First and second late pregnancies: what are the difficulties?

The most important factor in women's fertility - the ability to conceive and give birth to a child - age. The first late pregnancy is considered a serious problem, as the chances of having a baby decrease with age. Although the childbearing function of each woman has some individual characteristics.

When it comes to late pregnancy?

Today, the age interval of 25-30 years is unanimously recognized by both foreign and domestic experts as the most favorable for conceiving and bearing a child - from physiological, psychological and any other points of view.

But in most developed countries, there is a trend of increasing the age of women who decide to become a mother. According to statistics, many women in Western Europe - seeking to first get an education, establish themselves in the professional field and achieve financial stability - give birth to their first child, on average, at 29 years old, and in Australia and the UK - at 30. At the same time, one in five Britons have their first child gives birth at 35 years of age and older, and the number of first births at 35-40 years of age has doubled over the past three decades. The average age of Spanish women at first birth is a little over 30, in Germany 26% of women gave birth to a child around the age of 35, and in Ireland 6% of newborns of the first children in the family have 40-year-old mothers.

The average age of primiparous women in the US is 26-27 years, and in large cities - 31-32; at the same time, the first pregnancy after 40 years is steadily growing.

In Ukraine (according to 2017 data), four out of ten newborns have mothers under the age of 27 and almost the same number at the age of 2835, but 73% of women in this age group have a second pregnancy after 30 years or a third. However, the number of first pregnancies among 35-37 year olds has more than doubled since 2010.

So, when can pregnancy be considered late? According to doctors, for the first pregnancy, this is traditionally the age of 30+. And it's all about the female eggs (oocytes). Their number from the initial 300,500 thousand during puberty gradually decreases - after about 32 years, and in 37-year-olds, the ovarian reserve decreases by 12-15 times, not exceeding 25 thousand. At the same time, the reserve of eggs continues to deplete with a decrease in their quality: if at 25 years old, two thirds of oocytes have a normal set of chromosomes, then at 35 years old, about half of the eggs are chromosomally complete, and at 40 years old - no more than 10 15%.

Pregnancy after 30 years

Attempts to give birth to a child in 30+, having become pregnant naturally within one year, are successful in 75% of women. But, answering the question, what are the difficulties of pregnancy after 30 years, obstetricians gynecologists note several points. First, long-term oral contraception (birth control pills) - after its termination and the return of normal ovulation when planning a pregnancy after 30 years - for some time (from six months to a year) can weaken fertility due to hormonal imbalance and a decrease in cervical secretion. According to studies, in 90% of cases after giving up contraception, pregnancy ends with the birth of a child within four years.

Secondly, women of this age group may already have health problems, for example, overweight, high blood pressure, certain gynecological diseases. By the way, cardiovascular problems, hypertension, a tendency to form blood clots, as well as breast neoplasms in many people occur as a side effect of prolonged use of hormonal contraceptives.

The first pregnancy after 30 years and up to 35 increases the risk of its arbitrary termination, the probability of which reaches 15%.

Complications during pregnancy occur in younger women, but as clinical practice shows, with the first pregnancy in the fourth decade, they occur more often, including:

• preeclampsia and high blood pressure;
• gestational diabetes mellitus, for details see -  diabetes mellitus during pregnancy ;
• nephropathy of pregnant women ;
• placenta previa ;
• breech presentation of the fetus ;
• premature birth ;
• postpartum bleeding;
• weakness of labor activity (especially in nulliparous);
• delivery by caesarean section;
• underweight newborn.

How to prepare for pregnancy after 30 years?

Doctors include in preparing for pregnancy women over 30:

• giving up bad habits (smoking and drinking alcohol);
• normalization of body weight;
• maintaining an active physical form;
• proper  nutrition when planning pregnancy ;
• reduced caffeine intake;
• blood sugar control;
• taking certain  vitamins when planning pregnancy , in particular, folic acid - 0.4 mg per day, two to three months before conception;
• testing for sexually transmitted infections and promptly treating them;
• revision of the medications taken, since many of them have side effects that affect various body systems or physiological processes.

An  obstetric and gynecological examination is mandatory  - regardless of what kind of pregnancy is planned: the first, second or pregnancy after 30 years with a third child.

All necessary  tests are also given before pregnancy planning .

Pregnancy after 35 years

Reasonably enough, the first pregnancy after 35 years is considered risky, although a woman at this age may be healthier than a 25-year-old.

But - for the reasons already mentioned - the probability of pregnancy after 35 years (within 12 months) does not exceed 65 66%, and within four years after the cessation of contraception - 78 84%.

What are the difficulties of pregnancy after 35 years, in addition to possible problems with conception? At a higher risk of complications for the mother and for the fetus, both during its gestation and during childbirth.

The main problems are identical to those during pregnancy between 30 and 35 years. In particular, a pregnant woman often has high blood pressure and blood glucose levels; there is an increase in the fetus, leading to premature birth or birth trauma.

Features of pregnancy after 35 years are also associated with an increased risk of its spontaneous interruption - miscarriage, which occurs in 18% of pregnancies due to a woman's diseases,  placental abruption, chromosomal abnormalities of the fetus or other reasons. In addition, the level of stillbirth of the first child is higher: in comparison with pregnancies up to 30 years - 1.3 2 times.

