Prepare for Pregnancy After 40

Many women decide to have children later in life and many give birth to healthy babies. With increases in technology, advanced maternal age is safer than ever. However, pregnancy after 40 still poses some additional risks and complications to the mother and baby. Preparing yourself before you become pregnant can help you get your body in condition for a successful pregnancy.

Steps

Seeing A Doctor

1. Schedule a pre-conception consultation with your primary caregiver or gynecologist. As people age, the likelihood of suffering from common health conditions such as high blood pressure and diabetes increases and older women may also be more likely to have conditions that impair fertility.
   • Your health care provider will perform a routine exam and probably do a pap smear and pelvic exam. The exam should not take more than 15 or 20 minutes but you may take more time to talk to your provider about getting pregnant.
   • Ask your doctor how to increase your chances of conceiving and what lifestyle changes you can make to assure you have a healthy pregnancy. Be honest about your current lifestyle and be open about any recommendations for changes.
   • Discuss whether you will be able to continue using any medications you are currently taking while you try to conceive and while pregnant or breastfeeding. Ask your doctor if alternate therapies or medications are safe during pregnancy, and if such routes are realistic for you given your medical history.
   • Evaluate with your doctor which health problems are most important for you to address before pregnancy. As certain health problems, like high blood pressure, get worse with age it's important to discuss how to manage these issues with your doctor.
   • Get any immunizations your doctor recommends. Your doctor may perform blood work to check for immunity to diseases such as rubella and chickenpox. Wait a month to try conceiving after you get a vaccine.
   • Your doctor may wish to perform labs to evaluate your ovarian reserve, or the probability that good eggs still remain.
2. Discuss your risks for gestational diabetes and high blood pressure. The risk for certain pregnancy-related health issues increases with age. Discuss your personal risk with your doctor and what you can do to reduce that risk.
   • High blood pressure can sometimes temporarily develop in pregnant women and some research suggests the risk increases with age. Women of any age have their blood pressure monitored regularly during pregnancy, so your physician will strive to make sure your blood pressure is under control. You may need to be on certain blood pressure medications during pregnancy to assure a healthy delivery.
   • Gestational diabetes is a type of diabetes that occurs only during pregnancy. It becomes more common with age. Untreated gestational diabetes will cause the baby to grow much larger than average, so you will have to control your blood sugar levels with exercise, diet, and possibly medication if you are diagnosed with gestational diabetes.
3. Go over your options for childbirth. Many women over 40 give birth naturally. However, due to an increased risk of pregnancy-related complications, the likelihood of a C-section increases with age.
   • Go over a specific birth plan with your doctor and make sure you take the possibility of a C-section into account. If you've already had one child via C-section, some doctors will not allow you to give birth vaginally. Discuss any concerns with your doctor and let her know your preferences for giving birth.
   • The strain of childbirth is harder if you're older. Problems related to high blood pressure and issues with the placenta during birth increase with age. Your doctor should carefully monitor your health throughout pregnancy. If she believes you're at risk for delivery complications, she may want to induce labor and deliver the baby via C-section.
4. Consider fertility treatments. It can be more difficult to conceive after 40, so you may need fertility treatments. Talk to your doctor about the possibility of fertility enhancing drugs or surgical treatments.
   • Oral medications, such as clomiphene or clomiphene citrate, are taken by the mouth during days three through seven or days five through nine of the menstrual cycle. These medications increase the chance of ovulation. However, oral meds do increase the chance of multiple pregnancy. There is a 10% chance of twins on such medications. These meds have about a 50% success rate for conception and delivery, but only if the patient is not ovulating. They do not increase pregnancy rates substantially if the patient is already ovulating on her own.
   • Gonadotropins and Human Chorionic Gonadotropin (hCG) are hormonal injections used to boost fertility in older women. Injections start two to three days into the menstrual cycle and continue for seven to 12 days. You will need a health care provider to perform a transvaginal ultrasound during treatment to monitor egg size. The rate of multiple births are high for such treatments. About 30% of women who conceive via hormonal injections have multiple births, and two thirds of these births are twins.
   • If there is any damage to the reproductive system that is causing difficulties with delivery, a doctor may want to perform a surgery to correct the issue. If successful, surgeries should greatly increase the chance of conception.

