Medical conditions a bigger pregnancy risk than age itself, report finds
More women are having babies later in life and the findings of a new report is shifting understanding about the level of risk for those giving birth over 35.
The Australian & New Zealand Journal of Obstetrics & Gynaecology study found the presence of medical conditions conferred a greater risk of adverse outcomes in pregnancy than age itself.
Trends in motherhood are changing and the report found one in one in seven first-time mums gave birth at between 35-39 years of age.
Women in this age group without health concerns had a similar risk level of maternal death to those in the same circumstances who were over 40 years old.
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Lead author University of Sydney Professor Jonathan Morris said the study analysed 117,357 pregnancies among 99,375 women aged over 35 from NSW birth records from 2006 to 2012.
It encompassed women aged 35 to 56 years old, 32.2 per cent of whom were first time mothers and 67.8 per cent were women who had previously had babies.
Dr Morris said the data showed for the vast majority of women outcomes for pregnancy were good.
"What this work has done for the first time is looked at things other than age. When you examine the contribution of age compared with medical conditions or what's happened in your pregnancies before - those characteristics are far more important than age."
For example, a 35 year old first-time mum with no medical conditions had an estimated 5 per cent risk of perinatal baby death compared to 5.7 per cent for a first-time mother aged 40.
By comparison, the results showed a 35 year old first time mum with diabetes had a 12.4 per cent risk of perinatal baby death.
AMA ACT president Dr Stephen Robson, a highly-experienced obstetrician and gynaecologist, said the report refined thinking about risk, but demonstrated age was a factor in the mix along with medical and obstetric history.
"It would be a critical mistake to take this as reassurance that if you are well you can delay childbirth as long as you want," he said.
"As you get older it becomes harder to become pregnant. And you are more likely to have an early pregnancy loss or miscarriage which is a devastating experience."
Robson said there were limitations to the study. One was an under representation of women who have had previous complications with childbirth as many chose not to have further pregnancies.
And with high levels of screening, pregnancies with abnormalities discovered that might otherwise threaten the life of a mother or baby were often not carried to full term and delivery.
PLENTY OF UNKNOWNS
Brownyn Fagan was nearing 36 when she had her first child, Jade, and 38 when her youngest, Ivy, arrived.
The former elite athlete and busy lawyer said her two caesarean deliveries were not without their individual moments of panic, but she felt her level of physical fitness was an asset in both pregnancy and labour.
"When you are older, you are used to having control over what happens in your life but with birth and labour there are so many unknowns," she said.
"It's good to have statistics. To have that fear alleviated and have risks put into perspective it takes a weight off because there are so many things to think about."
Robson, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said "pejorative terms" such as geriatric pregnancy were out of favour within the profession as it dealt with a shift in the age of mums.
"We need to recognise those terms aren't helpful, they often put people offside, and as you can tell from this paper they are not particularly useful medical definitions," he said.
And while life was different and fewer women were having their first child in their early 20s, it was in everyone's interest to heed warnings about pregnancy risk.
"If you are in an older age group, you do have health problems like high blood pressure and so on or in previous pregnancies if you have had problems you need to engage a GP or someone skilled in pregnancy early, ideally before you try for pregnancy," he said.
"But if you do become pregnant and you are healthy from that point forward you should be confident."