Pregnancy after 30, 35 and 40 years of age

For various reasons, we often start trying for a child in our 30s or even 40s. Nowadays, this is no longer surprising. However, it is worth bearing in mind that a woman's fertility decreases from year to year, but also that it is worth preparing for such a pregnancy.

How to take care of yourself?

Pregnancy and childbirth is a period of major changes in a woman's body, posing quite a challenge even for a healthy body. It is therefore worthwhile a few months before the planned pregnancy:

• take care of physical fitness,
• give up stimulants,
• look at your weight.

And at least 12 weeks before a planned pregnancy it is also necessary to introduce folic acid supplementation, which reduces the risk of neural tube defects in the foetus.

What research is worth doing?

At present, there are no recommendations for examinations and medical appointments that patients should make during the planning stage of their pregnancy and this applies to both younger and older patients.

However, before a planned pregnancy, it would not hurt to perform tests such as:

• blood pressure measurement,
• morphology,
• general urine examination.

Given the fairly common prevalence of hypothyroidism at the present time, a TSH measurement may be a valuable test.

It is also useful to determine one's immune status against infectious diseases - rubella, smallpox and toxoplasmosis.

It is also a good idea to perform before planning a pregnancy:

• cytology,
• Breast ultrasound
• Ultrasound of the reproductive organs,

and also, something we often forget, to visit the dentist. Untreated caries can cause miscarriages and premature births.

What are the chances of pregnancy in your 30s, 35s and 40s?

A woman's fertility is an individual matter. Much depends on general health, lifestyle (nutrition, consumption of stimulants, physical condition) and genetic predisposition.

From a biological point of view, the best chance of getting pregnant is between the ages of 20 and 24. As we age, the ova also age. However, it should be emphasised that if a woman has no health problems, age is not a contraindication to becoming pregnant.

WHAT YOU NEED TO KNOW After the age of 30, the chance of getting pregnant is about 20%, after the age of 35 it is about 12% and after the age of 40 it is about 7%.

What are the risks to consider when getting pregnant in your 30s or 40s?

If you decide to become pregnant at a later age, it is worth doing so consciously and responsibly. The age of the mother-to-be is unfortunately conducive to pregnancy complications.

After the age of 30

there is an increased risk of miscarriage, preterm birth and pregnancy-related complications such as gestational diabetes, pregnancy-induced hypertension and pre-eclampsia. Older women are also statistically more likely to have thyroid function problems and uterine myomas.

For older mothers, also typical pregnancy complaints are nausea, vomiting, fatigue, mood swings, which can be more discomforting.

After the age of 35

More advanced age, also means a higher risk of genetic abnormalities in the cells. Patients over the age of 35 have an increased risk of degenerative defects in the oocytes and therefore of giving birth to children with chromosomal aberrations such as z. Down's, Edward's and Patau.

Perinatal complications and the need for a caesarean section are also more common.

However, two important points should be stressed. Firstly - the vast majority of ladies over 30 feel well throughout their pregnancy and give birth to healthy babies! Secondly, modern medicine follows to a certain extent the changes that are taking place in society and, consequently, late motherhood.

If we have difficulty getting pregnant, we have options for assisted reproduction. There are also a number of diagnostic tests to help us gain knowledge of the baby's condition at the very early stages of pregnancy, and in the case of certain conditions we can take preventive action to prevent their further development. Perinatal complications and the need for a caesarean section are also more common.

Modern medicine

Two important points should be emphasised. First - the vast majority of women over 30 feel well throughout their pregnancy and give birth to healthy babies! Secondly, modern medicine follows, to some extent, the changes that are taking place in society and, consequently, late motherhood.

In the event of difficulties getting pregnant, we have options assisted reproduction. There are also a number of diagnostic tests to help us gain knowledge of the baby's condition at the very early stages of pregnancy, and in the case of certain conditions we can take preventive action to prevent their further development.

Research for couples	Diagnostic and preventive examinations	Preimplantation diagnosis
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Why is it safer to have a pregnancy after 40 if it is the next pregnancy and not the first?

It is believed that a first pregnancy after the age of 40 is more challenging for the body than a subsequent pregnancy. This has to do with the fact that pregnancies at a later age are more often associated with long-term infertility treatment.

Women who have another pregnancy already have experience and are therefore more aware of changes occurring in their own bodies, ailments. They know how to interpret fetal movements and what contraction activity looks like. They find it easier to express their expectations of both the pregnancy and the birth. The next pregnancy is generally associated with less stress and fear.

Is it possible to get pregnant during the menopause?

To answer this question, it is first necessary to realise what the menopause is. Menopause is the last menstrual period in one's life, followed by no further bleeding in a 12-month period. By contrast, it is customary to refer to menopause as the entire menopausal period, i.e. the time when the ovaries simply age.

W Peri-menopausal pregnancy is possible. The rapid development of assisted reproduction techniques has also made it possible for post-menstrual patients to become mothers.

If a woman has previously decided to freezing of ova, ovarian tissue or embryos, she can use them at any time to obtain a pregnancy. For patients who have not protected themselves in this way, the option of oocyte adoption is available.

Is it possible to get pregnant without having ova?

Becoming a mum is possible even if we do not have egg cells. This makes it possible oocyte adoption programme. Patients can undergo oocyte adoption from anonymous donors. The cells are usually fertilised using the partner's sperm, and donors are selected according to the phenotypic characteristics of the recipients.

What characteristics are taken into account when ova are well?

When selecting oocytes, consideration is given to, among other things:

• race,
• body weight,
• eye and hair colour,
• type of hair twist,
• body structure,
• blood group.

The administration of the embryos follows the preparation of the patient's endometrium with medication, which mimics the woman's natural menstrual cycle.

What additional tests are worth doing when you are late in pregnancy?

If we managed to get pregnant at a later age, in addition to the diagnostic tests that are performed on all pregnant women in Poland, non-invasive diagnostic tests are recommended:

• ULTRASOUND,
• PAPP-A test.

In the case of a doubtful result, an amniocentesis is performed, i.e. a sample of amniotic fluid is taken under ultrasound guidance to determine the fetal karyotype. This test, while invasive, has a low complication rate. Women who do not wish to take this risk can perform a free fetal DNA testwhich involves taking the pregnant woman's blood and analysing the baby's genetic material present in it.

Good points of late motherhood

Pregnancy at a later age has many good points. Usually, women who are economically, professionally and personally stable choose to become mothers at a later age, which makes it easier for them to take care of themselves. Patients over 35 are generally calmer, able to take more conscious care of themselves and their baby and to savour motherhood.

Substantive consultation:

Blanka Malczewska, MD - Obstetrician-Gynaecologist at Invimed Gdynia