Pregnancy in the older mother

I’m over 35 years old and am pregnant. What do I need to be worried about?

It is now very common for women to get pregnant for the first time when they are 35 years and above – you are definitively not alone! While most women go on to have successful pregnancies and healthy children, there are certain risks that have been linked with mothers who are older. Here are some that you should know about: 

First trimester 

• Chromosome abnormalities 

As a mother gets older, there is a higher risk of error during cell division and baby ending up with an abnormal number of chromosomes. The most common one is Down syndrome. You can opt to do prenatal Down syndrome screening if you and your partner are keen.

• Miscarriage

This can be due to fetal chromosomal abnormalities or your pre-existing medical conditions

• Multiple pregnancies

Older mothers have a higher risk of twins (which is associated with risks on its own); multiple pregnancies are also linked with the use of in-vitro fertilisation

Second trimester

• Gestational diabetes (GDM)

Older mothers have a higher risk of GDM. If you have risk factors e.g. GDM in previous pregnancy, are overweight or 40 years and above, you may be asked to have a OGTT early in your pregnancy and again in your late second trimester. Poorly controlled GDM can result in big baby (macrosomia), polyhydramnios (excessive amount of water in water bag), low blood sugar in baby after delivery (hypoglycemia), jaundice in newborn.

• Pregnancy induced hypertension (PIH)/ pre-eclampsia (PE)

Your blood pressure will be measured every antenatal visit, and a urine dipstick performed to look for protein in your urine as these are signs that you may be developing PIH/PE. PE can affect placenta function and result in a small baby. It can also affect your liver/kidney function and put you at an increased risk of seizures and stroke. 

Third trimester

• Small baby 

Older mothers have an increased risk of having babies that are growth restricted, and may need additional ultrasound scans during pregnancy for monitoring.

• Premature birth 

Premature babies can have problems with their brains, lungs, hearts, eyes and other organs. They can also have long-term health issues including intellectual and development delays.

• Stillbirth 

Research has shown the rates of stillbirth (where baby’s heartbeat stops suddenly) is higher in first time mothers aged 35 year and above. The cause is not clear, hence the higher rates of induction of labour.

• Induction of labour (IOL)

This is related to a higher rate of pregnancy complications that an older mother may encounter and due to the higher risk of stillbirth in older mothers. If you are aged 40 years and above, you will be offered IOL from 39 weeks.

• Caesarean section 

This is related to a higher rate of pregnancy complications that an older mother may encounter, including low-lying placenta/ placenta previa and those listed above. 

• Bleeding after delivery (postpartum haemorrhage)

In some cases, you may require additional medications, procedures and blood transfusions.