What are the risks of giving birth at 39?
September 21, 2020 1:49 PM   Subscribe

We are considering have a child at age 39 or 40. What are the risks to the mother and child of having a baby at at this age? I'm looking for stats on complexity of the pregnancy and birth defects, or the increased risk of things like autism and down's syndrome. We've had two healthy children, if that matters.
posted by david1230 to Health & Fitness (12 answers total) 5 users marked this as a favorite
Best answer: hey, that's great that you are planning on having another child. how exciting.
i work on maternity units as part of my work in healthcare and there are many people having children at your ages. however, it is well known in the field that 'advanced maternal age' (an unpleasant term for it but that's the terminology they use) has increased risks for delivery, mum's health and baby's health (including increased chance of down's syndrome). you'll be given more appointments/scans/extra care during the pregnancy too.
if you search for 'advanced maternal age' on sites like UpToDate, NICE, PubMed, then you'll find plenty of specific articles and information. the best one i found to summarise so far is evidencebasedbirth.com's Evidence on: Advanced Maternal Age.
posted by thiosux at 2:29 PM on September 21, 2020

Down Syndrome risk for a child conceived at 40 is 1 in 100 per the NDSS.
posted by medusa at 2:32 PM on September 21, 2020

Best answer: Standard Metafilter Book Recommendation: read the bits about age in Expecting Better by Emily Oster. According to the index, this is mostly in the chapter on prenatal screening, e.g. chromosomal defects, but there are bits elsewhere.

The whole book is great (clear-eyed, accessible, etc.) but the chapter on prenatal screening is IMO a particular highlight of exposition. Cannot recommend it enough.
posted by caek at 2:42 PM on September 21, 2020 [5 favorites]

I had my first and only child at age 42. She is now a healthy three year old.

Here is a clickable version of thiosux's link of Evidence Based Birth. To sum up, yes, the risks of birth defects and chromosomal abnormalities is higher with advanced maternal age (my fucking insurance files had flat out "elderly pregnancy" listed). But even increased odds does not mean that it is a given, and for the trisomy problems there are screenings available as early as 10 weeks into pregnancy. Stillbirth is something I worried about even once our screenings came back good. There are some doctors who recommend induction at 39 weeks for older mothers because of this stat. Something to discuss with your OBGYN. (I was induced at 40 weeks, 2 days, more for my anxiety over the stillbirth issue then any medical concern for the baby.)

Good luck whatever you decide!
posted by weathergal at 3:44 PM on September 21, 2020 [4 favorites]

One thing to add since this isn't your first rodeo: if your most recent rodeo was more than a few years ago and you heard about or considered amniocentesis at that time, you should know that the standard screening test used nowadays carries a much lower risk of complications (it's a regular blood draw from the mother), can be done earlier in pregnancy, and tests for a larger set of possible genetic complications.
posted by caek at 3:50 PM on September 21, 2020 [1 favorite]

I’m having my 3rd child now, at 39. My chromosomal defect screen came back negative, ultrasound was normal, and so far I’m having a very uneventful pregnancy with a healthy baby (Knock on wood). The risks for certain things do increase with maternal age, but my doctor has not expressed one iota of concern regarding my “advanced maternal age.”
posted by katypickle at 4:00 PM on September 21, 2020 [1 favorite]

Best answer: Thanks. I grabbed the Oster book on the Kindle tonight and it included exactly the data I was looking for. FWIW, a 39 year old mother that has a negative cell free DNA test has about a 1 in 16,000 chance of birthing a baby with Down Syndrome. Other trisomy defects are even less likely with a passing test.
posted by david1230 at 8:46 PM on September 21, 2020 [3 favorites]

For more anecdata (and I realize that isn't exactly what you're asking for, but hoping it may provide some relief) I have two friends, both 41, both of whom had a kid within the last two years. These are healthy, happy, amazing toddlers.
posted by aspersioncast at 9:22 PM on September 21, 2020

This page triggers exactly me -- wanting another kid at this age! I think the worries for me are about the conditions that prenatal screening doesn't capture -- like autism (now 1:40 kids or so, apparently) that increase in likelihood with age. It's not so much that this would stop me from having a first kid, but I do question how I would handle this alongside my other children and later in life. But I think that most risks of older parents are highly exaggerated (as Oster describes) and some even decrease in risk as women get older. Good luck -- rooting for you!
posted by caoimhe at 6:35 AM on September 22, 2020

Response by poster: >>> like autism (now 1:40 kids or so, apparently)

Where did you get this number?
posted by david1230 at 12:42 PM on September 22, 2020

I can't find where I found 1:40 (a number I read that just lodged in my head -- I shouldn't have tossed that out so casually) but a more reliable source is probably the CDC, which estimates that about 1:54 kids has been diagnosed with autism, and seems to put the incidence of parent-reported developmental disabilities at about 1:6 in one study.

But actually I regret even posting this because even though the rate of autism seems somewhat higher in children of older parents, the actual increase in risk is apparently really small and may have other causes.

And debates about over-diagnosis and unreasonable/discriminatory fears of neurodiversity cast doubt on these numbers. Multiple sources give the incidence at different levels. I am ABSOLUTELY NOT AN EXPERT OR SCIENTiST, just a googler. I'm sure a doctor/pediatrician would be a good place to ask; I was just trying to give insight as to what my worries are as a person in a similar position as you.
posted by caoimhe at 3:11 PM on September 22, 2020

I just wanted to show up to say that it's possible the likelihood of autism increases with older parents because of capacity to navigate the system to get an assessment. It takes a huge amount of work, money, systems knowledge to know how to navigate to get the psych assessment. A lot of people end up with private assessments, which means you need to have good benefits. And you have to have the time to get to all the appointments and you need to know what good will come of it. Someone who is only 20 or even 25 may not be taken as seriously by doctors and professionals and may not have the money to access parts of the system who add information that eventually results in a diagnosis. Also, some career paths are more likely to attract NT parents and professionals often delay childbearing. So someone who is a 40yo accountant or engineer, with a good benefits plan and their spouse's good benefits plan, and some savings and a lot of experience talking to doctors, hearing from friends, hiring even employees, and getting through post-secondary has a lot of experience that lends itself to getting a diagnosis and they probably delayed having a child vs their friend who went into the workforce as a plumber at 20 and had a kid at 22.
posted by Chaussette and the Pussy Cats at 12:33 PM on September 23, 2020 [1 favorite]

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