Obstetrician Dr. Nan Okun talks about the Canadian Institute of Health Information's report that suggests women over 35 face higher risks of birth complications
Women over 35 face higher risks of birth complications but good prenatal care can help manage the risks, a new report suggests.
Thursday's report from the Canadian Institute for Health Information's report, In Due Time: Why Maternal Age Matters, looked at more than one million births across Canada from 2006 to 2009 to examine the impact of older moms.
Almost one in five births in Canada is to a mother over the age of 35.
"It shows that we can do a good quality audit in Canada and as a result, reassure the majority of women that they will do well and that they are in safe hands in this country," said Dr. John Kingdom, an OBGYN at Toronto's Mount Sinai Hospital who works on high-risk pregnancies, commenting on the report.
Mothers age 40 and older were at least three times more likely to develop certain complications than younger mothers.
For gestational diabetes, which develops or is first diagnosed during pregnancy when the body is not able to make enough insulin, one in every eight mothers older than 40 developed it. In comparison, one in 12 women aged 35 to 39 and 1 in 24 aged 20 to 34 had gestational diabetes.
Diagnosing gestational diabetes offers an educational opportunity, said Kingdom.
Gestational diabetes is temporary during pregnancy. If a woman with gestational diabetes controls her weight, watches her diet and exercises after giving birth, she will avert Type 2 diabetes later in life, Kingdom said.
The report's authors also found 41 per cent of mothers age 40 of older and half of all first-time mothers in this age group had Caesarean section deliveries. In comparison, about 35 per cent of mothers age 35 to 39 and about 25 per cent aged 20 to 34 gave birth by C-section — a difference Kingdom called "a wake-up call."
The report only looked at live births, not stillbirths that occur after 20 weeks and which are on the rise, he noted.
Leanne Miani-Vrkljan, 38, of Oakville, Ont. experienced a stillbirth at 25 weeks during her first pregnancy. Seven weeks ago, she gave birth to a healthy girl, Alayna Vrkljan, at Mount Sinai.
"It was such a traumatic experience to find out what was going on the first time around," Miani-Vrkljan recalled. "So knowing that we had a possibility that it could happen again really emotionally took a toll on us. But the fact that we were going to see Dr. Kingdom and he was taking over our care, there was that reassurance that they would do everything they could."
Doing everything involved appointments every two weeks after three months into the pregnancy for ultrasounds and checks for preeclampsia, a serious complication of pregnancy that includes high blood pressure, excess and rapid weight gain, and excess protein in the urine as a result of kidney problems.
Miani-Vrkljan was checked for preeclampsia because it can be related to the placenta problem that led to her stillbirth, she said.
Miani-Vrkljan experienced fertility problems and conceived using fertility drugs and then in-vitro fertilization, which isn't addressed in the report.
"I don't necessarily think it was a choice for me to wait, and I just think that that was my life circumstance," she said, who suggests adding financial support for IVF for women over 35.
Kingdom said the job has changed and health-care professionals need to be aware of the challenges that older women may have to offer them comprehensive assessment and multi-disciplinary care including nursing.
"I think motherhood the first time is hard on anybody no matter what age they are. So I think there are many reasons why people chose to have a baby later in life and we should celebrate and help them to have that baby," he said.