Pregnancy at 40 and beyond: What does it mean for you and the baby?
As more women in Singapore have babies in their 40s, CNA Women asks five medical experts if age is merely a number – and what older mums can expect of their pregnancies, including the inherent risks and mental preparation needed.
In October last year, CNA Women ran a story about a mother who had lost three pregnancies. Among the comments left by readers on social media, one theme stood out: There were women who were trying to get pregnant, or who had given birth, in their 40s.
“I have two angel babies, and I’m still trying hard to get over it. Although I’m turning 40 next week, I’m praying hard and trying hard – hoping I can be as strong and receive a rainbow baby,” wrote one woman.
Said one father: “You never fail unless you give up. My wife and I are over 40 years old and expecting our first baby this coming December.”
Said another woman: “I had my baby when I was 43. Never give up and you are halfway there.”
Having a baby in your 40s isn’t as uncommon as you’d expect. Statistics from the Immigration and Checkpoints Authority show that the number of live births from women aged 40 to 49 has increased – from 1,618 in 2014 to 1,827 in 2020.
There’s “certainly (an) increasing trend” in Singapore for women above 40 who are pregnant or looking to conceive, noted Dr Roland Chieng, the founding medical director of Virtus Fertility Centre.
The usual reasons, he said, include couples marrying later in life, as well as them being “undecided about childbearing”.
Many young couples are delaying their pregnancies due to long waiting times for their HDB flats or not being able to afford a property when they were younger.
Getting married later also means having children later, said Dr Jessie Phoon, Director and Senior Consultant at KKIVF Centre, at KK Women’s and Children’s Hospital (KKH).
She added that women aged 40 who came to KKIVF Centre seeking fertility treatment used to comprise a very small group. “However, since 2020, we've seen more women from this age group coming forward for fertility treatment.”
Another reason for couples having babies later: “Many young couples are delaying their pregnancies due to long waiting times for their HDB flats or not being able to afford a property when they were younger,” said Dr Tony Tan, a consultant obstetrician and gynaecologist at Tony Tan Women and Fetal Clinic, and Medical Director of Alvernia Obstetric Screening Centre at Mount Alvernia Hospital.
THE SUCCESS RATES
The question then: Is age really just a number when it comes to pregnancy? And if you’re in your 40s, how can you mentally prepare yourself for a baby – and life as an older mum?
While medical studies tell us that a woman’s fertility declines sharply after the age of 35, it doesn't mean that you can’t ever get pregnant after that. In fact, many women do get pregnant and have healthy children – and well into their 40s, too.
Many medical tests and interventions now exist to reduce some of the risks faced in the second and third trimesters.
Dr Tan pointed out that the “majority” of pregnant women aged 40 or above who do not miscarry in the first trimester go on to have successful, uneventful pregnancies. “Many medical tests and interventions now exist to reduce some of the risks faced in the second and third trimesters,” he said.
Dr Chieng added: “Age alone should not be the only consideration whether you should have a pregnancy. It is best to always discuss this with your doctor.”
However, do note that if you are trying to conceive for the first time, it’s more difficult to get pregnant in your 40s, said Dr Ng Kai Lyn, a consultant obstetrician and gynaecologist at Astra Women’s Specialists at Mount Elizabeth Novena Hospital.
Even if you have had children before, she advised women in their 40s to seek professional help early if they face difficulties in getting pregnant.
“Fertility potential is the highest before 30, and by the age of 40, only two in five of those who wish to have a baby naturally will be able to do so,” said KKH’s Dr Phoon.
Age alone should not be the only consideration whether you should have a pregnancy.
Diana Cheng, who is 40 and recently gave birth to her fifth child, told CNA Women that although she knew that hers was considered a high-risk pregnancy, she believed that “age is just a number”.
She was 33 when she had her first child. “When we got married, we were keen to have children but chose to prioritise our couple time first, and travelled extensively when we were younger.”
WHAT TO EXPECT: INCREASED PHYSICAL CHALLENGES AND EMOTIONAL STRESS
When it comes to managing a pregnancy later in life, you may find it a lot more physically and emotionally taxing as compared to when you were younger, said Dr Ng.
Cheng shared the same sentiment: “At night, it would almost feel as if my hip was dislocated, and it was painful to lift up my leg to walk. That was the toughest challenge, as I had never experienced difficulties walking in previous pregnancies.”
She also said she felt the “largest” and “heaviest” in her last pregnancy. Dr Choo Wan Ling, an obstetrician and gynaecologist at Mount Elizabeth Novena Hospital, said this was “quite common” in older mums, as the abdominal muscles may get more lax with each pregnancy, which makes them feel less supported.
Then, there’s also the added stress over potential pregnancy complications, Dr Ng said. “As a woman’s age increases, there is a higher risk of the baby having an abnormal number of chromosomes – the most common one being Down syndrome.”
The risk of having a baby with Down syndrome is one in 952 at the age of 30, as compared to one in 100 at 40 years, she added. “In a similar vein, the risk of having a baby with genetic problems is one in 66 at age 40, compared to one in 385 at age 35.”
Since 2020, we've seen more women from this age group coming forward for fertility treatment.
Expectant mums in their 40s should expect more visits to see their ob-gyn throughout the pregnancy for frequent checks on maternal and foetal well-being, Dr Ng added.
Aside from tests for Down syndrome and gestational diabetes, which Dr Choo said are offered to all pregnant women regardless of age, preeclampsia screening is an option given to older mums when they're 12 weeks pregnant.
This is especially to put their minds at ease, she explained, adding that if the woman's risk of developing preeclampsia is high, her doctor may start her on aspirin as a preventive measure.
CONSIDER THE SOCIAL CHALLENGES
Some social concerns of having a child in later years include the child losing a parent at a young age, which could be a stressful event, especially in the absence of other siblings for support, Dr Phoon of KKH pointed out.
“It could also mean that the young adult will have to be burdened with the heavy responsibility of caring for his or her aged parents at a tender age. Generational issues and the challenges of meeting the emotional and physical demands of parenting are also very real,” she added.
Additionally, Dr Tan of Mount Alvernia Hospital said that older mothers tend to have more, and heavier, responsibilities at work too – and therefore could be emotionally more stressed than younger mothers.
But there’s an upside to being in your 40s.
Most women would already have a level of financial stability, compared to younger women. Older mums would worry “slightly less” about finances as they would have already set aside a proportion of the necessary expenses, said Dr Ng.
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