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40 Not The New 20, But More Older Women Giving Birth

By Marilyn Meyer The Ledger, Lakeland, Fla.

WWR Article Summary (tl;dr) Dr. James B. Mammel, a board-certified fellowship-trained obstetrician and gynecologist says part of the reason more older women are giving birth is that it is now safer and easier to determine and monitor the health of the fetus earlier in pregnancy.

The Ledger, Lakeland, Fla.

It is still rare for women who are 40 and older to give birth, but in Polk County that number has doubled in the past 20 years.

The numbers remain so low in Polk County they are looked at in rolling three-year averages. Still there's a big shift.

From 1994 through 1996, 191 women age 40 to 49 had babies. From 2013 to 2015, the number had risen to 413, according to statistics from the Florida Department of Health.

Among the local women who are just starting families or are still adding to their families in their 40s are:

Anne Gonzalez of Lakeland, who at age 43 gave birth to her first child, daughter Jane Anne, now 9.

Molly Stricklen of Alturas, who at age 44 gave birth to daughter Charity, now 5, and at age 41 gave birth to son Nathaniel, now 7. Nathaniel and Charity are children No. 7 and 8 for Stricklen.

Stephanie Rovira of Lakeland, who at age 43 gave birth to daughter Sara, now 7 months old. Sara is her fourth child.

Tracy Ackroyd Howe of Clermont, who at age 41 gave birth to her first child, Cassidy, now nearly 5 months old. Howe is a Polk County native who formerly was the town clerk of Dundee.

Their pregnancy experiences are as different as their stories.

"Over the past 10 to 15 years, we are seeing an increasing number of older mothers," said Dr. James B. Mammel, a board-certified fellowship-trained obstetrician and gynecologist who practices with Watson Clinic of Lakeland.

"Part of it is due to baby boomers entering the workforce and then generation after generation postponing having children," he said.

And, he said, it is now safer and easier to determine and monitor the health of the fetus earlier in pregnancy. It has been only in the last few years that a simple blood test has been available to check for chromosome mutations that become increasingly prevalent in fetuses as women age.

When Mammel started practicing at Watson Clinic in the 1980s, a pregnant woman in her 40s was an anomaly.

"Nowadays, I typically am seeing two or three patients who are in their 40s and pregnant," he said.

Many of those oldest patients are using donor eggs from women in their 20s, he said. The oldest mom he has worked with was 48, and she had a donor egg, he said.

Dr. Bruce Cohen, medical director of maternal fetal medicine services who flies in from his private practice in Boston to work on Mondays at Winter Haven Women's Hospital, said the oldest pregnant patient he has treated was 59, a Boston-area woman who had a donor egg.

Because he specializes in pregnancies involving women and babies at risk, many of his patients are in their 40s and into their early 50s, he said.

Cohen has been coming to Polk County for only a month, but has a long-established practice in Boston, where he is head of the obstetrics-gynecology department at St. Elizabeth Hospital.

"In my experience, generally speaking, women 42 and younger use their own eggs and generally those 43 and older use donor eggs," Cohen said.

"If you are in your 40s or 50s and thinking of becoming pregnant, it is a good idea to meet with a specialist to understand the risks involved ahead of time," Cohen said.

Both Mammel and Cohen point to risks for older moms: gestational diabetes; high blood pressure and pre-eclampsia, which can affect all the organs in both mom and baby; low birth weight; still birth; and chromosomal mutations in the fetus. Second Family Rovira has had four children. Her two older children, Caleb Rexach, 22, and Steven Rexach, 18, were born when she was in her early to mid-20s.

Now in her second marriage, she and husband Elias Rovira have two children. Sofia, 8, was born when her parents were both 35. When when Sara came in March, Stephanie was 43.

"Being pregnant is different at 43. I am more tired; I was half the age when I had my first children. But with this one I was more relaxed, not as uptight," she said. "The first one, you really don't know what to expect, what is happening. "

Rovira, who was a teacher until five years ago when she quit to be a caretaker for her ill dad, said she has seen many changes in maternal care over the years.

"Even from eight years ago, everything is so much more advanced. One thing is my smartphone. If I have a question, I Google it," she said. "There are blogs, there are Facebook groups. There is so much access to information.

"The first time, I was reading books," she said.

While the four births were pretty much the same, she noticed one change at the hospital. Twenty years ago, the first couple of nights after the baby was born, the mother could send the baby to the nursery at night so she could rest, but not now.

While she said she appreciates the concept of mother-child bonding, at 43 her body could have used that extra recovery time.

Body changes While most pregnancies among older moms go well, the incidence of problems go up with age, Mammel said.

Hypertension: The older we get, the stiffer our blood vessels get. And with stiffer arteries, higher blood pressure is more likely to happen.

Vascular issues: Because of changes in the vascular system, the placenta might not get as much blood, which can lead to less nutrition getting through to the fetus, causing low birth weight. Or it might not deliver as much oxygen, which can cause still birth.

Gestational diabetes: As the pancreas and endocrine system age, there is a higher incidence of gestational diabetes.

Pre-eclampsia, formerly called toxemia: High blood pressure, protein in the urine and swelling are among the symptoms of this sometimes deadly disorder that can affect both the mother and baby. It is more common in women older than 35.

Chromosomal mutations: In older eggs, the risk of chromosomal mutations increases. "At 39 years old, a woman's chance of delivering a baby with Down syndrome is about 1 in 100," Cohen said. "At 40 years old, it is 1 in 90; at 41 years old, 1 in 70; at 42 years old, 1 in 50 and about 1 in 25 for any chromosomal abnormality."

That is why by age 43, most women who decide to become pregnant do so with a donor egg, which also carries certain risks of complications, he said.

Monitoring Before 2011, there was not a simple screening to check for chromosomal abnormalities.

But since then, a non-invasive, prenatal blood test has become widespread, especially for women older than 35.

As early as 11 weeks into the pregnancy, the blood test can screen for Downs syndrome, Edwards syndrome (also known as trisomy 18) and Patau syndrome, all of which impact the baby's development.

If there are indications of abnormalities, follow-up can include more invasive tests. Amniocentesis, which usually is done at 15 to 20 weeks into the pregnancy, involves using a long needle to extract a small amount of amniotic fluid in the sac surrounding the fetus.

Chorionic villus sampling, which involves taking a tissue sample from the placenta, can be done a little earlier at week 10 to 13 and can test for Down syndrome, sickle cell anemia and most types of cystic fibrosis.

And a level 2 ultrasound, usually performed in the first trimester, checks on the health of the fetus and formation of organs.

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