Why Patients Choose Maternal Fetal Medicine Associates For High Risk Pregnancy
We have a large and distinguished staff of health care professional gathered together who provide the broadest range of high-risk services within one practice setting. Within Maternal Fetal Medicine Associates, patients have access to physicians, nutritionists, genetic counselors, registered nurses, and diagnostic ultrasound.
Maternal-Fetal Medicine Associates strives to effectively provide personalized care to each patient. We hold weekly multidisciplinary meetings where the entire team agrees on the management plan for individual high-risk patients in the practice. Those care plans are transcribed into each patient chart so that whoever sees the patient has access to them. This allows us to individualize care for each patient and make sure that care is consistent across the practice platform.
Our guidelines for the management and care of high-risk conditions are published and standardized for the practice. Again, this is done so that care is consistent across the practice no matter who sees the patient. Those guidelines are continually updated to assure that all providers follow the most current methodologies in the care of patients.
Q: Will All My Future Pregnancies Be High Risk
A:Having one high-risk pregnancy does not mean that all your futurepregnancies will be deemed high risk as well. You may have a fetalcomplication occur in one pregnancy that wouldnt in another, and certainhealth conditions may change over time.
However, if you have had a pregnancy that ended in preterm delivery, youare at greater risk of having preterm labor during your next pregnancy. Ifthis occurs, your obstetric provider will manage your pregnancy usingmedication, and a maternal-fetal medicine specialist will monitor yourcervical length with ultrasound surveillance.
Ultimately, the most important thing to remember about having a high-riskpregnancy is that your maternal-fetal medicine specialist and Ob/Gyn havethe knowledge and experience required to keep you and your baby as healthyas possible.
Pregnancy Risks By Age Chart
One of the most debatable topics among women is what is the perfect age to conceive. You will be surprised to hear a plethora of answers. The women in their 20s will have endless energy and super-elastic bodies.
Women in their 30s will have a secured career, whereas women in their early 40s will have a high self-confidence as well as a few doubts while delivering their first baby.
However, there are drawbacks at each age. Don’t get disheartened and hopeless if you have stepped into your 40s, because according to researchers even at that age you can be lucky to be blessed with an enjoyable motherhood, despite a few complications. Sometimes a 40-something woman can be healthier as compared to a 20-something woman.
It all depends on your lifestyle and how you have maintained yourself. Your energy, health, perspective, and personality can beat all the odds and help you to have a healthy and happy pregnancy, no matter what your age is.
As you get older, both you and your baby have to deal with pregnancy-related risks and other health issues. The reason is that your reproductive system changes with your age and you are more likely to experience the age-related health issues.
The article highlights the drawbacks and risks of pregnancy experienced by women at different stages by different age groups. Read on to know more:
- When You Are Between 20 And 25 Years Of Age
- When You Are Between 26 And 34 Years Of Age
- Pregnancy At Age Between 35 To 40
- Pregnancy After 40
What If Someone Is Healthy And Over The Age Of 35 Do They Still Have A Higher Risk Of Stillbirth
Reddy et al. also looked at this question in their study of 5.5 million U.S. birth certificates. When they compared healthy people to the overall sample, they found that the healthy people had a lower risk of stillbirth, but the risk still went up with age.
In other words, being healthy lowers your risk of stillbirth, but if you are 35 or older, your risk as a healthy older person is still higher when compared to a healthy younger person.
Figure 4 shows the overall sample vs. healthy people only.
In 2017, a large systematic review and meta-analysis of the effects of the pregnant persons age on outcomes also found that the increased risk of stillbirth with age was not fully explained by maternal medical conditions .
The authors analyzed 44 observational studies with nearly 45 million births, including over 185,000 stillbirths. The majority of studies were conducted in high-income countries and judged to be low risk of bias. They found a significantly increased risk of stillbirth with pregnancy at age 35 and older, independent of maternal health status. Overall, about 5% of total stillbirths in the study population were attributed to pregnancy at age 35 or older.
But What Is The Actual Risk Of Stillbirth In Pregnant People Who Are 35 Or Older
So we know that the risk of stillbirth is higher in people who are 35 or older. But what are the actual numbers? If someone is 35 or older, what is their chance of having a stillbirth?
In 2000, Jolly et al. looked at the medical records of 358,120 people who gave birth at 18 hospitals in the United Kingdom between the years 1988 and 1997 . They found that pregnant people aged 35 and over were at increased risk of stillbirth even after considering body mass index, ethnic group, medical problems, and whether or not the mother was giving birth to her first child. However, the authors did not specify their definition of stillbirth. This means that the babies could have been stillborn starting at any gestational age after 20 to 28 weeks.