The pathogenesis was studied, the relationship between the age of the mother and the occurrence of chromosomal abnormalities of the fetus - changes in its karyotype (aneuploidy) was traced and statistically confirmed. First of all, it is trisomy 21 or  Down syndrome . If during pregnancy at the age of 25 the probability of this syndrome in a child is one case per 1200 1250 births, then in women 35+ - one case per 350 385 gestations (and at 38 39 years old - one per 137 175 births).

However, planning a pregnancy after 35 does not contradict the physiology of childbearing, especially when this is the second child (and the birth of the first child was uneventful and healthy) or the third pregnancy after 35.

How to prepare for pregnancy after 35?

Preparing for pregnancy after 35 is the same as for pregnancy after 30 - read above.

Such tests are required during pregnancy after 35 years, such as:

• tests during pregnancy for infections ;
• analysis for hormones during pregnancy ;
• analysis for alpha fetoprotein ;
• plasma protein A (PAPP A)  analysis - PAPP analysis  - for early detection of embryonic pathologies.

In addition, since there is a significant risk of genetic and chromosomal abnormalities, a  genetic analysis is recommended for the expectant mother .

Possible chromosomal abnormalities are also detected during prenatal diagnosis: with ultrasound, cell-free testing of fetal DNA (based on a mother's blood sample), with the analysis of amniotic fluid - amniocentesis or sampling of the villous chorion.

Screening from the first to the third trimester is mandatory: ultrasound and  diagnostic tests to assess the course of pregnancy .

Pregnancy after 40 years

If we mean the desire of a woman to become a mother for the first time in her life, then planning a pregnancy after 40 years is figuratively called an attempt to "have time to jump into the last car of the outgoing train." This is especially true for those who have a female family history of early menopause.

What are the opinions of doctors about pregnancy after 40 years? They can be illustrated by the conclusion developed by the specialists of the American College of Obstetricians and Gynecologists (American College of Obstetricians and Gynecologists) and the American Society for Reproductive Medicine, which notes the most common obstacles to late childbearing: diseases of the pelvic organs; transferred operations on the ovaries; severe endometriosis, adenomatous hyperplasia of the endometrium -  adenomyosis and pregnancy  after 40 years, fraught with the inability to become pregnant; uterine fibroids during pregnancy  (which often provokes a miscarriage). For more information, see -  Pregnancy and uterine fibromyoma

But mastopathy and pregnancy after 40 years are not considered mutually exclusive by mammologists:  fibrous changes in the mammary gland  at any age can be eliminated during the period of breastfeeding.

So, in practice, only the state of health of a particular woman of this age category can limit her desire for motherhood when a second or third pregnancy is planned after 40 years.

For information on how to prepare for pregnancy after 40, read How to prepare for pregnancy after 35.

Chances of getting pregnant after age 40

The monthly probability of pregnancy after 40 years in healthy women does not exceed 5-7%, and within 12 months is approximately 44%. Many resort to ovulation stimulation (take prescribed drugs for infertility), intensively treat endometriosis or obstruction of the fallopian tubes, remove fibroids...

But getting pregnant naturally after 45 years - due to a decrease in the level of female sex hormones - is problematic.

Now this problem can be solved with the help of  in vitro fertilization (IVF) . However, it should be borne in mind that IVF pregnancy after 40 years occurs, according to reproductologists, in 5-12.4% of cases (compared to 22% in women aged 38-40 years), while in 44-45 year-old patients - only in 1% of cases. More successful (up to 50%) is IVF with the use of donor eggs.

At the same time, it is highly likely that the result of assisted reproduction will be a  multiple pregnancy  after 40 years, which is more difficult for a woman’s body, requiring maximum activation of metabolism and often entailing obstetric complications and postpartum consequences for mother and children.

Risks of Pregnancy After 40

Of course, all the previously listed gestational problems take place (and often worsen), and doctors especially emphasize such risks of pregnancy after 40 years as a significant increase in the frequency of aneuploidy and spontaneous abortions associated with age-related decline in fertility.

So, at this age, 34% of pregnancies (according to other sources, up to 50%) end in miscarriage, and at the age of 45 years and older - 90%.

Also, non- developing pregnancy due to various factors is more often observed  , that is, a frozen pregnancy after 40 years.

The risk of stillbirth and the birth of a child with a chromosomal disorder increases. The incidence of Down syndrome at 40 is one in 106, at 42 it is one in 64, at 43 it is one in 50, at 44 it is one in 38, at 45 it is one in 30, and at 50 it is one in 12., higher is the threat of another genetic anomaly - trisomy 18 or  Edwards syndrome , in which most fetuses die in utero, and those born alive, on average, survive for 3-15 days.

Pregnancy-related maternal risks also increase in women over 40, and one of the main factors is hypertension and heart problems that result from high blood pressure. Childbirth after 40 years is also often complicated.

How to prevent pregnancy after 40 years? Various methods  of contraception are used to prevent pregnancy , most notably,  combined oral contraceptives are recommended .

In general, obstetricians are urged not to forget that late pregnancy is a  high-risk pregnancy .