over 43 and pregnant, are you taking extra precautions?

[contactmaya]

Any other 43 and over pregnant ladies out there?  I am 44 and finally got pregnant after 14 cycles of trying. The cycle i conceived on  seemed to be very weak-spotting and slow temp rise.  Yet i am here, and  cautiously optimistic. I  had my 2 other pregnancies at 37 and 40 but was more confident since i conceived them easily.

Are there any risks specific to this age group that i should know about ? Ive heard that the placenta can give out sooner, that placental abruption is more likely, that there is a higher statistical rate of stillbirth. Should i ask for more monitoring this pregnancy? Should i not do a homebirth? I realize that miscarriage is also more likely.  Ive never had a miscarriage before.

I  also wonder if there is  correlation between the time it took to conceive and the quality of the egg so to speak. Since i am 44, i consider this my super egg.

I would be grateful for any clarification, and especially from  the over 43  crowd. I know there are some of you out there!

[contactmaya]

Anyone?

[sundaya]

Congratulations!

I'm 43 and 31 weeks, due in July. It took me 16 cycles to conceive while breastfeeding my daughter, whom I conceived at 40.
My opinion is that the m/c risk is the biggest one, BUT I don't mean I think it's  a huge risk. Once you see a heartbeat, the risk drops. It doesn't mean a miscarriage can't happen, just that it's more likely that it won't, per my doc. 

I think that the other risks are a bit overblown, but probably  very much depend on your overall health. I know a lot of over 40 year olds who are terribly unhealthy with unhealthy lifestyles. So, I always take statistics with a grain of salt, you know? Are those *my* risk factors, simply because of my age? Also, when you look at them,  I don't think the risks are really as high as many would like us to believe.

Anyways, the only extra precaution I have taken is to find a doctor that a) has an extremely low c-section rate (because I don't want myself or my baby to be subjected to the risks of surgery simply because I'm older) and b) believes in the normalcy of pregnancy. One of the first things my OB said to me was that women have been having babies in their 40's for thousands of years. We've only seen it as something to worry about very recently.

I'm guessing you're in the 1t? That was the hardest time for me, as I felt like every story I read about women pregnant over 40 was of loss. There are lots and lots of us having babies at our ages, but I think when things are going well, people aren't as quick to post on message boards, so we hear and read all the sad stuff.

I hope that helps. Good luck!!

[Shami]

Hi! I am 42, but will be 43 when I deliver this baby. I took clomid to conceive this baby. When I was asking my doc about using a fertility drug at my age, he said all of your concerns (high blood pressure, over weight, gestational diabetes with first baby) are very treatable. I also have had several miscarriages so I had the attitude, 'well, I guess I am done'. But my doc is very pro natural and his attitude is women have been doing this since humans were created. He encouraged me to go for it and we would treat whatever comes up. He never said we should do more monitoring. I think the regular prenatal check ups will catch anything. Congrats everyone!

[contactmaya]

Thanks for your replies, and congratulations on your pregnancies! A double congratulations given our age group!!

Sundaya, we are sort of similar. I too have been breastfeeding ds2 whilst ttc. He is down to twice a day. Also, i conceived him at 40. 

 

I guess  i am worried because it took me so long to conceive this time, which i guess is an indication of low egg quality. Also, my cycle was weak, so i am worried about inadequate progesterone which is produced by the ovaries in the firs ttrimester, even though the hcg causes it to increase (if i got that right) Im supplementing progesterone for that reason (the cream, though i started on 50mg of suppositories, but have weaned off that )

 

Yes, i am in the first trimester, and know that the risk of miscarriage is high. It so true about many of the stories in our age group are about loss.  I am only 5 weeks, and havent got progesterone/hcg results, or done an ultrasound. But so far, im feeling pretty pregnant. Im realistic though.

 

Im not worried about my general health, diabetes and all the jazz.  Never developed complications in pregnancy before, and am just as fit now as then. No intentions of termination if baby isnt 'normal' other than if conditions are life threatening.

 

I am worried about direct connections between maternal age, as far as strength  of the placenta, uterus, ovaries, is concerned. Ive read that placental abruption can happen more easily because, well, its weaker in an older woman. Ovaries may not be able to produce adequate progesterone in the first trimester. I dont know. there is so little information on our specific age group. Its all'over 35', which i feel is irrelevant to me. I also consider risks associated with ill health are irrelevant to me.  

 

Anyway, wishing you both easy pregnancies  and complication free births!

