Advanced Maternal Age

In our travel clinic over the last few years we have been seeing an increasing number of women whom we call “elderly gravidas.” They are also commonly referred to as being of “advanced maternal age.” (AMA)  Although we are mentioning high risk issues, we want to reassure you from the start that the vast majority of these pregnancies proceed without any problems whatsoever.

There are several reasons for the increase in AMA pregnancies. Mostly it is because more women are delaying pregnancy as they pursue higher education and a career.  Many of these women then find it necessary to use assisted reproductive technologies in order to get pregnant.

In the obstetrical field the term “advanced maternal age” has come to refer to pregnant women in their mid-30s and beyond.  It may seem odd to refer to a woman of 35 as “elderly” but as a woman ages past this age, reproductive problems can become more common. Statistics show that in the last 15 years or so there has been a 25% increase in first births to women over the age of 35. Women in this age group find it harder to get pregnant and the pregnancy is more apt to be complicated.

In our practice, the women who fit this category are most commonly business travelers. Others are people who travel for a living such as pilots and flight attendants. Some are tourists who can finally afford to travel and want to see some of the world before settling down with a family. And then there are women who are traveling abroad for family reasons such as to visit their home country or to meet in-laws.

There are a number of problems that occur more commonly in pregnancy as women get older.

Early in the pregnancy miscarriage is more common than in younger women. This is partly due to low-quality eggs receiving poor hormonal support from aging ovaries. Sometimes the cause is a genetic abnormality in the developing fetus. Also contributing are uterine abnormalities that have developed over the years, such as uterine fibroids. Miscarriage, when it does occur, may happen later than would be expected and even take place after a reassuring ultrasound.  Ectopic pregnancies are also more common in this age group, as are twins and other multiple gestations .

During the middle part of pregnancy, as further testing is done, birth defects may become more apparent and are more frequent than in younger pregnancies. These are due to genetic as well as environmental issues, smoking and so forth. Especially common are heart defects in the baby.

Late in pregnancy, AMAs are more apt to end up in the hospital with various complications. Preterm birth is more common, as are small for gestational age babies. Nearer term, preeclampsia is more common as are problems with the placenta such as abruption (the placenta coming loose too soon) and placenta previa (the placenta being in front of the baby.)  Stillbirth is also more common in this age group even in the absence of any known birth defects. Finally, progress in labor tends to be poor and the patient may be more apt to end up with a cesarean section.

The question arises as to why all these things happen in these particular pregnancies. A lot has to do with the fact that as women mature they may develop ongoing chronic illnesses such as high blood pressure, diabetes, coronary artery disease, kidney disease and obesity. Also, some women by this age have started smoking and lead stressful lives.

If you fall into this age group and are pregnant or planning to be, there are several things you can do to prevent these complications.

The first thing is to address any chronic medical conditions you may have. If you have high blood pressure or diabetes, get them under good control before you conceive. Similarly, if you are overweight, see if you can reach a more ideal weight before pregnancy. If you are a smoker, stop smoking and stop using any other drugs that you do not really need. Further, it is a good idea to start taking prenatal vitamins before you even get pregnant, as this is known to prevent certain birth defects.

Early in the pregnancy, try to get under the care of a high-risk pregnancy specialist. Your provider will probably order ultrasounds, genetic testing and other sorts of tests to get an early warning of any impending problems. You will need to have more frequent and more intense prenatal visits than the average pregnant woman and this may hamper your schedule.

There are some travel-specific issues that you should address as well. If at all possible, arrange contact with an obstetrical provider at your destination before you travel. Take with you a copy of your obstetrical record and always know your blood type. One of the most important things you can do is to get adequate rest. Business trips especially tend to be overbooked with too many meetings and dinners and not enough time to rest, so try to lighten up the itinerary.

Despite all these warnings be assured that the vast majority of AMA pregnancies do just fine! If you take good care of yourself, you will be able to carry your pregnancy and continue to travel without any mishaps.

If you are reading this because you have personal concerns about yourself or someone else, please contact us via our consultation page.  We will be very happy to give you personalized advice specific to your situation.

Safe travels…until next time.