Are you an advanced-maternal-age Mater Mamma?

Are you having a baby later in life? If so, Advanced Maternal Age (AMA) is a term you may see written on your Mater antenatal record if you are 38 years or older.

In this blog Dr Alice Whittaker, Mater Obstetrics and Gynaecology specialist, talks about this issue and why it’s important for your doctor and midwife to draw attention to this in your pregnancy.

It’s certainly becoming more common for women to wait a little later in life before starting a family. 

The number of mothers aged 35 and over has doubled between 1991 and 2015. There are many reasons women are waiting to start a family, including career opportunities, not meeting Mr Right, or travel. It may be a conscious choice too, with women feeling more emotionally ready for parenthood later in life, or being more financially stable.

However, being pregnant over the age of 38 is not without its issues. The first stumbling block for many women is actually getting pregnant. Science tells us our ovaries start winding down from age 32 (that’s when we the number and quality of eggs start declining), and at a more rapid rate after the age of 37.

Once pregnant, older mum’s face a higher rate of miscarriage.  The miscarriage rate is 25 per cent for women aged 35 to 39 and 51 per cent for women aged 40 to 44, compared to approximately 12 per cent for women aged 25 to 29.

Some of these pregnancy losses will be due to an incorrect number of chromosomes (aneuploidy) such as Down Syndrome (Trisomy 21).

This raises the next important question, how should an older mum be screened for aneuploidy? The standard screening approach has been the Combined First Trimester Screen (CFTS), combining the results of certain blood tests with ultrasound features such as the baby’s nuchal (neck) translucency measurement, with out-of-pocket costs from $100. This test has a detection rate of 85 to 90 per cent.

However in the last four years or so, Australian women have had access to Non Invasive Prenatal Testing (NIPT). At $400 to $500, this test obviously costs more, but with its higher detection rates (over 99 per cent for Down Syndrome), this may be the preferable option for the older mum to be who is wanting aneuploidy screening.

Older mums-to-be are also more likely to have a complicated pregnancy with increased rates of gestational diabetes, pre-eclampsia, growth restriction and caesarean section among other things and your doctor is more likely to keep a closer eye on you.

If you’re over 40, your doctor may perform diabetes screening in your first trimester, as well as at 24 to 28 weeks. Your doctor may also start you on aspirin to prevent pre-eclampsia if you are older than 40 years old and have another risk factor for pre-eclampsia.

Finally, Advanced Maternal Age is also associated with an increased risk of stillbirth. For that reason, your doctor or midwife may advise an induction of labour before your due date.

So for the older woman—yes there are more risks, but at Mater we can help you to manage these to help you achieve a healthy pregnancy and baby.

And on the plus side, there is some research to suggest being an older mum has some advantages; older mums are more likely to live longer, and have smarter kids with fewer behavioural problems.