How does age affect pregnancy? Am I too old to have children?
It's a biological fact that as women and men age, their fertility declines, although the exact moment this begins can vary from person to person. Ainhoa Coco Lizarraga, a specialist in gynecology and obstetrics, discusses how age influences pregnancy.
Delayed motherhood is increasingly common in today's society. As we age, a series of pathophysiological changes occur in our reproductive system, leading to comorbidities. This is why advanced maternal age is considered a risk factor, not only when trying to conceive but also during pregnancy. Studies have shown that obstetric and perinatal outcomes are worse in older pregnant women without significant medical history, indicating that advanced maternal age is a strong and independent risk factor that must be considered in this initial assessment.
What is considered advanced maternal age and what risks does it entail?
Advanced maternal age is defined as motherhood in a woman over 35 years of age. As we have discussed, it is a growing trend, especially in developed countries. There is evidence linking advanced maternal age with complications during pregnancy such as fetal growth restriction, preeclampsia, placental abruption, premature birth, and fetal death. Furthermore, it has been shown to be associated with a higher risk of cesarean section. All of this underscores the importance of properly informing and educating women about the optimal age for childbearing and their desire to have children.
Can assisted reproductive technologies have an influence?
More and more couples in today's society need assisted reproduction treatment (ART), and the techniques have evolved remarkably in recent years.
One of the main indications is advanced maternal age and consequently low ovarian reserve, a factor that in itself implies a series of associated comorbidities that increase the risk of pregnancy.
Furthermore, the link between pregnancy complications and pregnancies conceived through ART is well-established. Biochemical pregnancy loss rates range from 11 to 35 per 100,000 live births (pT3). The risk of ectopic pregnancy is twice as high in pregnancies following IVF. The incidence of late pregnancy loss (beyond 12 weeks) after ART is between 2 and 4 per 100,000 live births (pT3), higher than the 11 pT3 in spontaneous pregnancies. The risk of multiple gestation is clear and increases with the number of cycles.
At the maternal level, women who conceive through ART have a higher risk of developing hypertensive disorders such as gestational hypertension or preeclampsia, gestational diabetes, placenta previa, and perinatal mortality. There is also a higher risk of labor induction and cesarean section, both emergency and elective. At the neonatal level, the risk of premature birth (< 37 weeks) and low birth weight is also well-documented.
Despite everything mentioned, the idea should be that most children conceived through ART are healthy children, but this does not mean there is no slightly higher risk that we must take into account, especially when planning pregnancy check-ups.
Important things to keep in mind
Pregnancy involves a period of stressful changes in our bodies that occur during the weeks of gestation. Therefore, it is important to have an initial visit to assess the patient's baseline health and identify factors that can help predict how she will adapt to these changes. This first visit should also be an opportunity to obtain tools not only for managing the pregnancy but, above all, for promoting health.
