there is even a blood test available that can look for fetal cells in maternal blood (I have only a vague memory of reading something to this effect)?

[flapjack]

As far as obesity goes, prepare yourself for nine months of being treated as if you're at death's door, they just haven't figured out what you're going to die of yet. Could be pre-eclampsia, could be GD complications (you are actually not allowed to not have GD and be fat. It's in the textbooks that obese women are more likely to be hyperglycemic, therefore we must all do as we're told and have GD. It's part of being a good patient.) I'm assuming that if you're over 35, they're merely expecting you to expire peacefully of old age before you're done gestating. In both cases, there is a significant incidence of intervention (more c-sections, inductions, augmentations and instrumental deliveries) in addition to actual real life problems like pre-e, shoulder dystocia and so on.

In your shoes, though, I'd get checked out and try and rule out the possibility of insulin resistance when you're not pregnant.

[Mamatoabunch]

I just had my 10th at 35 3/4 y/o. I have have almost always been obese starting a pregnancy, but last two I was "lighter" at 210. My last 8 were born at home, last 7 unassisted. I have had very little issues.

[jennica]

So, I'm loving all these comments, so much good info. I'm feeling a lot less worried, which is good because I tend to over think these things. Here's a little more info: I'm 5'4" and under 200 pounds. In my last pregnancy I think I got up to just over 200 pounds. He weighed 7 pounds 7 ounces. The birth was fast (6 hours from first contraction) and pretty smooth physically speaking (it was traumatic in other ways, but would have been uncomplicated if I had not been in a hospital with people bothering me at every turn).

To answer someone's question, my son is 4 years old, and I wanted 3 years spacing between him and a sibling, which would have put me at 36 when that second child turned 3 (in case I wanted another at that point). But, I kind of missed that window, and he will be over 5 by the time I could complete a pregnancy now. But, if all goes well, that would still give me 2 years spacing before I turn 37 and could then choose to have another if I so desired. I mean, assuming I get pregnant soon, and assuming I decide to have another.

So, another question I just thought of: when is the cutoff for the higher risks of maternal age? Is it the day I turn 35, or the day I turn 36? If I get pregnant before that time, but deliver after, would I still be considered in that higher risk category (I mean, higher risk for infertility, down syndrome, or other risks associated with age - not just a general 'high risk' label)?