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The health care system must adapt to the new reality that more women are having children later in life and will consequently face higher risks for serious complications and health problems, says a new report.
While the trend toward delayed childbirth is on the rise as more people look to establish careers before family, one reproductive health expert is warning too few prospective parents grasp the scope of challenges involved with trying to conceive in their 40s.
Nearly one in five babies born in Canada has a mother age 35 or older, the age at which a woman's risk of preterm birth, developing complications such as gestational diabetes or having a child with a chromosomal disorder starts to increase, according to a report published Thursday by the Canadian Institute for Health Information (CIHI) .
The new report provides a detailed snapshot of the risks associated with women who give birth in their late 30s or 40s. The report looked at more than one million hospital births in Canada from 2006-07 and 2008-09. CIHI says it is the largest study of its kind to examine the impacts of advanced maternal age on mothers and babies.
It found that more than half of first-time mothers age 40 and over delivered by means of cesarean section. Two out of five mothers in their 40s who had previously given birth had C-sections. Meanwhile, only 25 per cent of women ages 20 to 34 had C-section births.
The report found one in eight mothers over age 40 had gestational diabetes, defined as high blood sugar during pregnancy, which can lead to serious complications in the mother as well as the infant. For instance, mothers with gestational diabetes can develop high blood pressure, or have heavier babies that can lead to delivery complications.
Among pregnant women between 20 and 34, only one in 24 had gestational diabetes, while one in 12 women aged 35 to 39 were diagnosed with it.
At the same time, one in 65 mothers age 40 and over had placenta previa, compared with just one in 97 women between 35 and 39, and one in 208 women between 20 and 34. Placenta previa occurs when the placenta covers the mother's cervix, a complication that can lead to significant bleeding and other complications.
Despite the potential for problems, experts say the trend of having children later in life is unlikely to change and, if anything, will increase in the future.
That's why it's important for the medical community to develop a much clearer understanding of how to prevent certain problems and the best ways to manage complications, according to Kathleen Morris, director of health system analysis at CIHI.
"Many of these increased risks that we see can be effectively managed with good prenatal care," she said. "I think the takeaway is it's important for women to understand the risks and contact a care provider early in their pregnancy so they can get the right screening."
But Judith Daniluk, professor of counselling psychology at the University of British Columbia,who focuses on the psychosocial aspects of reproductive health, said the issue that's usually overlooked when it comes to advanced maternal age is the sheer difficulties involved with conceiving later in life.
Prof. Daniluk has conducted research that has found many Canadian men and women believe as long as you're healthy, fertility shouldn't be a concern, even into a person's 40s. She also said most people think assisted reproductive technology will help them if their fertility has declined.
But Prof. Daniluk has seen many people devastated by the fact they are unable to conceive in their 40s and are "unintentionally childless."
"These are women who always expected to have children," she said. "They delayed for various reasons."
Part of the problem is many don't truly understand the difficulties of getting pregnant as they age. At the same time, doctors may be reluctant to address the urgency of the issue, while the celebrity culture reinforces the idea that anyone can have a baby at any age, Prof. Daniluk said.
"I think a lot of people, men and women alike, are seduced into believing they have plenty of time," she said.
Prof. Daniluk said her work has sparked a backlash, particularly among women. But the fact is later pregnancy comes with many challenges and the potential for serious risks. She hopes to launch a new online project to spread information about advanced maternal age and fertility issues in order to better arm people with information.
"At least if we have information and it's accurate information, we can make the decisions we need to make," she said. "At least [prospective parents]won't feel duped and feel like 'Why weren't we told this.'"
Carly Weeks