[sundaya]

I don't know that there are any "direct connections" between maternal age and complications. Everything I've read says, placental insufficiency due to gestational diabetes, etc. I don't know that many studies have been done on maternal age ALONE, and even if they have been, if there hasn't been some exclusions made for poor health, I still probably wouldn't put much stock in them :)  I do know that even my old OBGYN group, who were extremely negative about having babies after 40, weren't worried until I developed GD. I managed to avoid it this time (dietary changes), and so far (knock wood) this pregnancy is actually much healthier than the one with my DD. So, my tendency, based upon my experience, is to think that it has more to do with maternal health than maternal age.

I did use progesterone cream (Pro-gest) during my first trimester, but didn't start it until my surprise bfp at 17 dpo (I was taking a month off from ttc!!) and I weaned off of it by 12 weeks. I don't know that I needed it, and my doctor laughed at me, but I figured it couldn't hurt anything....you know?

I look at it this way, if we didn't have internet, we wouldn't know all that we have to worry about. But, the first trimester is just one big worry, for everyone. Try to remind yourself that most women who are pregnant enough to know that they are pregnant, stay pregnant. The odds are in your favor.I had an affirmation I used, whenever I would start to worry. It helped to redirect my brain. " I trust my healthy body to build a strong healthy baby"  Sending you some vibes for a healthy 9 months.

[BHappy]

hi, i'm 43 and almost 40 weeks. just wanted to say congrats i honestly am no help at all, as i did not research any potential ama concerns.

it sounds like you are strong and healthy and capable of making babies yay for that and damn the statistics !

blessings on an uneventful, healthy and happy pregnancy !

[dot1]

I'm only pushing 40...but can relate to taking a long time to conceive and wondering about egg quality (2 yrs, luteal defect, long cycles, skipped cycles (?anovulatory) suggesting poor egg quality).  Had complications 1st pregnancy (hypertension, very low amniotic fluid and had to be hospitalized and induced)....so I'm taking it as easy as possible this time around, just trying to keep stress levels low.  For that reason I skipped all the genetic screening and just decided that it was better for my baby and my pregnancy just to believe everything would go as well as it could...and take things as they come doing standard prenatal care with a midwife.  Before conceiving, had a couple cycles of clomid (unsuccessful), then decided to take a break.  On the natural cycle, got progesterone monitored and to my surprise it was actually very high 9 dpo!  I had been thinking it would be low (had all the classic symptoms in other cycles of low prog, spotting before af, short luteal phase, etc).  Now 22 weeks and things seem to be going well. 

I wouldn't pay too much attention to statistics....as chances are the statistics on people your age have been skewed by a population that might not have things in common with you clinically.  e.g. if you have no history of difficulty conceiving, no prior hx. of miscarriage, etc. then you could actually be quite a different study subject from those studied in the research on the over 40, 43, etc population.

I would request an early ultrasound around 7-8 weeks (most accurate time to get due date...plus once the heartbeat is found on ultrasound, the chance of mc is really low).  I might also request some progesterone levels (blood test), just in case they are low.  Most OB's will say that prog. supps haven't been proven that effective in research; however so many people have had personal success with them.  It may simply be that the research done hasn't been thorough enough to say yay or nay yet.

I hope your pg goes well - don't see anything in your post to suggest it won't :). 

[contactmaya]

Dot1, thanks for your post, and congratulations on your pregnancy and reaching 22 weeks. Its such a nice time in pregnancy.

I had my first prenatal appointment yesterday at 8 weeks, and without telling me, or discussing it, the doc had recommended i get my heart checked. Frankly, thats the last thing im worried about. I mean, i could laugh at that. 

I received a few private messages, and know there are a  few of us 'over 43's' out there, and some more over 40's. Care to join the discussion? or maybe  theres nothing much to say once you are past the first trimester.....

[SDFarmgirl]

Congratulations, Mamas!  I'm "only" 41 and my DS is 10 weeks old.  He was a surprise, and both Daddy (age 32) and I are extremely healthy, so I took all maternal age risks with a grain of salt.  Surely overall health and lifestyle count for more than just age, no?  My biggest concerns were genetic disorders, because the older you get, the more likely your eggs have been exposed to harmful toxins and other things.  So I subjected myself to the hell of genetic testing, which totally sucked, but at least I could enjoy my pregnancy knowing my only risk was Down's Syndrome.  I also had two non-stress tests after 36 weeks to check the placenta and amniotic fluid.  Both were completely normal, so I didn't go back every 72 hours as suggested by my clinic provider.  I had two prenatal care providers, a home birth midwife and a regular clinic.  I'm a two or more source kind of gal - I blame Journalism school.  