Changing Your Lifestyle

1. Manage any existing health problems before conceiving. If you have any existing health problems, make sure they're under control before you try to conceive.
   • Sexually transmitted infections can prevent your ability to conceive, so get tested if there's any risk you have an STI. Most STIs can be treated effectively with antibiotics. Get proper treatment for sexually transmitted infections and diseases immediately and do not try to conceive until you're STI free.
   • If you're on any medication for a chronic condition, such as hypothyroidism, you should take a blood test before attempting to conceive to make sure it's under control. You will need periodic testing throughout your pregnancy and your doctor may need to alter medication dosage over time.
2. Start eating a healthier diet. Dietary changes are important during pregnancy as you'll need increased amount of certain nutrients during pregnancy. Make sure you're prepared for a healthier diet.
   • Over half the grains you eat each day should be whole grains. This means whole-grain cereals, brown rices, whole-wheat pasta, and whole-wheat bread. You should also eat a wide variety of healthy fruits and vegetables throughout your pregnancy.
   • You should also strive to get extra protein, preferably in the form of lean meats, nuts, eggs, and legumes. Fish is a good source of nutrition and high in protein, but you should avoid fish like king mackerel, shark, swordfish, and tilefish as they may be high in mercury.
   • Dairy products are also important during pregnancy due to the calcium and vitamin D they contain. You can talk to your doctor about calcium supplements if you're unable to digest dairy.
   • There are a variety of foods that are off limits during pregnancy as they can be harmful to a fetus. Raw meats and deli meats can contain contaminants that are harmful to a fetus. Smoked seafood can also be harmful. Anything that contains raw eggs or egg yolk can be damaging, so make sure your eggs are cooked all the way through. Soft cheeses, like brie, are often made from unpasteurized milk and should be avoided. Caffeine intake should be lessened during the first trimester.
3. Maintain a healthy weight. If you are overweight or underweight, your doctor will likely want you to get your weight into a healthy range before you conceive. Talk to your doctor about how to gain or lose weight in a healthy fashion and work with her to form a diet and exercise regimen that works for you.
   • Underweight is defined as having a BMI under 18.5 and overweight is a BMI over 25. A BMI of 30 or more is considered obese. If you're underweight prior to pregnancy, you'll be expected to gain more weight throughout your pregnancy and if you're overweight you'll be expected to gain less. As weight can be somewhat hard to control during a pregnancy, it's best to strive for a healthier weight before conceiving.
   • Being overweight during pregnancy increases the risk for gestational diabetes and high blood pressure. Being underweight can increase the risk for a premature birth, and your body may not be strong enough to support a pregnancy.
   • Work with your health provider prior to conceiving on achieving a healthy weight for your height. Talk about exercise and nutrition and what changes you should make to your lifestyle to achieve a healthy weight.
4. Avoid harmful substances. Tobacco, alcohol, and recreational drugs of any kind will be off-limits during pregnancy, so you should avoid using such substances while you're trying to conceive. You should also minimize caffeine intake, as caffeine should only be used in moderation during pregnancy. If you're a heavy caffeine drinker, work on cutting back before trying to conceive to minimize symptoms of caffeine withdrawal. You should only have about 150 mg of caffeine a day, which comes to about two cups of coffee.
5. Exercise. Exercise is safe and even encouraged during pregnancy, and there are a variety of pregnancy-safe exercises you should be engaging in before and during your pregnancy.
   • Aerobics, resistance, and flexibility exercises are important for pregnant women. Walking, stationary biking, yoga, swimming, and weight lifting are generally safe for pregnant women. However, every pregnancy is different so discuss your health with your doctor beforehand. She may recommend more or less exercise depending on your overall health.
   • Your heart rate should raise during a workout, but if you're over 40 it's important to keep your heart rate between 125 and 140 beats per minute. You can measure your heart rate by taking your pulse through your neck or wrist and counting the number of beats in a 60 second timeframe.
   • Be careful about abominable exercises that involve lying on your back. These can be dangerous to the fetus as they restrict blood flow.

Understanding Risks

1. Consider the risk of chromosomal birth defects. The rate of chromosomal birth defects is higher in infants born to women over 40. Be aware of these risks and be open to testing for chromosomal abnormalities.
   • Aneuploidy, or an abnormal number of chromosomes, is more likely to occur with age, and can cause disabilities such as Prepare for the Birth of a Child With Down Syndrome. A person is born with a set number of eggs, and healthier eggs tend to be released at a younger age. Eggs with chromosomal abnormalities are more likely to be released and then fertilized in your 40s. By age 40, the chance of Down Syndrome is 1 in 60 and that number continues to increase with age.
   • There are a variety of tests that can be conducted to check for abnormalities. A sample of amniotic fluid or placenta tissue can be used for testing. Such tests do come with a slightly increased risk of miscarriage but there are new test that can be done at no risk to the fetus. A simple blood test, called a Cell Free DNA test, can now be used to detect fetal abnormalities.
2. Take into account the higher rate of pregnancy loss. Pregnancy loss can be very traumatic, and the risk increases with age. Whether via stillbirth or miscarriage, you will be at an increased risk if you're over 40.
   • Carefully consider the possibility of pregnancy loss before trying to conceive. While many women do deliver healthy babies after 40, miscarriages due to preexisting health conditions and hormonal abnormalities become more common. Make sure you prepare for the emotional impact pregnancy loss will have on you, in the event that it occurs.
   • Close monitoring of the fetus throughout pregnancy is important if you're over 40, as it can prevent the likelihood of pregnancy loss. Talk to your doctor about any personal risks associated with your age and ask her for increased monitoring during pregnancy.
   • At 40, the rate of miscarriage increases to 33% and that number gets higher as you age. By 45, the miscarriage rate is at 50%. Talk to your doctor about what you can do to prevent miscarriage.
3. Understand the increased risk for multiple births. The chances of having twins or triplets increases with age, especially if you use in-vitro fertilization or fertility drugs to increase your chance of conceiving.
   • Make sure you're financially able to support a multiple pregnancy. Educate yourself about the specifics of carrying twins, including options for delivery. Many twins need to be delivered via C-section.
4. Have patience. It can take much longer to conceive if you're over 40. Older women's eggs are not fertilized as easily as younger women's, and it may take over six months to conceive. If you still have not successfully conceived after six months, talk to your health care provider.
   • The chances for multiple births depend on a variety of factors, but certain fertility treatments increase the rate. Hormonal injections have a 30% chance of multiple births and oral medications carry a 10% chance of twins.

Warnings

• If you have a family history of a certain genetic disease, you might want to consider genetic counseling. A geneticist will take an overview of your family tree and also do blood work on you and your partner to evaluate your risk for passing on certain diseases.

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Sources and Citations

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