I was 36 and nearly 39 when I had my two daughters. Even though I was in excellent health, because of my age both times, I was automatically placed in the high-risk pregnancy category. Pregnancy after 35 is still considered high-risk, but several other factors are also on the list, including:
• 35 or older
• 15 or younger
• Under or overweight before pregnancy
• Carrying more than one fetus
• Problems with previous pregnancies
• Pre-existing health conditions, such as high blood pressure or diabetes
Dr. Michael Pinette, medical director of Maine Medical Center’s Division of Maternal-Fetal Medicine, says he’s seen an increase in high-risk pregnancies. That’s partly because older women are having more in vitro fertilization and ovulation-induced pregnancies and a slightly higher number of multiple births. According to the Centers for Disease Control and Prevention, in 2010 the birthrate for women aged 40-44 years was 10.2 births per 1,000, a 2 percent increase from 2009, and the highest rate since 1967 (10.6). It is the only age group to show an increased birth rate.
On the other hand, improved assisted reproductive technologies may have helped lower some risks. Pinette comments that he and his colleagues are seeing “fewer triplets and quadruplets. We still see a fair number of twins,” he adds.
Other technologies have improved, as well. He points out that, “We understand better what we’re seeing now when we evaluate pregnancies, primarily by ultrasound. Ultrasound technology continues to improve.”
The improvements mean doctors are better at identifying structural problems early and referring patients for treatment. “Most problems we can handle here very well,” said Pinette. “Maine Medical Center has developed an A No. 1 children’s hospital and peri-natal program.” When necessary, a family will be referred to a more appropriate facility. “There are specific centers for specific problems,” he said. Some are better than others. “Everybody works together for the best outcome, which is very refreshing.“
Down syndrome was supposedly the biggest risk during my pregnancies. At the suggestion of my obstetrician, both times I went through an amniocentesis, which involves withdrawing amniotic fluid from the sac that surrounds the fetus and sampling the DNA it contains for genetic abnormalities. The procedure was invasive and scary, but the results brought great relief -– nothing detectable was wrong and we knew for sure we were going to have daughters.
The scenario would be much different today. Pregnant women of all ages are now offered non-invasive screening tests in the first trimester. That’s because the risk for a woman over 40 having a baby with Down syndrome is the same as for a 20-year old, says Pinette. “The screening tests are a combination of fetal measurements, in particular the nuchal translucency or skin behind the neck combined with fetally derived biochemical markers – proteins that the fetus makes,” he said. “We’re able to do that earlier in pregnancy to determine who is at increased risk for things like Down syndrome and offer earlier testing. That’s been a huge change.”
Even bigger changes are on the horizon. The most exciting, says Pinette, is genomic sequence testing. The ability to look – when the mother is only 10 weeks along – at genetic material and determine fragments of DNA that are associated with various chromosomal abnormalities.
“It also opens up a whole new world of what we call micro-array testing, where you take this same DNA material and actually look for deletions and single gene abnormalities in the genetic code. Some of those are important, some are not, we’re still trying to figure out exactly what it means. It’s opened up this whole new area of research and interest at the genetics level in terms of genetically inheritable disorders, so that is very new and very exciting,” Pinette said.
Pinette has been practicing in Maine since 1989. Every day brings a new challenge. Every day he is reminded of a child who, just 10 years ago, may not have lived because the technology to even make a diagnosis didn’t exist.
“I get lots and lots of pictures from families,” he said. “It’s very gratifying. It’s what makes what we do so worthwhile.”
Diane Atwood is a health and wellness communicator based in southern Maine. Her website is www.dianeatwood.com.