- As teen birth rates continue to drop, birth rates among women 40 and older have climbed
- A new study describes potential health risks teen and older moms might face
- “Age is just one piece of the puzzle. What is more important is the overall health of the mom,” one expert says
Stacie Krajchir-Tom spent her 20s learning the ropes as a television producer and her 30s building her powerhouse career. By the time she reached her 40s, she was ready to start a family.
Krajchir-Tom was pregnant at age 42.
“What did I feel? Elated, like a miracle had happened. Grateful, joyous and also very, very cautious,” she said.
Yet Krajchir-Tom experienced no serious complications, and after 23 hours of labor, son Milo Kekoa was born.
Now, Milo is a healthy and thoughtful 5-year-old boy who makes profound statements, such as “Mommy, the best part of life is taking your time,” which is his response when asked to quickly put his pajamas on for bed.
“Having children later in life is where we are at as a society now,” she said. “I have friends whose parents gave them the gift of freezing their eggs so they can have grandchildren. That’s happening. That’s for real.”
Among women in the state of Washington, the study showed that the risk of potentially life-threatening conditions, or morbidity, during pregnancy — including kidney failure, shock, acute heart problems and being admitted to the intensive care unit — escalates among mothers-to-be who are 40 and older.
The study also showed some elevated risks among teenage mothers, such as an increased risk of sepsis.
Moms by the numbers
“I was not surprised that maternal morbidity increases with maternal age; however, I was surprised that the increase in relative risk was exponential, meaning that the rate of increase was higher as maternal age increased beyond 39 years,” said Dr. Sarka Lisonkova, assistant professor of obstetrics and gynecology at the University of British Columbia in Canada and lead author of the study.
“The elevated risk of sepsis among younger mothers was also surprising,” Lisonkova said. She added, however, that severe adverse conditions in mothers overall are rare.
However, the proportion of first births to women 30 and older in the US rose from 24% to 30% from 2000 to 2014, according to the new statistics in Pediatrics. The numbers also showed that the birth rate among women 40 to 44 has increased in the US, rising by about 2% from 2013 to 2014.
Yet “once pregnant, older women should not feel anxious or nervous about their babies or childbirth, and keep a healthy diet, optimal weight gain, and normal blood pressure and glucose levels,” Lisonkova said.
“We all age differently, and that includes our reproductive age; staying active and having a healthy lifestyle is the best possible prevention of any health problems,” she said. “However, it is important to counsel women prior to pregnancy about all potential risks and our study provides detailed information.”
The ‘J-shape’ of pregnancy risks
The researchers examined the data to determine trends in pregnancy outcomes and health risks by age. They took a close look at maternal morbidities but did not have sufficient data to analyze extremely rare cases, such as maternal death.
The largest proportion of the births in the study, 28.9%, was among women 25 to 29. About 25% of the births were among mothers 30 to 35, about 22% were among mothers 20 to 24, and 12.7% were among mothers 35 to 39. Teen moms made up 7.6% of the data, mothers 40 to 44 made up 2.8%, and mothers 45 and older made up 0.2%.
The researchers found that the incidence of potentially life-threatening conditions during pregnancy appeared as a J-shape when examined in association with age.
Starting with teens at the front of the J, there were some elevated health risks, which dipped to low risks among mothers 20 to 34, at the bottom of the J. Then, the risks sharply increased among mothers 40 and older, the researchers found.
For instance, the incidence of kidney failure was 2.1 per 10,000 teen mothers and about 1.2 to 1.8 per 10,000 among moms 20 to 34 years old. It then increased markedly with maternal age to 4.3 per 10,000 among 40- to 44-year-olds and a whopping 28.4 per 10,000 among mothers 45 and older, the researchers found.
“The risks associated with maternal age are generally higher for the fetus and the baby than for the mother; however, our study shows that for mothers over 49 years, the situation is reversed,” Lisonkova said.
She thinks the results could be generalizable to the rest of the country.
‘Age is just one piece of the puzzle’
Though the study provides new data, a woman’s overall health is more important for a complication-free pregnancy than her age, said Dr. Petra Casey, an obstetrician-gynecologist at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.
“Age is just one piece of the puzzle. What is more important is the overall health of the mom and her risk factors for some of these complications,” Casey said.
“Some women are healthy at 40, and some women are really sick at 20, and you have to provide that individualized kind of care … and look beyond just plain age,” she said. “I had a child at 31 and then 38 and then 41, and all of my pregnancies have been blessed and pretty uneventful.”
Ideally, a woman would have such risk factors reviewed by a doctor before she attempts to get pregnant, Casey said.
“Enter pregnancy at the best optimal health. Make yourself as healthy as you can be before you get pregnant,” she said. She stressed the importance of a healthy diet, exercising, losing weight if a physician has recommended doing so, and quitting smoking or using illegal drugs.
“Try to stay away from alcohol as well, especially those times around the time of conception,” Casey said. “Then, see your physician early and often.”
‘Others will not only be informed but inspired by our stories’
Having discussions with your doctor about potential risks once you are pregnant could be too late, said Krajchir-Tom, the mother in California, who was not involved in the study.
“I feel like if we educate young women and even men — because no one is thinking about any of this as they’re focusing on their careers — so if we aren’t educating people via a PSA, it’s very likely they won’t receive or think about any of the potential risks or issues they could potentially face until they’re right in the middle of the roller coaster of fertility issues,” she said.
“The thing is, we spend our entire 20s praying to Jesus that we do not get pregnant,” she said. “Then we spend an entire time of our 40s praying that our period never comes, ‘let me get pregnant.’ ”
Therefore, many women and men may not think about risk factors or potential complications until they know for sure that they are expecting, Krajchir-Tom said.
“What’s the worst thing if they said, ‘Guess what, I had trouble getting pregnant. It took 10 rounds of IVF for me to get pregnant’? I wish they would be more forthright and honest, because they are kind of doing a disservice to women by not,” Krajchir-Tom said. “If we can be honest and share our journey, others will not only be informed but inspired by our stories.”