Pregnancy Over 35

Intro: We’re talking wellness at MemorialCare Health System. It’s time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Hello. Welcome to the program. You're listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Health System. I'm Deborah Howell. Today our guest is Dr. Michael Haydon, medical director for the Women's Hospital at Saddleback Memorial. His specialties include perinatology and obstetrics/gynecology. Today we'll be discussing pregnancy over the age of 35. Welcome, Dr. Haydon.

Michael Haydon, MD: Thank you.

Deborah Howell (Host): Great to have you on the show. What are some of the health concerns or pregnancy complications that women over 35 should be aware of if they're considering having a baby?

Michael Haydon, MD: It's an important question. Certainly 35 has become popular in the lay press for a time when women should start considering attempting to conceive if they have not yet, and they're starting to think about the additional risks. And most women are certainly waiting to later have their first child. Careers, later marriage, but it's important to let everyone know that most women in this age range, anywhere from 30 to 35 to 38, actually do very well in their pregnancies. As we age, there are certainly more medical issues that arise, just based on the risks associated with certain female medical conditions that occur more commonly in the mid 30s. But as long as they're identified, ideally identified and managed prior to pregnancy, as noted, patients will do very well.

Deborah Howell (Host): Okay. Now the old adage was, oh, your eggs start deteriorating at age 28. Could you speak to that?

Michael Haydon, MD: It's certainly something that people are concerned about, and that has been, in the 30ish, like you mentioned, 28, 30, it seems to be a time when women start really starting to talk to their friends or talk to their healthcare provider about what the likelihood of achieving pregnancy is as they get to that point due to the eggs age. And probably statistically it's higher maybe in the mid 30s that you start to see a drop. Most women have regular intercourse and don't have any major medical problems, usually in their, throughout the course of a year they will achieve a pregnancy. And that's why that's kind of become popular in the obstetrical world is that if you've been attempting to conceive for a year and you haven't, then you should maybe consult with a physician to do some additional testing. But I think it's important to let women know that probably it's closer to that 35 age range when we start to see a little drop off per month. And that's essentially why if a woman is considering achieving a pregnancy and they're having fertility issues, if they're closer to 35, it's probably preferable to see someone within six months versus waiting that whole year. Oftentimes it's not the woman, and there can be a male factor. And sometimes it's easier just to investigate that at that six-month window rather than waiting for the year.

Deborah Howell (Host): Well that leads me to my next question - which patients, both men and women, would be candidates for special preconception planning visits?

Michael Haydon, MD: Yeah so, our specialty is designed to manage women's pregnancies that are maybe a little higher risk, whether there's a medical condition or something related to the pregnancy itself, bleeding, preterm labor, fetal issues. And so outside of those issues, we do see patients prior to conception if we want to help them maximize their medical condition prior to getting pregnant. We work closely with their primary care physician or with their specialist. And so the big things that we see in pregnancy would be diabetes and hypertension. And those have the most impact on pregnancies. In our experience, where we deal with women that are a little bit older, and so if you look at a woman who has possibly prediabetes or what we consider mild diabetes, maybe requiring oral hypoglycemics or medical therapy, those women should be seen a little bit prior to attempting to conceive. It's important just that we want to have their total health and overall wellness at its maximum before they start to conceive. High blood sugars in the first trimester are not ideal, and so if we can get that under control with the assistance of their primary care doctor, that can be managed and then fortunately managed very well throughout the pregnancy. It's one of the things that we can get women through with pretty little complications. Hypertension, being high blood pressure, is probably the most concerning in the sense that the pregnancy itself puts a lot of stress on the woman's body with the additional blood volume, and when that happens whatever underlying higher blood pressure may be unmasked or cause a little additional issues with the pregnancy. And so if those can be managed prior to the pregnancy, either with medical therapy, weight loss, diet, exercise, those patients will do very well.

