Enf.º Tito Félix

Maternal and Obstetric Health Specialist Nurse 
Gynecology and Obstetrics Service

Pregnancy in advanced maternal age

HPA Magazine 22 // 2024

GERIATRIC PREGNANCY: A CONCEPT FROM THE PAST?
Traditionally, the concept of geriatric pregnancy referred exclusively to a pregnancy in a woman over 35 years of age. However, this reductive concept is outdated. If you are planning to become pregnant and have a baby over 35 years of age, this designation will no longer apply to you. Experts, instead of a rigid classification based solely on age, have opted for an individualization of the pregnant woman, preferring the designation of Advanced Maternal Age. Thus, in addition to maternal age, genetic factors, the woman's past and current clinical history, and the way in which all of this will influence conception and pregnancy are considered.

POSTPONEMENT OF MATERNITY
In the past, motherhood occurred between the ages of 20 and 30. Sometimes even earlier. Marriage took place early, and family formation was directly related. Women rarely had career ambitions, and domestic duties associated with motherhood fully fulfilled their social role. This trend has reversed, and women find their full fulfillment in other fields, postponing motherhood. Marriage does not immediately lead to the creation and expansion of a family. 
Career, material and financial stability, housing, plans to travel without children, professional instability, among others, relegate parenting to a secondary level. Sometimes, finding a partner late also means that the desire for parenthood is postponed.
Currently, it is estimated that worldwide around 19% of all pregnancies and 11% of first pregnancies occur after the age of 35, with the average age for a first child being 27.1 years, compared to 21.4 years in the 70s.
In Portugal, the average maternal age for the birth of the first child has also increased in recent years. In 1994, it was 25.4 years, in 2004, it was 27.4, and in 2014, it was 30 years. These data corroborate an average increase of 2.1 years in maternal age every 10 years for the birth of the first child.

PREGNANCY AND MENOPAUSE
Despite the biological clock ringing earlier, getting pregnant after the age of 35 is increasingly common, and for a variety of reasons, many women do so successfully in their 40s and 50s. The difference is that the conception process, instead of being natural and spontaneous, can be accompanied by assisted reproduction methods. This is because the option for late motherhood can be made difficult by the proximity of menopause and the organic changes that occur at this stage. Therefore, it is essential to understand how menopause affects fertility so that women can plan their pregnancy preferably within reproductive age.
Menopause occurs within a wide age range, generally between 45 and 58 years of age, and can occur much earlier, for various clinical reasons (medical and/or surgical treatments). It is only definitively established when the woman does not menstruate. for a period exceeding 12 months.

GET PREGNANT AT 50
Biologically, a woman is born with all the eggs she will have and will release in each menstrual cycle, decreasing until menopause, which marks the end of her fertile age. It is estimated that at the beginning of puberty, a woman has 500,000 eggs, around 25,000 by the age of 30, and around 1,000 by the age of 51. Eggs not only decrease in quantity but also in quality. The small amount determines the probability of getting pregnant, while low quality determines the probability of genetic anomalies or chromosomal alterations. This is why we understand the difficulty in getting pregnant naturally at an advanced age and the likely need to consult a fertility specialist. The preservation of cryopreserved eggs collected before the age of 35 or the use of donated eggs can be a solution for delayed pregnancy. Therefore, while it is not impossible to get pregnant at 50, it is very rare and always involves a specialist in medically assisted reproduction.
According to a study conducted with a sample of 58,000 women, it was shown that at the age of 25, 4.5% of women were unable to get pregnant naturally, the same was true for 20% of women at the age of 38, 50% at the age of 41, 90% at age 45, and 100% at age 50. As women age, the probability of getting pregnant decreases drastically due to the quantity and quality of available eggs. However, theoretically, there will always be this possibility as long as ovulation occurs. If the ovary produces a single viable egg and it is fertilized, conception can occur. The In Vitro Fertilization (IVF) method allows for the use of both your own and cryopreserved donated eggs.

If becoming a mother is part of your life plan and you are considering pregnancy at an advanced age, age alone does not constitute an absolute obstacle. Reproductive medicine exists to help you achieve this goal. Consider your general health status, medical history, medications you depend on, conduct a pre-conception study, and schedule a consultation with a specialist in maternal-foetal medicine. Despite being a high-risk pregnancy, it can be healthy, safe, and enjoyable with proper monitoring and control. Always be aware of the calculated risks for yourself and the foetus.