Later-age pregnancy: Preparing for the happy, healthy event after 40

If you're in your 40s, your chances of getting pregnant are around 50 percent. If you've had no luck getting pregnant naturally, you can increase your odds of carrying and delivering a baby to about 10 percent with infertility treatment. But the whole issue of infertility treatment is another story. Before you check into the possibilities of getting pregnant, check out your health.
Although most older mothers (older than age 40) have uncomplicated pregnancies and healthy babies, you're at higher risk than younger women for complications.

Facing chromosome abnormalities

One of the biggest issues for older mothers is the risk of having a child with chromosome abnormalities. The most common is Down syndrome, a condition that causes mental retardation and defects of the heart and other organs. While your risk of having a child with Down syndrome is relatively low — only about 1 percent at age 40 — it's still greater than when you were 20.

There are, however, two prenatal tests — amniocentesis and chorionic villus sampling (CVS) — that detect chromosome disorders. Both tests carry a slight risk of miscarriage. If your test findings are abnormal, you'll be faced with the difficult decision of whether to continue or terminate the pregnancy.

Taking care of you

Diabetes and high blood pressure are more common in women in their 40s. Diabetic mothers are at greater risk for pre-eclampsia, preterm delivery, placental problems or stillbirth. Women with diabetes are also more likely to have a child with poor fetal growth or birth defects. Blood pressure also normally rises during pregnancy, which can worsen an existing condition, putting you at risk of seizures or stroke.

Even if you don't have diabetes or high blood pressure, you have an increased chance of developing pregnancy-related diabetes (gestational diabetes) as well as pregnancy-induced hypertension (PIH). Both gestational diabetes and PIH increase the chances of eclampsia, a complication characterized by high blood pressure, swelling of your face and hands and protein in your urine. Eclampsia can impair your nervous system function, leading to seizures, stroke or other serious complications.

Both conditions occur infrequently and complications are rare. Gestational diabetes is controlled with diet and exercise (and insulin injections for about 15 percent of women). PIH is treated with bed rest and close monitoring of your condition as well as the baby's, both during pregnancy and delivery.

Other concerns

Your chances of having twins or triplets also goes up as you age, even without infertility treatment. As an older mother, the possibility of multiple births is riskier to your health as well as the babies'.

Your chances of cesarean delivery are also about 40 percent higher than a younger woman's. Although a cesarean delivery is riskier than a vaginal delivery, most are uncomplicated and require only a slightly longer hospital stay and recovery time.

Planning ahead

Here's what you can do to improve the health odds for you and your baby:

• Control existing health problems such as high blood pressure or diabetes.
• Lose weight if you're overweight. Women who are overweight when they get pregnant are more likely to develop problems during pregnancy.
• Take prenatal vitamins containing folic acid before getting pregnant to help prevent neural tube defects such as spina bifida, a condition in which the tissue over the baby's spinal cord doesn't close.
• Learn about your health risks and the diagnostic tests you may want to have to detect chromosome abnormalities.
• The benefits of waiting

Although later-age pregnancy can put you at higher risk for a number of health complications, there's an upside. As a potential older mother, you may be more mature, realistic and dedicated to the idea of having a baby than a woman in her 20s. You've probably also given a lot of thought to the changes a new baby will bring.