Our home birth was successful and DS is completely normal, although he did deliver 2 weeks early and was only 5 lbs 9 oz.  However, he's already 12 lbs and 24 inches long at 10 weeks, so he's made up for it.  Good luck to you!  We may have another in a couple of years, so it's nice to see this convo!

[greenmama66]

I'm 44 and didn't take any precautions I didn't take with last one at age 37. I did have an amnio though and that was it. Eating well, exercise and thinking positive thoughts- this pregnancy has been routine like my others.

[music.mama.pdx]

 I'm 45 and just about to hit 12 weeks. I have not done anything differently than when I was pregnant in my twenties, though I am far more aware of what I am eating and how I am taking care of my body. I am getting an NT u/s and then based on that, either CVS or an amnio. My partner is far more worried about problems than I am, most likely as its his first baby and my third. My Midwife did say that the risk of still birth goes up with women over 40. This was news to me, but again, I am not worried. I figure I will just be very tuned in with the little one at term and be sure to get intermitent monitoring during labor.

[contactmaya]

Nice to hear from some more mamas., and some familiar faces/or rather names, from the ttc over 40 forum. I beleive there were some of us that werent even ttc.

Congratulations on reaching 12 weeks music.mama! i look forward to that day, only 3 1/2 weeks to go now....

I wish i could understand why the risk of stillbirth goes up. I wonder if its actually from undiagnosed/diagnosed fetal abnormalities ( i dont intend to do any any testing apart from the 20 week ultrasound. My doc scheduled an ultrasound for 11weeks. I did one already at 6 weeks and there was a heartbeat.:-) Im comfortable with a baby that has a disability, but i want to know if there is anything that can be done in utero or at birth in case an abnormability turns up) I might change my mind i guess. I cant see myself doing an amnio with its risk of miscarriage, hell no. That is my number one fear right now.

I asked a bunch of questions in the homebirth forum, someone listed the ostensible risks for 'over 35/over 40'. They were high blood pressure, gestational diabetes, placenta abruption, stillbirth. Maybe some others.   I had some questions about it, but so far noone has really addressed them :-(. Im still not convinced they are genuine risks  caused by age, but merely associated with age.  http://www.mothering.com/community/forum/thread/1294684/homebirths-for-mothers-35/20#post_16504232

Im feeling more confident now, dont seem to have any ostensible progesterone problems, not even using the cream anymore. But again, the first trimester is the first trimester...

[dot1]

That's awesome to detect a heartbeat so early (6.5 weeks)!  My mw said the risk of mc goes down dramatically after heartbeat found.  It's not zero of course...but much lower.  Everyone I personally know who has miscarried either hadn't had an early ultrasound nor had heard heartbeat with doppler yet.

I felt the same re. declining the genetic testing.  The thing that clinched it for me was that I learned that if downs, neural tube, trisomy, etc. were detected, then there is no in utero treatment to  address that.  I also didn't want to ever be faced with a decision of having to decide whether or not to terminate a pregnancy, the stress of "preparing" for a child with a disability (would rather just deal with things as they come), nor did I want to subject myself to amnio and increased risk of mc. 

I'm certain age would be an "association" risk...I don't know if the research has addressed the age issue without first teasing out all the other confounding variables.  In general, adults' risk of cardiovascular problems (e.g. due to having less elastic arteries making high blood pressure more likely, more tummy middle fat) increases with age - but that really does have to do with how well one takes care of oneself, as well as genetics.  In my case, I think stress was a factor in my blood pressure as it was totally normal until 35 weeks and I got the flu and got dehydrated.  My guess is that the higher risk of stillbirth and miscarriage would have more to do with the age of the sperm and eggs and the possibility of DNA damage over the years with exposure to toxins, etc....but again that's another really tough thing to research.  The partner's sperm quality also declines with age, increasing the chance of a chromosomal defect.  I work in the medical field and the reality is that it's really hard to research these things - statistical power comes with high numbers of study subjects....but the more study subjects you have, the greater the variability.  Whereas if you have a case series with subjects who are basically exactly alike you, then you can have a bit more confidence in that research.  If you and your partner have lived a healthy lifestyle, have favourable genetic health history and don't work in occupations with exposure to poor air quality/toxins/pesticides, then I would intuitively think that you may in reality have the risk profile of someone under 35 yrs.

Congrats again!

[contactmaya]

Dot1, music to my ears. :-)

I think what you say is very pertinent. I wish there was more honesty about this when doctors, and/or informational websites talk about these issues.

