Mother, May I? Late Motherhood Emerges

No. 10 of the Top 10 Stories of 2004: The number of women getting pregnant in their middle years is rising. But is later really better than never?

From the WebMD Archives

When actress Geena Davis gave birth to twins earlier this year, her age -- nearly 48 at the time -- became the bigger story. Likewise, a swell of publicity surrounded Elizabeth Edwards, wife of recent vice presidential candidate John Edwards, when it was learned that she too got pregnant at age 48, and again when she was nearly 50.

Soon after, however, both women began to seem like "younger moms" when in November of this year headlines touted the birth of twins to a 57-year-old, single, first-time mom, Aleta St. James from New York City.

Indeed, while the term "older mother" once referred to women who conceived around age 30, today our birthing timeline has moved significantly, with the number of much-older women becoming first-time mothers on the rise.

"There is no question that the age where getting pregnant is considered a possibility is definitely expanding -- we are continuing to push the time line up and up and have been doing so since the 1980s," says Frederick Licciardi, MD, associate director of the NYU Program for IVF, Reproductive Surgery, and Fertility in New York City.

A new report issued this month by the CDC control verifies that a greater number of older women are getting pregnant. The birth rate for women aged 30 to 34 increased by just 4% in 2003, while those giving birth between 40 and 44 rose 5%.

And while births to women aged 45 to 49 held steady (at 0.5 births per 1,000), the rates for women in their early 20s -- once considered the prime age for motherhood -- decreased by 1%.

But just because we can push the birthing envelope, should we? And are we tinkering with Mother Nature in a way that may come back to haunt us -- if not as a society, then on an individual case-by-case, mother-by-mother basis?

Doctors say it's a hard game to call.

"It's not an issue that is going unnoticed, that's for sure -- but right now we don't have enough medical data to tell us one way or the other if older motherhood is a good thing; there just aren't enough women over 50 who have pushed the envelope to give us a clear picture of what happens when you do," says Michael Brodman, MD, chairman of obstetrics, gynecology and reproductive science at the Mount Sinai School of Medicine in New York City.

Continued

Health, Age, and Pregnancy: What We Do Know Now

Among the major arguments in favor of advanced-age motherhood is that women are living longer and are essentially healthier than ever before. Brodman tells WebMD that better nutrition, better health care, more information about disease prevention, and better living conditions have all worked to increase a woman's life expectancy significantly.

At the same time, however, rarely do these benefits extend to the heart and soul of a woman's fertility -- her ovaries and her eggs.

"Despite the fact that we have advanced our longevity, menopause still remains pretty constant -- as does the fact that, as a woman ages, she produces fewer eggs, and fewer healthy eggs, " says Margareta D. Pisarska, MD, co-director of the Center for Reproductive Medicine at Cedars Sinai Medical Center in Los Angeles, and editor-in-chief of the American Society for Reproductive Medicine News.

And that, say experts, not only means that getting pregnant grows more difficult with each birthday, if you do manage to conceive, the risk of potential problems can be significant.

"The primary cause of some of the most serious birth defects, as well as miscarriages occurring after age 40, are related to egg quality," says Licciardi. By some estimates, miscarriage rates can soar as high as 90% in women over 40.

For many, however, the best solution to becoming pregnant later often lies in the technology known as "donor eggs."

"It's the great secret that no one talks about -- in all these late-life pregnancy headlines the vast majority of the women getting pregnant are using donor eggs," says Charles J. Lockwood, MD, chair of the department of obstetrics and gynecology at the Yale School of Medicine.

With widespread availability since the early 1990s, egg donation first stimulates egg development from the donor and harvests "ripe" eggs, which it later combines with sperm in a lab. The woman donating the egg is a younger female who is given medications, which stimulate egg development.

The resulting embryo is implanted in the uterus of the older women seeking to get pregnant.

"From the perspective of the egg -- it's like the mother is 25 years old again," says Lockwood.

Continued

While for many women pregnancy and birth proceed without a hitch, the older a woman is, the quicker she discovers that egg quality is not her only barrier to motherhood.

"The truth is, the older a woman is when she gets pregnant -- even with donor eggs -- the greater her risk for pregnancy complications, including preterm birth, gestational diabetes, and preeclampsia," Pisarska tells WebMD.

All these issues, says Lockwood, are further complicated when she is carrying more than one baby -- which is particularly common in women undergoing in vitro fertilization (IVF) procedures.

"When a 50-year-old is carrying twins, she is at very high risk for delivering at an extreme premature point, and because of that she has a not insubstantial risk of at least one of the babies having a major handicap," he says.

What's more, studies indicate that all of these risks of pregnancy rise in direct relation to the mother's age -- with even as little as one year making a big difference.

