More and more women decide to give birth to a child after the age of 35 or even 40. Does such a late pregnancy carry more risks for both mother and baby? On the problems of late motherhood - an interview with prof. dr. hab. med. Romuald Dębski, gynecologist-obstetrician, endocrinologist, head of the 2nd Department of Obstetrics and Gynecology at the Medical Center of Postgraduate Education at the Bielany Hospital in Warsaw.
Late fruit is said to be the sweetest or is it alsolate pregnancy ? Ahaving a child over 40of a woman is a more and more frequent phenomenon. Does this also apply to motherhood? A statistical Polish mother gives birth to her first child at the age of 27, but the number of women who think about enlarging their family only in their forties is growing.
- What does late motherhood mean from a medical point of view?
ROF. ROMUALD DĘBSKI: If you look at the problem through the prism of reproductive biology, it has to be said that the optimal time for giving birth is when a woman is 18-20 years old. However, looking at this issue realistically, for many women it is too early to become pregnant. After all, this is the time when young women get an education, start working and do not think about motherhood at all. But in many regions of the world, having children in their teens is the norm. Not with us, if only because of socio-economic dependence. Therefore, the peak of reproductive capacity in Poland falls on the period of 20-25 years. However, this does not mean that giving birth to the first child after the age of 25 carries a certain number of risks. From a medical point of view, it is assumed that the first pregnancy after the age of 35 is a late pregnancy. We speak of true late motherhood when a woman decides to have her first child after the age of 40. However, it must be remembered that not only the first, but also the next pregnancy after 40 is burdened with a much higher risk of complications than the previous ones.
- What are the arguments for giving birth earlier?
R.D .: There are many of them. But the simplest one: most women in their 40s are less physically fit than they were when they were 20. Consequently, it is more difficult for them to bear the burden of pregnancy. Let us take the example of the load on the heart. In 28-34. week of pregnancythe heart has to pump 2-3 liters of blood more, which has an impact on the condition of the whole organism. I often hear from my patients that they felt great in their first pregnancy, and now, after a few years, pregnancy tires them much more. Another problem is that women over 40 years of age often suffer from chronic diseases, such as hypertension, type 2 diabetes, which affect the course of pregnancy and increase the risk of complications. Finally, it is important to remember that the frequency of multiple pregnancies increases with age. I am fully aware that a late child will be happy to have twins. But for us, doctors, there are not so many reasons to be happy, because such a pregnancy carries a several times greater risk of complications for both mother and children.
- Does the mother's age really determine the quality of pregnancy?
R.D .: Yes and no. Most pregnancies after the age of 40 are successful, but not always. When something goes wrong and you fail to deliver a baby, a woman's drama can be enormous. If only because it is too late for a second chance. These are the most dramatic situations in obstetrics. But late pregnancies also have a happy ending. Last year, four Polish women over 50 gave birth to he althy children. I do not deny women the right to have children after the age of 35 or 40. But these ladies should know that even when they are completely he althy, do not suffer from chronic diseases, pregnancy can be not only a joyful expectation of a baby. Until recently, the inelegant term "old primiparous" was used to refer to women who gave birth to their first child after the age of 30. From the point of view of biology, 25 years of age is the optimal time for the first child. Currently, the average age of giving birth to the first child is 27-28. The term "old element" (there is probably no more delicate term) is used with reference to women who give birth to their first child after the age of 35. A woman giving birth after the age of 40 is sometimes referred to as "last minute mom". I don't like these terms, but they do work and it's worth knowing what they mean.
- More specifically?
R.D .: All right. First of all, it is much easier to get pregnant when you are 20 than when you are 40. Another problem may be childbirth. Usually, after the age of 35, it lasts longer and is more difficult, more burdensome for a woman. One of the reasons is the decreased elasticity of the tissues, which translates into difficulties with the opening of the cervix. In obstetrics, we are talking about the lack of progress in labor, i.e. a situation when a woman's age is an obstacle to the birth of a child. The crowning argument againstvery late in motherhood is at greater risk of developing chromosomal abnormalities, such as Down's syndrome. Simply put - the older the mother, the greater the risk of this defect. Approx. In the age of 30, the risk of having a baby with Down's syndrome is 1: 1000. This does not mean, however, that children with chromosomal abnormalities are not born to young women. What's next? After the age of 35, the risk of pregnancy poisoning and gestational diabetes increases. Of course, we can deal with such problems, thanks to which pregnancy and childbirth usually end successfully. But you have to remember that we can't always control complications.
