Dear Doctor,

I am 45 years old with three children, the youngest is 8. I recently found out that I was pregnant (about 12 weeks) even though I’ve been on the pill. This was so unexpected and I was honestly done having kids. What complications do I stand to face at my age?

Tina

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Dear Tina,

The fertility of a woman reduces around the age of 35 and above. Moreover, if one is on the pill, chances of conception are very low, unless one is on daily pills and skips a dose or more. If a woman has her desired number of children and is using contraception, pregnancy is least suspected, with a missed period. Many times, it may be confused with menopause until a pregnancy test or sonography shows the correct diagnosis. Chances of a miscarriage are high with advanced age of pregnancy. With middle age, other health related issues come up, which can create complications during pregnancy. These health related issues are like hypertension, diabetes, thromboembolism, and etcetera. Due to this, chances of failure in early pregnancy, still births, and or pre-term delivery, are increased when a woman conceives at an advanced age. The risks of abnormal location of the placenta or premature separation of the placenta are also higher, both of which carry a risk for the mother and baby. There are more chances of delivery by a C-section, which is not free of potential complications at a later stage.

With the aging of a woman, the ovum present in the ovaries also ages. This carries risk of chromosomal abnormalities in the baby, including stunted growth. Thus, a baby may be born with Down syndrome or mongolism, or worse, a spastic child.

However, in spite of these risks, a woman can also have a normal baby, without any troubles. It is vital to go for routine antenatal visits, where apart from clinical examination and other laboratory tests, sonography is also carried out. It is also advisable to go for genetic counselling and if needed, amniotic fluid examination. These, along with the sonography, will help detect any chromosomal abnormality early. If one has hypertension or diabetes, it should be controlled very well with dietary measures, regular exercise and medications. Even in absence of these conditions, it is useful to take a balanced diet and do regular physical exercise to help carry out the pregnancy smoothly. Alcohol and tobacco are strictly forbidden. It is also vital to remain physically and mentally relaxed.

Dr. Rachna Pande is a specialist in internal medicine.