 

Interestingly, i used donor sperm, so the sperm is from a 22 year old.  That might increase my odds too.

 

With some of these issues, there is nothing you can do. If a chromosomal disorder turns up, well, you cant change that. But if risk of stillbirth is real, i would love to know what i can do to prevent it. If it means c section, or some other high interventionist strategy, then so be it. It seems  to me, that if a baby makes it as far as term, and then dies during labor, then must be some cause (perhaps an older egg or sperm makes the child less resilient, who knows) but there must be  something that can be done to prevent it.

 

[greenmama66]

I also think the sperm has to be accounted for as well- when I went to a genetics doc to get the amnio he told me of course it does, and it's 50% of the equation. My husband was 29 when this baby was conceived so it also may have given me more health assurance with the baby and all too, but I firmly believe a healthy lifestyle which I have lived (grew up eating organic and such) have played a major role in preserving egg quality. I have a friend that is 24 and due the same time I am and she doesn't eat healthy etc; and has had loads of pregnancy problems/issues I haven't had in any of my pregnancies. My midwife says she's rather have an older client like myself who takes care of herself than one of the younger one's eating McDonalds and such.

[sundaya]

My pet theory on stillbirth being an increased risk, is that overall, the older we get, the more chance that we have compromised blood flow, whether to the heart, the eyes, the uterus, etc. I think that, over the length of the pregnancy, maybe that could give baby less resilience or energy stores when it comes time to labor and deliver. BUT, I think that is so dependent upon general health, more so than the number of years you or I have been here. I am also under the impression that the increased risk is very small. My doctor said something like instead of 1%, it is 1 1-2 % or something like that. I have not seen studies to that effect, though. I just refuse to worry about something I cannot change. I will, as with other pregnancies, stay very much in tune with what baby is doing, how much movement, etc, and hope that because I have taken good care of myself both before and during the pregnancy, that will be enough. And overall, I feel better during this pregnancy, and have had fewer complications, than in prior ones.

Good luck and continued health to all of us!!!!

[contactmaya]

Interesting theory Sundaya. But if it is just a case of compromised bloodflow, would exercise, or perhaps massage and acupuncture be enough to  prevent this?issue?  I mean even long walks would be enough to increase  general blood flow.... (i do alot of walking,so im hoping thats true..._

[dot1]

Would make sense if someone is developing some sort of problem that affects blood flow in the arteries.  Generally we think of heart attacks and strokes, but really blood vessels go to every single organ and body part, including the uterus, kidneys, etc.... and so if there is atherosclerosis, or vessels losing elasticity, blood more prone to clotting, etc. in 1 place, then they will most likely have the same thing occuring in vessels near other body parts.   The older we are the greater the risk of that occurring.  However, genetics and lifestyle are the 2 biggest factors here.  For someone with low-normal blood pressure, normal cholesterol, no significant family history of cardiovascular disease starting young, who is physically/aerobically fit and who doesn't carry excess fat around the middle (apple shape) then I think the risk of compromised blood flow to the fetus would be lower than for a younger person who didn't have the same things going for them. 

[sundaya]

Exactly, dot1.

Contactmaya, I think we have some level of risk, because being pregnant has never in history been totally risk-free for every pregnancy for every woman. But, the overwhelming majority of the time, women, of every age, have healthy babies. For whatever reason, this pregnancy, at 43, is the easiest I've had, including my first pregnancy at 21. I've had no complications, and am still seeing the doctor every 4 weeks (although we go to once a week at the next appt, but that's his normal schedule). I haven't heard the words "high risk" once. As opposed to the pregnancy at 41, where I had a SCH (small placental bleed) at 20 weeks, preterm labor at 23 weeks (and 15 weeks of bedrest, ack!) gestational diabetes,  polyhydramnios (too much amniotic fluid), and a small placental abruption at birth. But a healthy baby, thank goodness. Don't want to jinx myself, but this pregnancy....none of the complications. The difference....in between pregnancies, I increased my level of exercise, decreased my over-all stress level, changed my eating habits in many ways, but mainly cutting out all processed foods. Here I am at 36 weeks, and I feel better pretty darn good. So, because of my own life experience, I am convinced that any risks I have, have way more to do with my own personal health/ genetics/lifestyle choices than the risks of a huge group of women who happen to be of similar age. And I also believe that those risks can be changed by lifestyle choices at any point. So, yes, walking, massage, yoga, acupuncture, eating as well as possible for your own body, all of those things can change your own personal risk factors, in my opinion.

Dot1, Contactmaya, how are you doing?