Does the growing trend of delayed childbearing pose any health risks to parents and children?
A recent study published in the journal Obstetrics & Gynecology has shed light on the adverse pregnancy outcomes women may face if they become pregnant later in life.
“We found that pregnant women aged 35 years and above face a higher risk of several adverse pregnancy outcomes, including chromosomal abnormalities, miscarriage, and preterm birth, when compared to pregnant women aged 20 to 34 years,” the lead author, Line Elmerdahl Frederiksen, MSc and PhD student, told Healthline News.
Frederiksen and colleagues analyzed data from more than 369,500 women in Denmark who were followed from weeks 11 to 14 of their pregnancies, to the time their pregnancies ended.
They found that the women over age 35 had an increased risk of certain complications, although overall, the risk of these complications remained low.
Among women who were 20 to 34 years old, 0.56 percent had a fetus with chromosomal abnormalities.
In comparison, the percentage of older women who had a fetus with a chromosomal abnormality was more than double. They found that 1.3 percent of women aged 35 to 39 years, and 3.8 percent of women aged 40 years or older, had a fetus with chromosomal abnormalities.
While miscarriage affected 0.4 percent of women aged 20 to 34 years, the risk was statistically much higher for older women. Nearly 1 percent of women aged 35 to 39 years, and more than 1.6 percent of women aged 40 years and older reported having a miscarriage.
Birth before 34 weeks of gestation occurred in 1.2 percent of women aged 20 to 34 years, 1.35 percent of women aged 35 to 39 years, and slightly over 2 percent of women aged 40 years and older.
The associations between advanced age and adverse pregnancy outcomes didn’t change much when the researchers controlled for ethnicity, body mass index, smoking, use of assisted reproductive technology, or pregnancy history of chromosomal abnormalities.
“It is important to state that our message with this study is not that women at advanced maternal ages should not have children, but we find it paramount that these women are well informed about their increased risk,” Frederiksen said.
“We hope that our study helps to enrich the understanding of this increased risk, so individuals can balance [factors affecting their decisions] and make an informed choice of the timing of pregnancies,” she added.
While certain risks were identified, the study authors pointed out that their research did not show the older mothers faced a statistically significant increased risk of stillbirth or having children with congenital malformations or birth defects. However, they said that more research is needed.
Additionally, since the study was conducted in Denmark, the demographic makeup of these women may be far different than that of other countries like the United States.
Education without stigmatization
Judith Daniluk, PhD, a professor of counselling psychology at the University of British Columbia believes that it’s important to educate women about the risks associated with advanced maternal age, while acknowledging the factors that influence their decisions about childbearing.
“Education is important, but it needs to be contextualized,” she told Healthline.
“Certainly, the women in our studies said they’d like to get information from their physicians, but physicians don’t often ask the questions. So, physicians need to be asking these questions to women earlier, and not in a ‘come on, you better get on this’ way,” she continued.
For example, offering information about fertility testing, egg freezing, and assisted reproductive technologies can potentially help women understand and weigh their family planning options.
When women do get pregnant at an older age, adequate monitoring, clinical counseling, and antenatal care can help them manage their heightened risk of adverse outcomes.
“In many countries, pregnant women at advanced maternal ages are monitored more closely during pregnancy, which may reduce the risk of pregnancy complications or [help their doctors] detect adverse pregnancy outcomes earlier,” Frederiksen noted.
“An earlier detection of pregnancy complications could potentially reduce the risk of preterm birth,” she continued, “or an early detection of congenital malformations could ensure sufficient attention and staff available to provide specialized neonatal care.”
Similarly, physicians should also speak with men about their family planning goals and the risks associated with advanced paternal age, Daniluk said.
She suggested that many people would also benefit from increased financial support for family planning and childcare services.
“It’s not considered a public policy issue, when in fact it should be,” she said.
Women are having children later in life
The average age of mothers in the United States and many other countries is on the rise.
Many factors influence women’s decisions about if and when they will try to get pregnant.
Although a sense of personal desire and emotional readiness for parenting plays a role, it’s only one factor among many — and it may not be the largest.
According to Daniluk, the primary reason that women delay having children is that they haven’t found a partner with whom they’re comfortable starting a family, she said.
“Most women still believe they would rather parent in a relationship with a partner,” Daniluk told Healthline. “Whether that’s another woman or a man, they believe that kids should ideally grow up in a two-parent household.”
In practice, it can be challenging to find a partner who’s ready to have children, committed to parenting, and otherwise a good fit, she said.
Economic pressures also shape women’s relationships and their family planning decisions.
“They want to be sure that when they have kids, they’re going to be able to afford to take care of them,” Daniluk explained. “That means that, for many women, they’re going to have to wait because they have to get their careers in order, and they have to secure enough of a solid income to be able to say, ‘okay, I can afford to do this now.’”
The lack of high-quality affordable day care contributes to the financial pressures that prospective parents face, she added.
“Often, delaying is not a choice about putting other things ahead of having children, it’s a value-laden decision to make sure that women have their ducks in the row — that they have the appropriate context financially and in terms of their relationship — to bring a child into the world,” Daniluk said. “It’s a responsible choice.”