In her career as a medical practitioner spanning two decades, Dr Kavitha G Pujar has successfully handled several pregnancies and infertility cases. Many among those were cases of delayed pregnancies. In medical parlance, pregnancies post-30s are considered to fall under the delayed pregnancy bracket.
A closer look at recent childbearing trends explains how an increasing number of women are embracing delayed motherhood. Recalling one of her most rewarding cases, Dr Pujar, senior consultant, obstetrics and gynecology, Kinder Women’s Hospital and Fertility Centre, Bengaluru, draws attention to the measures that could help women navigate delayed pregnancies with greater ease.
“A woman who had got married at 41 and was trying to conceive for two years came to me for consultation. Eventually, she underwent in vitro fertilization (IVF) treatment under my supervision and conceived within a year,” Dr Pujar told Happiest Health.
“Another patient of mine conceived at the age of 39. However, she developed gestational diabetes in her third month of pregnancy. Nevertheless, we advised her to follow a diabetic diet and include exercise to her daily routine. The woman was also treated with insulin. To everyone’s delight, she delivered a perfectly healthy baby.”
Delayed childbearing or late maternal age
According to the research paper ‘Delayed childbearing’, fertility declines with increasing maternal age, especially after the mid-30s. “For this reason, delayed childbearing is traditionally defined as pregnancy occurring in women aged 35 or above. This population has been referred to as advanced maternal age or late maternal age.”
Women’s reproductive physiology after 30
Pregnancy is largely determined by the fertility rate of a man and a woman. “Among the two, female fertility is the larger determiner when it comes to conceiving. The oocytes (the immature eggs) are the main determining factor. As women grow older, these oocytes (eggs) deplete both in quality and quantity,” Dr Preeti Prabhakar Shetty, senior consultant, obstetrics and gynecology, Apollo Hospitals, Bengaluru, told Happiest Health.
A study titled ‘Ageing and assisted reproductive technology (ART): a waste of time and money?’ cites that “Female infants have 6-7 million oocytes at 20 weeks of gestation, 1-2 million oocytes at the time of birth, about 250,000 oocytes at menarche (the first occurrence of menstruation), 25,000 oocytes at 37 years of age, and only a few hundred or thousand at the end of their reproductive life.”
Things to keep in mind
Experts recommend a few things to keep in mind for women planning to welcome a child into their lives after 30. “Women above 30 do conceive, but it would be a good idea to consult fertility experts to minimise the chances of any complications likely to arise during their pregnancy,” suggests Sushma Appaiah, founder and director of Golz – Nutrition and Diet Solutions, Mysuru, Karnataka.
Some of the possible issues that could arise during delayed pregnancies are:
“As women age, they are more prone to develop lifestyle disorders such as blood pressure, excess weight, polycystic ovary syndrome (PCOS) – a hormonal issue among women of reproductive age – thyroid and insulin resistance,” elaborated Appaiah.
“These conditions could lead to complications during conception. Moreover, women with pre-existing thyroid, PCOS and high fasting sugar levels are likely to develop gestational diabetes,” the doctor cautioned.
“Gestational diabetes is one of the common health conditions in late pregnancies because women with this condition have higher hormonal disturbances due to their age,” states Dr Rashmi Dsouza (Rasquinha), consultant nutrition therapist and ENT surgeon at Kasturba Medical College Hospital, Mangaluru.
Elaborating on two other comorbidities associated with gestational diabetes, dietician Soumya S Nair, who works in ESIC Hospital, Ezhukone, Kerala, says, “Infertility treatment increases the chances of weight gain. These women are also more prone to developing gestational diabetes. Secondly, gestational diabetes is also closely associated with hypertensive disorder such as preeclampsia.”
Doctors also pointed out that women who choose to conceive in their 30s and beyond are likely to go for ART. Studies show that resorting to assisted technologies to conceive sometimes leads women to give birth to twins, triplets or quadruplets.
Commenting on the cases of multiple births among women going for ART, Dr Shetty explains, “It could be due to hormonal changes that lead to the release of more than one egg in each cycle.”
Talking about some of the other challenges associated with the process, the doctor adds, “ART could also lead to the delivery of premature babies. Sometimes, women might even have a miscarriage. Additionally, they could also develop diabetes or hypertension or both.”
Fetal chromosomal irregularities
There are chances of chromosomal irregularities such as Down’s syndrome to develop in the fetus during delayed pregnancies. “The risk is said to be 1 in 250,” Dr Shetty informs.
“Higher incidents of operative delivery or cesarean sections are also seen among women who give birth in their 30s or later,” said Dr Shetty.
Other issues include ectopic pregnancy (wherein the fertilised egg grows outside the uterus), placental abnormalities (such as placenta privia) and congenital anomalies (such as heart defects) in the child.
Can you overcome these challenges?
While a delayed pregnancy has its challenges, experts feel that with proper medical guidance and care, one could certainly overcome the hurdles. “Today, a delay in pregnancy could be due to various reasons, including late marriage, educational or professional or family commitments, history of miscarriage or abortion and pre-existing health conditions such as cancer or diabetes.
“However, a detailed study of the medical history of the patient could reduce the challenges associated with delayed pregnancy to a considerable degree,” said Nair.
Tackle your lifestyle disorders
Appaiah, who has handled several cases of delayed pregnancy with lifestyle disorders, specifies that hormone regulation could help women in their post-30s to conceive.
“Maintaining the body mass index (BMI) between 19 and 23 could also help. Monitoring hemoglobin levels along with nutritional intervention at the pre-conception stage could even reverse diabetes,” suggests the doctor.
Physical exercises and weight management
Dr Dsouza (Rasquinha) advises that for women who are diagnosed with gestational diabetes, hypertension or any weight-related issues, the first step should be to get to a healthy weight. “To achieve this, one needs to eat healthy foods and exercise for 30 minutes every day,” advises Dr Dsouza.
Dr Pujar has a word of recommendation for women who plan to embrace delayed pregnancies. “Such women could consider preserving their oocyte and ovarian tissues. Oocyte freezing and ovarian cryo-preservation could help younger women to freeze their eggs and utilise them later for conception,” says Dr Pujar.
Dr Shetty recommends opting for screening tests and pre-needle tests as a mode to eliminate complications during pregnancy. “These tests help in screening chromosomal defects during the first trimester of the pregnancy,” Dr Shetty explains.
A ray of hope
Throwing light on how women wishing to go in for delayed pregnancies could work around their situations, Dr Pujar shares an inspiring case of a young woman with early-stage breast cancer. “The cancer diagnosis left her devasted. Nevertheless, her family decided in favour of oocyte freezing before her chemotherapy (since chemotherapy may cause oocyte distraction).
“With the help of oocyte cryo-preservation, the patient concerned could plan for pregnancy after completing her treatment for breast cancer, preserving her chances of reproductive potential. She agreed to freeze the eggs before her chemotherapy sessions commenced. Her treatment got over in a year. A couple of years later, she underwent IVF and conceived,” Dr Pujar recalls.