The researchers in the United Kingdom found:
- People aged 18 to 34 had a stillbirth rate of 4.7 per 1,000, or 0.47%
- People between 35 and 40 years old had a stillbirth rate of 6.1 per 1,000, or 0.61%
- People 40 and older had a stillbirth rate of 8.1 per 1,000, or 0.81%
A larger and more recent study from the Netherlands included over 1.6 million people who gave birth to a single baby at term from 1999 to 2010 . They excluded people with pregnancies complicated by congenital anomalies, hypertensive disorders, or diabetes.
The researchers examined many adverse pregnancy outcomes by maternal age, including stillbirth .
The researchers in the Netherlands found:
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Why Does The Risk Of Stillbirth Increase With Maternal Age
Researchers dont know why there is an increased risk of stillbirth in pregnant people as they age. The relationship is complicated and not completely understood.
Some think that the increased risk of stillbirth may be related to other health problems that are more likely to occur with aging, such as high blood pressure, gestational diabetes, high BMI, and other chronic medical problems. However, as we already talked about, it looks like medical problems do not fully explain the increased risk of stillbirthbecause even when we remove these risk factors, healthy people 35 and older still have an increased risk of stillbirth .
Lean et al. proposed that older people are at greater risk of placental problems , and this could be increasing their risk of stillbirth. In a meta-analysis, they looked at 12 studies on fetal growth restriction . They found that older maternal age was linked to an increased risk of having this complication. The risk of fetal growth restriction was only significantly increased over the age of 40.
In addition to fetal growth restriction, they also found that older age was linked to increased risk of placental abruption and preeclampsia. Since these are all conditions related to placental pathology/dysfunction and to stillbirth, the authors concluded that placental factors are a logical avenue to explore, especially in pregnant people over the age of 40.
Fetal Complications And Multiples
Pregnancy risks are higher if youre having twins, triplets, or other multiples, because carrying more than one baby places additional stress on your body. Your babies are also more likely to develop complications or arrive early.
You may be considered high-risk if you have a history of miscarriage, preterm labor, or cesarean delivery. Likewise, if youve already had one child with a birth defect, any subsequent pregnancies may be treated as high-risk. This helps ensure you receive extra diagnostic testing to detect birth defects in utero in some cases, defects can be treated before birth.
Expectant mothers with herpes, chickenpox, and other dangerous infections require careful fetal monitoring to reduce the risk of birth defects or growth problems. You may also require extra care and monitoring if your baby doesnt appear to be growing normally.
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Pregnancy At Different Ages: 20s 30s And 40s
Is there a perfect age to get pregnant? It’s a question that’s probably crossed your mind, particularly if your 30s are around the corner. But if you’ve put off having a baby until your 30s or 40s, you’re in good company. In 1999, 23 percent of first births were to women over 30, compared with only 5 percent in 1975. In fact, the number of births to women ages 35 to 49 has tripled since the 1970s.
Fortunately, much of what we hear about potential risks, especially for expectant mothers older than 35, is unnecessarily alarming. The truth is that no matter what your age, you’re very likely to have a healthy baby as long as you are in good health, seek early prenatal care, and adopt sound lifestyle habits. Here’s what you can expect in your 20s, 30s, and 40s.
Role Of Drug And Alcohol Use
Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking them to teenage pregnancy are alcohol, cannabis, “ecstasy” and other substituted amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido it appears that teenage opioidusers have significantly reduced rates of conception compared to their non-using, and alcohol, “ecstasy”, cannabis, and amphetamine using peers.
Girls who mature early are more likely to engage in sexual intercourse at a younger age, which in turn puts them at greater risk of teenage pregnancy.
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Pregnancy Advice For All Ages
Regardless of statistics, whatever your age, there are steps you can take to improve your chances of having a healthy baby.
- See your health-care provider for a prepregnancy visit. This is especially crucial if you have chronic health problems such as high blood pressure or diabetes. Your provider can make sure that any medications you take for these conditions are safe during pregnancy.
- Take a vitamin containing 400 micrograms of folic acid daily. Start before you become pregnant and continue throughout the first month of pregnancy to help prevent certain serious birth defects of the brain and spinal cord.
- Get early and regular prenatal care. Working with a health-care provider to come up with a game plan for a healthy pregnancy will go a long way toward keeping you and your baby safe and sound.
Getting Pregnant In Your 40s
You are significantly less likely to get pregnant in your 40s than in your 20s or early 30s. By age 40, your chances of getting pregnant are only 5% during each menstrual cycle, compared with 25% per cycle during your 20s. Your odds of miscarriage, pregnancy complications, and birth defects are also highest in your 40s.
In your 40s, you may only have a few years if you want to get pregnant naturally. By age 45, the American College of Obstetricians and Gynecologists says that getting pregnant naturally is unlikely for most women. After age 45, you will probably need to use assisted reproductive technology, such as in-vitro fertilization , to get pregnant. For more information on getting pregnant in your 40s, check out our blog post here.