Deborah Howell (Host): Okay, and that's half the formula. The other half is the male, 'cause we're talking fertility here. What are your bits of advice for men who are also in the picture and definitely over 35, and many over 50 becoming fathers?

Michael Haydon, MD: It's become a very important question because of the age of the male. Interestingly, there's really not a lot of issues on the medical side for the male. Certainly any major issues like malignancy or medical therapies that are not compatible with early development of a fetus, those things need to be addressed. Usually those patients do see us prior to attempting to conceive. And if they have one of those issues, they've usually stored sperm or attempted to do other kinds of therapies for treatment of infertility later. But outside of that, there has been a little bit of a concern for autism in babies of men that are over 50. It hasn't been convincingly determined in large randomized trials, but it's certainly something people are investigating currently. I wouldn't be an alarmist and say that men should attempt to conceive as soon as possible because of that risk, because I really don't believe personally that we're there, but it's something that needs to be investigated further.

Deborah Howell (Host): Okay. Sounds good. So which prenatal tests do you recommend for women over age 35?

Michael Haydon, MD: It's interesting, things have changed quite a bit in the last two to three years in terms of tests that we provide to women. If starting with the medical side, certainly most women are going to have basic prenatal labs. And so that's something that's done by the primary obstetrician, blood counts, looking for anemia, thyroid studies looking to make sure they don't have low thyroid, and so those things are done by the primary OB. And then where my partners and I would get involved are related to the genetic side of the screening. And so when we look at women nowadays, it's changed quite a bit. There's a growing body of evidence that non-invasive tests, blood tests on the woman, can be equally effective and limit the risk to pregnancies that we've traditionally had with what we call chorionic villus sampling or amniocentesis, which do are still very useful and are used occasionally, but have a little bit of higher risk. And so the way we look at it is most governing bodies now recommend that all women be offered genetic screening. Not just women over 35, but all women. And when we do that in California we have a pretty straightforward approach where we do some blood testing early, ultrasound, and assist women in determining if they are high or low risk for genetic abnormalities, specifically Down syndrome. That's what we're mostly looking for. And we can give them an assessment whether they're high or low risk, and that's all done with ultrasound and blood testing. And then if they are in a higher risk category, we can then offer them some more specific testing. And so when I mentioned earlier things have changed historically, we've done things like an amniocentesis, to take some fluid and check the baby's genetics if they're at a high risk category for having a baby with Down. And now there are very good tests, what we call non-invasive prenatal testing, that can just draw mom's blood. And the technology is quite complicated, but basically they can identify a little bit of fetal or the baby's DNA in the mom's bloodstream and they can assess that and determine whether the baby does or does not have Down syndrome. So it's very popular in the lay press now where these tests are available to all women because it is recommended that all women be offered some form of screening, and when they hear how specific and how non-invasive and how little risk there is to it, it's become quite popular.

Deborah Howell (Host): That is just incredible. You just blew my mind with that. So, last question because sadly we’re almost out of time. Do you also recommend prenatal vitamins?

Michael Haydon, MD: We certainly do. Most women nowadays are taking multivitamins and eating quite healthy diets, and so usually their requirements are satisfied by that, but certainly the recommendations are prenatal vitamins. Prenatal vitamins have most of the other vitamins, calcium, folic acid, which is important for reducing the risk of spina bifida or neural tube defects. And so yeah, we do recommend women take the prenatal vitamin. More recently people have been asking questions about what's called DHA, which is a component of some prenatal vitamins or can be taken separately. And nonetheless, whether it's a prescribed prenatal vitamin or one that's purchased at Costco or Walgreens anywhere, they really are recommended and they do have great benefit.

Deborah Howell (Host): Awesome. Well we thank you so much, Dr. Haydon, for spending some time with us this afternoon. It's a great day to be pregnant over 35, and it's been wonderful to have you on the program today.

Michael Haydon, MD: Thanks for your time.

Deborah Howell (Host): To listen to the podcast or for more information, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Thank you so much for joining us. Have a fantastic day.