As teen birth rates continue to drop, birth rates among women 40 and older have climbed
A new study describes potential health risks teen and older moms might face
"Age is just one piece of the puzzle. What is more important is the overall health of the mom," one expert says
She was the classic California woman who had everything: a thriving public relations firm, a loving husband and a core group of friends she could count on. The one thing missing: a baby.
Stacie Krajchir-Tom spent her 20s learning the ropes as a television producer and her 30s building her powerhouse career. By the time she reached her 40s, she was ready to start a family.
“Kris says it perfectly,” Krajchir-Tom said of her husband, Kristopher Tom. “He says, ‘We would have been fine without having a baby, but you wouldn’t have been fine.’ “
So the couple made plans to have their first child. They tried to conceive naturally, which led to three miscarriages and one fibroid surgery to remove benign tumors in Krajchir-Tom’s womb. They then tried intrauterine insemination, a fertility treatment in which sperm is placed directly inside a woman’s uterus – and the procedure worked.
Krajchir-Tom was pregnant at age 42.
“What did I feel? Elated, like a miracle had happened. Grateful, joyous and also very, very cautious,” she said.
As much as she loved being pregnant and watching the baby grow inside of her, she said, she also knew that having her first child in her 40s was high-risk.
Yet Krajchir-Tom experienced no serious complications, and after 23 hours of labor, son Milo Kekoa was born.
Now, Milo is a healthy and thoughtful 5-year-old boy who makes profound statements, such as “Mommy, the best part of life is taking your time,” which is his response when asked to quickly put his pajamas on for bed.
When it comes to being a mother, Krajchir-Tom says she couldn’t be happier. However, she wishes she had known at a younger age what being a first-time mom in her 40s would look like. She could have better prepared for her fertility struggles and the fatigue that comes with raising a 5-year-old.
“We have billboards and bus stop ads about HIV and getting tested, wearing condoms, check your breasts, get mammograms, put kids in school by age 5, but we have zero education about fertility, family building and high-risk maternal age pregnancies or potential fertility issues that men might also have,” said Krajchir-Tom, who wrote about having a baby after 40 in The Huffington Post in 2013.
“Having children later in life is where we are at as a society now,” she said. “I have friends whose parents gave them the gift of freezing their eggs so they can have grandchildren. That’s happening. That’s for real.”
A study, published in the journal PLOS Medicine on Tuesday, offers new data on age-specific adverse pregnancy outcomes that might help health-care providers in the United States better counsel women of all ages who are planning for parenthood.
Among women in the state of Washington, the study showed that the risk of potentially life-threatening conditions, or morbidity, during pregnancy – including kidney failure, shock, acute heart problems and being admitted to the intensive care unit – escalates among mothers-to-be who are 40 and older.
The study also showed some elevated risks among teenage mothers, such as an increased risk of sepsis.
Moms by the numbers
“I was not surprised that maternal morbidity increases with maternal age; however, I was surprised that the increase in relative risk was exponential, meaning that the rate of increase was higher as maternal age increased beyond 39 years,” said Dr. Sarka Lisonkova, assistant professor of obstetrics and gynecology at the University of British Columbia in Canada and lead author of the study.
“The elevated risk of sepsis among younger mothers was also surprising,” Lisonkova said. She added, however, that severe adverse conditions in mothers overall are rare.
A new annual summary of vital statistics, published in the journal Pediatrics on Tuesday, found the birth rate among females age 15 to 19 dropped 9% from 2013 to 2014 in the US, continuing a historic decline. Overall, the teen birth rate decreased 61% from 1991 to 2014, according to the latest data.
Since the mid-1990s, teen pregnancies have declined not only in the US but in the United Kingdom and some other European countries, New Zealand, Israel and other parts of the world too, according to a study published in the Journal of Adolescent Health in 2015.
However, the proportion of first births to women 30 and older in the US rose from 24% to 30% from 2000 to 2014, according to the new statistics in Pediatrics. The numbers also showed that the birth rate among women 40 to 44 has increased in the US, rising by about 2% from 2013 to 2014.
Since 1970, the average age of having a first child has increased among women not only in the US but in the UK, Germany, Sweden and other parts of the world, according to a study in the journal Population and Development Review last year.
Yet “once pregnant, older women should not feel anxious or nervous about their babies or childbirth, and keep a healthy diet, optimal weight gain, and normal blood pressure and glucose levels,” Lisonkova said.