Research published in the Journal of the American Medical Association in 2002 on women aged 50 and older who received egg donation indicated a higher risk of high blood pressure and diabetes induced by pregnancy, as well as a high rate of cesarean deliveries.

"We're still talking about small numbers of women affected by all these complications, but nonetheless, there is good evidence to show that the risks do increase significantly with age," says Brodman.

Long Life, Medical Ethics, and Pregnancy

Even more disconcerting, say experts, is that many prospective parents -- and in particular single, older moms -- may fail to recognize the simple realities of raising children in your 60s and 70s. Indeed, at an age when most of their peers will be selling off their homes and businesses and retiring to Leisure City, many older parents will be knee deep in soccer games, PTA meetings, and making cupcakes for the class bake sale.

An even more sobering thought: How many will actually live long enough to do any of these things with their kids -- and if they don't, how will that affect their children's lives?

Continued

"Ultimately you can do all the testing and assess people's health and make a judgment, but you cannot predict longevity," says Lockwood. While the donor egg procedure -- and even the pregnancy itself -- may succeed, Lockwood tells WebMD that none of that means much if the couple is not prepared to deal effectively with life after giving birth.

"If you have a family history of relatively short lives for example, you need to think about that -- just as you need to think about financial and emotional resources to support this child, particularly if there is a handicap involved, when you are not around," says Lockwood.

Indeed, even comic David Letterman -- who became a dad at the age of 56 -- frequently jokes about teaching his toddler how to push a wheel chair as he wonders aloud if he'll even be around to see baby Harry become a man.

Admittedly, however, experts do concede there are many positive aspects to raising a child in your 50s. Brodman points out the value of life wisdom and what you can pass on to a child as an older parent is priceless.

Additionally, he says that most women who go through the rigors of getting pregnant at a late age are generally so highly motivated, they make excellent parents.

But both ethicists and medical experts alike say the point no one can ignore is how little we know, not only about the immediate health implications of late-age pregnancy, but how it will affect family structure, as well as the mother's future health.

Some studies have already shown that the risk of breast cancer increases the older a woman is when she has her first child and her last child. Lockwood says his files are brimming with anecdotal stories of women who got pregnant in their late 40s with the help of what he calls "unscrupulous medical care" -- and are now severely disabled with advanced lupus, an inflammatory autoimmune disease that affects various part of the body.

Pisarska also expresses concern: "We already know by the increased risk of complications that the body is telling us to some degree that it is not comfortable sustaining a pregnancy at a later age -- but in reality it will likely be 10 or even 15 years or more before we have the kind of data that tells us what this really means -- and what the true risk picture really looks like for late-stage motherhood."

Continued

For Brodman, the bottom line is this: "At the end of the day, all things being equal, it's better to have kids at 25 than 45; it's better to have one kid at a time than three times at a time; it's better to use your own egg than somebody else's egg. But it's also safer to walk than drive -- and in the end much of what makes life worthwhile involves taking risks."

The older women who are doing that now, he says, are the ones who will ultimately tell us whether or not we are pushing the envelop too far, and if so, when we should stop.

While some fertility centers already refuse patients older than 49, others have more open policies, choosing to make decisions on a case-by-case basis.

However, all our experts told WebMD that any woman seeking to get pregnant after 40 should seek the guidance of a reputable fertility center, as well as getting a clean bill of health supported by reliable medical testing, including a Pap smear, mammogram, electrocardiogram, blood screening, and an extensive family and personal health history. In most instances, doctors say a psychological profile and at least one meeting with a reproductive psychiatrist or therapist can help a couple further determine if advanced age parenting is really right for them.

WebMD Feature Reviewed by Brunilda Nazario, MD

Sources

Colette Bouchez is the author of Getting Pregnant: What You Need To Know Now.

Published Dec. 23, 2004.

SOURCES: Frederick Licciardi, MD, associate director, NYU Program for IVF, Reproductive Surgery, and Fertility, New York City. Michael Brodman, MD, chairman, obstetrics, gynecology and reproductive science, Mount Sinai school of Medicine, New York City. Margareta D. Pisarska, MD, co-director, Center for Reproductive Medicine Div. of REI, dept. of ob-gyn, Cedars-Sinai Medical Center, Los Angeles. Charles J. Lockwood, MD, chair, department of obstetrics and gynecology, Yale School of Medicine, New Haven, Conn. Centers for Disease Control. CDC, "Births, Preliminary Data for 2003." Obstetrics and Gynecology, 2004, vol 104: pp 727-733. "Pregnancy in the Sixth Decade of Life: Obstetric Outcomes in Women of Advanced Reproductive Age," The Journal of the American Medical Association, November 2002; vol 288: pp 2320-2323.
© 2004 WebMD, Inc. All rights Reserved.

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