- Is the course of pregnancy affected by the age of the father?
R.D .: Fortunately not. Supporters of late motherhood eagerly cite the age of the mother of Johann Sebastian Bach, a genius composer who was born when she was 47 years old. But apparently more often the genius of a child is linked to the mature age of the father, not the mother. In the body of a he althy man, new, full-value sperm are constantly produced, which are capable of fertilizing the egg. Sperm are formed throughout the life of an adult male. Sperm matures around 100 days. So in a man of 40 years and three months of age, a sperm that could be involved in fertilization developed when he was 40 years old. A woman is born with a certain number of eggs and there is no way to increase the number of eggs. Oocytes are formed during the period of intrauterine life, so they are older than the women themselves, whose age is counted from the moment of birth. With age, they are selected, mature and either a new life arises from them, or they die. Over time, the eggs also require much more hormone stimulation in order for them to fully develop. Oocytes that mature and ovulate in women aged 40-45 are more likely to have genetic abnormalities than in young women.
- And the risk of miscarriage also increases with age?
R.D .: Yes, very clearly. The greater the risk of chromosomal defects, the greater the risk of miscarriage. After 40, women miscarry more than 40 percent. pregnancies, after 45 - half.
- Are babies born to mature mothers weaker, have lower birth weight?
R.D .: If no pathology has developed during pregnancy, babies are born he althy. I will say more. Children born to mature women are usually cared for more carefully, often have better conditions for development, and are said to be ill less often. Let's go back to the birth itself. You said that in a mature woman it is more difficult.
- Are these ladies giving birth by force of nature or do they decide to have a caesarean section?
R.D .: Thisindividual case. But statistics confirm that in most of these mums, pregnancies are terminated by caesarean section, and this is medically justified. Often we are dealing with the cervix that is unprepared for childbirth and its limited capacity to open. But you have to look at it another way. Delivery by caesarean section is easier to control and monitor its course than by natural forces. In addition, it is widely believed, though not entirely true, that babies born via Caesarean section have fewer he alth problems. So ladies, who are likely to give birth only once in their forties, often press to terminate their pregnancies with a caesarean section.
- We often hear that late pregnancy rejuvenates a woman and postpones the aging process. Is it true?
R.D .: Pregnancy does not biologically rejuvenate a woman. Each woman, regardless of the age of the woman, is a heavy burden, a huge effort for her body. I would not like it to be read that I am against childbearing. But let's face it, a woman who gives birth to several children has a more exhausted organism than the one who has not given birth at all. However, that doesn't mean it's he althier. Another issue is the psychological aspect of late parenthood. I myself have a 4-year-old son and when I am in kindergarten, among parents younger than me, I feel much younger. I gain energy, I have to take care of my condition, be up to date with toy novelties, etc. I think that women feel it in a similar way. I often hear from my patients that after having a baby they feel fulfilled, fully feminine. I understand this and I am happy with them. However, my many years of professional experience suggest that women should be persuaded to early motherhood, when pregnancy does not carry so many risks for both the woman and the child. Living, career - these are important arguments not to give birth to children right after graduation. But it's better not to put it off indefinitely. In biology, including the one that concerns us, everything has its time and it is worth using it.
ImportantPrenatal tests
Currently, in every pregnancy, regardless of age, the individual risk of chromosomal defects should be assessed on the basis of ultrasound and sometimes biochemical determinations. If these tests indicate a high risk, it is advisable to perform an invasive test - amniocentesis, chorionic villus sampling, and in selected situations, taking a child's blood sample. But on the other hand, I have had many pregnancies for women in their 40s in whom I did notthere was justification for such research.
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