“We all age differently, and that includes our reproductive age; staying active and having a healthy lifestyle is the best possible prevention of any health problems,” she said. “However, it is important to counsel women prior to pregnancy about all potential risks and our study provides detailed information.”
The ‘J-shape’ of pregnancy risks
The new study in PLOS Medicine included data on 828,269 women, ages 15 to 60, who gave birth in Washington state between 2003 and 2013. The data came from birth certificates and hospital files linked in the state’s birth events record database. The data involved only singleton births, excluding the birth of twins or more.
The researchers examined the data to determine trends in pregnancy outcomes and health risks by age. They took a close look at maternal morbidities but did not have sufficient data to analyze extremely rare cases, such as maternal death.
The largest proportion of the births in the study, 28.9%, was among women 25 to 29. About 25% of the births were among mothers 30 to 35, about 22% were among mothers 20 to 24, and 12.7% were among mothers 35 to 39. Teen moms made up 7.6% of the data, mothers 40 to 44 made up 2.8%, and mothers 45 and older made up 0.2%.
The researchers found that the incidence of potentially life-threatening conditions during pregnancy appeared as a J-shape when examined in association with age.
Starting with teens at the front of the J, there were some elevated health risks, which dipped to low risks among mothers 20 to 34, at the bottom of the J. Then, the risks sharply increased among mothers 40 and older, the researchers found.
For instance, the incidence of kidney failure was 2.1 per 10,000 teen mothers and about 1.2 to 1.8 per 10,000 among moms 20 to 34 years old. It then increased markedly with maternal age to 4.3 per 10,000 among 40- to 44-year-olds and a whopping 28.4 per 10,000 among mothers 45 and older, the researchers found.
“The risks associated with maternal age are generally higher for the fetus and the baby than for the mother; however, our study shows that for mothers over 49 years, the situation is reversed,” Lisonkova said.
She thinks the results could be generalizable to the rest of the country.
‘Age is just one piece of the puzzle’
Though the study provides new data, a woman’s overall health is more important for a complication-free pregnancy than her age, said Dr. Petra Casey, an obstetrician-gynecologist at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.
Besides maternal age, risk factors for a high-risk pregnancy include underlying health conditions, such as high blood pressure, diabetes, being HIV-positive, or being overweight or obese.
“Age is just one piece of the puzzle. What is more important is the overall health of the mom and her risk factors for some of these complications,” Casey said.
“Some women are healthy at 40, and some women are really sick at 20, and you have to provide that individualized kind of care … and look beyond just plain age,” she said. “I had a child at 31 and then 38 and then 41, and all of my pregnancies have been blessed and pretty uneventful.”
Ideally, a woman would have such risk factors reviewed by a doctor before she attempts to get pregnant, Casey said.
“Enter pregnancy at the best optimal health. Make yourself as healthy as you can be before you get pregnant,” she said. She stressed the importance of a healthy diet, exercising, losing weight if a physician has recommended doing so, and quitting smoking or using illegal drugs.
“Try to stay away from alcohol as well, especially those times around the time of conception,” Casey said. “Then, see your physician early and often.”
‘Others will not only be informed but inspired by our stories’
Having discussions with your doctor about potential risks once you are pregnant could be too late, said Krajchir-Tom, the mother in California, who was not involved in the study.
“I feel like if we educate young women and even men – because no one is thinking about any of this as they’re focusing on their careers – so if we aren’t educating people via a PSA, it’s very likely they won’t receive or think about any of the potential risks or issues they could potentially face until they’re right in the middle of the roller coaster of fertility issues,” she said.
“The thing is, we spend our entire 20s praying to Jesus that we do not get pregnant,” she said. “Then we spend an entire time of our 40s praying that our period never comes, ‘let me get pregnant.’ ”
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Therefore, many women and men may not think about risk factors or potential complications until they know for sure that they are expecting, Krajchir-Tom said.
Additionally, as many more celebrities are having babies at older ages – such as Janet Jackson, Jennifer Lopez, Halle Berry and Celine Dion – that could perpetuate a misconception that getting pregnant is easy, Krajchir-Tom said.
“What’s the worst thing if they said, ‘Guess what, I had trouble getting pregnant. It took 10 rounds of IVF for me to get pregnant’? I wish they would be more forthright and honest, because they are kind of doing a disservice to women by not,” Krajchir-Tom said. “If we can be honest and share our journey, others will not only be informed but inspired by our stories.”