Who Is At Risk For Pregnancy Complications
Women with heart disease like Chelsea, are one of several groups that may benefit from high-risk pregnancy care. These groups include women with other preexisting medical conditions, women who develop complications during pregnancy, women at risk for premature birth, and women of advanced maternal age . Maternal-fetal medicine specialists provide individualized care before, during, and after pregnancy for women who are considered high-risk.
High-risk pregnancy specialists often work closely with other specialists to make adjustments to a womans medications prior to and during pregnancy. They also recommend key nutritional supplementation and lifestyle changes to help reduce risks during pregnancy.
During high-risk pregnancy, there may be concerns about how the baby is developing. In addition to closely monitoring the mothers condition, high-risk pregnancy specialists track the babys development and may provide treatment to support the babys developing systems. In some cases, they may be able to correct certain conditions before the baby is born.
When To Get Help
The process of TTC can feel exhausting and frustrating at times, no matter how old you are. However, most women do not need to worry if it takes them a while to get pregnant. Women who are under the age of 35 and have been trying for at least one year, or women older than 35 who have been trying for at least six months, should consult a fertility specialist for help getting pregnant. You should also talk to your doctor if you want to conceive but have a health condition that may impact your fertility, such as endometriosis or PCOS.
Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treatingcouples and individuals with infertility since 2014.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation.
Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
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How Early Can I Know Im Pregnant
From the moment of conception, the hormone human chorionic gonadotrophin will be present in your blood. This hormone is created by the cells that form the placenta . Its also the hormone detected in a pregnancy test. Even though this hormone is there from the beginning, it takes time for it to build within your body. It typically takes three to four weeks from the first day of your last period for the hCG to increase enough to be detected by pregnancy tests.
Huangs 2008 Systematic Review
In 2008, Huang et al. published a systematic review of all the studies from the previous ten years that looked at the risk of stillbirth with increasing age. They looked at 37 studies, and the overall quality of these studies was good. Participants in these studies gave birth any time between the years 1959 to 2003, so some of the studies took place a long time ago, and some were more recent. Most of the studies were very large, with half having a sample size over 78,000 births per study .
The results? In Huangs systematic review, researchers in 24 out of 31 studies found that older pregnant people were more likely to have a stillbirth than younger pregnant people.
When they only looked at studies from developed countries, the risk of having a stillbirth was about 1.2 to 2.23 times higher among older people when compared to younger people.
The increased risk of stillbirth with age was not due to other known risk factors for stillbirth.
The Huang review was limited in that most of the studies picked an arbitrary age and compared the stillbirth rates between two groups, either above or below the cut-off point. It would have been better if they had also reported how the risk increases year by year so that we could see the trajectory. The results from Huang et al.s review, lumped into one of two groups, make it seem like there is a drastic increase in risk at age 35. However, as we mentioned before, the risk might instead rise gradually each year.
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When Should I Reach Out To My Healthcare Provider About A New Pregnancy
Most healthcare providers will have you wait to come in for an appointment until you have had a positive home pregnancy test. These tests are very accurate once you have enough hCG circulating throughout your body. This can be a few weeks after conception. Its best to call your healthcare provider once you have a positive pregnancy test to schedule your first appointment.
When you call, your healthcare provider may ask you if you are taking a prenatal vitamin. These supplements contain something called folic acid. Its important that you get at least 400mcg of folic acid each day during a pregnancy to make sure your babys neural tube develops correctly. Many healthcare providers suggest that you take prenatal vitamins with folic acid even when you arent pregnant. If you werent taking prenatal vitamins before your pregnancy, your provider may ask you to start as early as possible.
Advanced Maternal Age: What It Is Why It Matters And What You Need To Know
Recent data from the Centers for Disease Control indicates that for the first time ever, thirty-something women are having more babies than their twenty-something counterparts.
Whether its earning a higher level of education, focusing on a career, struggling with infertility, relationship changes or simply not feeling ready to have children in their 20s, there are many factors contributing to women and their partners deciding to have children later in life.
Regardless of your age, if you are pregnant or planning to have a baby, its important to talk to your primary care physician or your obstetrician/gynecologist either before or as soon as you find out you are pregnant to ensure your health and that of your baby. However, if you are 35 years of age or older, its essential to take special care to ensure that you give your baby the best possible start. The good news is, the majority of women of Advanced Maternal Age go on to have relatively normal pregnancies and deliver healthy babies.
At Moreland OB-GYN, our team of obstetricians have the expertise to help you and your partner overcome challenges with infertility, guide you through every stage of your pregnancy, and deliver additional care that may accompany advanced maternal age.
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