First and second late pregnancies: what are the complications?

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

When is it late pregnancy?

Today, the age range 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 towards an increase in the age of women deciding to become mothers. According to statistics, many women in Western Europe – seeking to first get an education, establish themselves in the professional sphere and achieve financial stability – give birth to their first child, on average, at 29 years old, and in Australia and Great Britain – at 30. At the same time, every fifth British woman gives birth to her first child at 35 years old and older, and the number of first births at 35-40 years old has doubled over the past three decades. The average age of Spanish women at their first birth is a little over 30, in Germany 26% of women gave birth to a child at the age of about 35, and in Ireland 6% of newborn first children in the family have 40-year-old mothers.

The average age of women giving birth for the first time in the United States is 26-27 years, and in large cities - 31-32; at the same time, the number of first pregnancies after 40 years is steadily increasing.

In Ukraine (according to 2017 data), four out of ten newborns have mothers under 27 years of age and almost the same number of those aged 28-35, but for 73% of women in this age category, this is the second pregnancy after 30 or the 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 female eggs (oocytes). Their number from the initial 300-500 thousand during puberty gradually decreases - approximately after 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 have a baby at 30+, having become pregnant naturally within one year, are successful in 75% of women. But, answering the question of what are the difficulties of pregnancy after 30, obstetricians-gynecologists note several points. Firstly, long-term oral contraception (birth control pills) - after its cessation 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 reduced production of cervical secretions. According to research, in 90% of cases after stopping contraception, pregnancy ends with the birth of a child within four years.

Secondly, women of this age category may already have health problems, such as excess weight, high blood pressure, and certain gynecological diseases. By the way, cardiovascular problems, hypertension, a tendency to form blood clots, and breast tumors occur in many as a side effect of long-term use of hormonal contraceptives.

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

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

• preeclampsia and high blood pressure;
• gestational diabetes mellitus, for more details see – diabetes mellitus during pregnancy;
• nephropathy of pregnancy;
• placenta previa;
• breech presentation of the fetus;
• premature birth;
• postpartum hemorrhage;
• weakness of labor (especially in first-time mothers);
• delivery by caesarean section;
• low birth weight of the newborn.

How to prepare for pregnancy after 30?

Doctors include women over 30 in their preparation for pregnancy:

• giving up bad habits (smoking and drinking alcohol);
• normalization of body weight;
• maintaining active physical fitness;
• proper nutrition when planning pregnancy;
• reducing 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 their immediate treatment;
• review of 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 which pregnancy is planned: the first, second, or a pregnancy after 30 with a third child.

All necessary tests are also taken before planning a pregnancy.

Pregnancy after 35 years

It is quite reasonable to consider the first pregnancy after 35 years of age to be 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 stopping contraception – 78-84%.

What are the difficulties of pregnancy after 35, besides possible problems with conception? In the higher risk of complications for the mother and the fetus both during pregnancy and during childbirth.

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

The peculiarities 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 diseases the woman has, placental abruption, chromosomal abnormalities of the fetus or other reasons. In addition, the level of stillbirth of the first child is higher: compared to pregnancies before 30 years - 1.3-2 times.

The pathogenesis has been studied, the relationship between the mother's age and the occurrence of chromosomal abnormalities in the fetus - changes in its karyotype (aneuploidy) - has been traced and statistically confirmed. First of all, this 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 - one per 137-175 births).

However, planning a pregnancy after 35 years does not contradict the physiology of the reproductive function, especially when it is the second child (and the birth of the first child was without complications, and he is healthy) or the third pregnancy after 35.

How to prepare for pregnancy after 35?

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

The following tests are required during pregnancy after 35 years of age:

• tests for infections during pregnancy;
• Hormonal analysis during pregnancy;
• alpha fetoprotein test;
• 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, the expectant mother is recommended to undergo genetic testing.

Possible chromosomal abnormalities are also detected during prenatal diagnosis: ultrasound examination, cell-free fetal DNA testing (based on a maternal blood sample), amniocentesis, or chorionic villus sampling.

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

Pregnancy after 40 years

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

What are doctors' opinions on pregnancy after 40 years? They can be illustrated by the conclusion developed by specialists of the 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; previous surgeries on the ovaries; severe endometriosis, adenomatous hyperplasia of the endometrium - adenomyosis and pregnancy after 40 years, fraught with the inability to get pregnant; uterine fibroids during pregnancy (which often provokes miscarriage). For more details, see - Pregnancy and uterine fibroids

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 health status of a particular woman in a given age category can limit her desire for motherhood when planning a second or third pregnancy after 40 years.

For information on how to prepare for pregnancy after 40, read the section How to Prepare for Pregnancy After 35.

Probability of pregnancy after 40 years

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

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

Now this problem can be solved with the help of in vitro fertilization (IVF). However, it should be borne in mind that according to reproductive specialists, IVF pregnancy after 40 years occurs 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%) IVF using donor eggs.

At the same time, there is a high probability that the result of assisted reproduction will be multiple pregnancy after 40 years of age - more difficult for the woman's body, requiring maximum activation of metabolism and often entailing obstetric complications and postpartum consequences for the mother and children.

Risks of pregnancy after 40 years

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

Thus, at this age, 34% of pregnancies (according to other data, up to 50%) end in miscarriage, and at the age of 45 and older – 90%.

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

The risk of stillbirth and the birth of a child with a chromosomal disorder increases. The frequency of Down syndrome at 40 years is one in 106, at 42 years – one in 64, at 43 – one in 50, at 44 – one in 38, at 45 – one in 30, and at 50 – one in 12. In addition, there is a higher risk 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, with hypertension and heart problems caused by high blood pressure being a major factor. Childbirth after 40 is also often complicated.

How to protect yourself from pregnancy after 40 years? To prevent pregnancy, various methods of contraception are used, first of all, combined oral contraceptives are recommended.

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