More women are choosing to becoming pregnant later in life

Although there are considerable risks to becoming pregnant later in life, more and more women are choosing to do it, a scientist told the 21st annual meeting of the European Society of Human Reproduction and Embryology today (Tuesday 21 June 2005). Professor Michael de Swiet, from Queen Charlotte's Hospital, London, UK, said that in the UK in 2000-02, 10% of women in their first pregnancy were over 35 compared to 3% in 1988-90.

Declining fertility is an obvious risk for older mothers, as is miscarriage and still birth. At the age of 42 years, more than half all pregnancies result in fetal loss. Complications for the mother include hypertension, which occurs in 35% of women aged 50 or over having egg donation, and there is also an increased risk of maternal mortality. "In the UK between 2000 and 2002, about 1 100 children lost their mothers because of pregnancy", he said. "If these women delay their pregnancies till age 40 or more, they will have the worst recorded maternal mortality in W. Europe, 35 per 100,000 maternities compared to the UK average of about 10 per 100,000 women."

All causes of maternal mortality are likely to increase with age, but Professor de Swiet said that the number of deaths from a pulmonary embolism (PE) was particularly striking. A woman who had had more than one child and was over 35 had nearly a hundred-fold increased risk of dying from a PE compared to the risk of a first-time mother aged 20.

For women seeking a career and seeking to postpone motherhood, Professor de Swiet advised that having a baby between 25 and 35 years of age was ideal; between 35 – 45, it was safe enough but there were risks of decreasing fertility, miscarriage and chromosomal abnormalities; and after 45: "That is only for the healthy and wealthy", he said.

During pregnancy, older mothers seemed to be particularly prone to what Professor de Swiet calls the "misery factor". "I am impressed by how tired and ill older mothers become, suffering from extreme breathlessness, postural hypotension, syncope and palpitations caused by nothing other than pregnancy", he said.

Social factors need to be taken into account too. "Will a 66 year old woman live long enough to be a mother?" asked Professor de Swiet, adding that it was not the responsibility of doctors to legislate or make policy statements on these kinds of issue. "What about the child? Is using donor egg and sperm to enable an elderly woman to become pregnancy just 'an elaborate, expensive, and grotesque form of adoption', or is it true that 'a woman who has not had a child has not led a complete life'? Someone needs to find some way of reconciling all these conflicting points of view and laying down a proper framework for doctors to work within", he said.