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Pregnant on the Margins

 We live in a society marked by contrasts. Republican and Democrat; male and female; innies and outies.  

Nowhere is that dichotomy more apparent than in the extremes of pregnancy. By that I mean the very young mother to be and the older lady with child. 

While some may disagree as to the relative ages that apply to these designations, for the sake of this article (and in the hopes of not offending anyone), I will label young as under 18 and old as over 40. 

The most recent statistics would indicate that the “children having children” category is decreasing in numbers while the “I thought I was in menopause” group is increasing. As an obstetrician I am grateful that the teen pregnancy rate is declining and, likewise, I find solace in the maturity of the over-40 moms. 

Pregnancy in Teens

I suspect few will argue that a decline in teen pregnancies is a good thing. The physical and psychological burdens are monumental. Eighty percent of teen moms are not married and few give up children for adoption or care by others. For this reason, the mothers often must drop out of school and cannot hold full-time employment. They must suddenly assume the responsibility of raising a child before they are ready, emotionally or financially. The number one predictor of poverty in adulthood is a teenage pregnancy.

Physically, teens are more likely to have a Caesarean section delivery secondary to pelvic bone structure immaturity and are at greater risk from medical problems such as preeclampsia. 

TV shows such as “16 and Pregnant” have actually done a good job at painting a realistic picture of the trials and tribulations of teen pregnancy.

Despite the odds against them, I have had a number of teenagers who have had babies and done very well physically and psychologically and the outcome is very dependent on the individual and their level of maturity. There is no doubt, however, that the majority of kids with kids have a very tough time.

Pregnancy in 40-Plus Moms

There are a number of reasons for the rise in older women getting pregnant. Interestingly, there are about the same number of unintended pregnancies as their youngest counterparts. Nevertheless, many women are making a conscious choice to delay childbearing until their 30s and 40s.

There are a few increased risk for this group of moms, yet generally those women who enter pregnancy in good health tend to do much better than those who smoke, are overweight or have medical conditions like diabetes and hypertension. 

One of the biggest concerns of older moms is the increased incidence of chromosome problems such as Down’s Syndrome. The most recent data from the American College of Obstetricians and Gynecologists suggests this is indeed the case. 

Risk of Down’s Syndrome based on age alone:

At age 25, 1 in 1,250
At age 30, 1 in 1,000
At age 35, 1 in 400
At age 40, 1 in 100
At 45, 1 in 30
At 49, a 1 in 10

A key point here is that the majority of babies born with Down’s Syndrome are born to moms under the age of 35. The other side of these statistics is that the vast majority of babies born to women over 35 have no genetic changes.

Healthy Pregnancy at Any Age

Enough of the downer statistics. What can you do, regardless of age, to promote a healthy pregnancy? 

Here are some suggestions from the American College of Obstetricians:

• Have a pre-conception checkup with a health care provider.
• Get early and regular prenatal care.
• Take a multi-vitamin containing 400 micrograms of folic acid daily, starting before pregnancy and in early pregnancy, to help prevent neural tube defects.
• Begin pregnancy at a healthy weight (not too heavy or too thin).
• Don’t drink alcohol.
• Don’t smoke and stay away from second-hand smoke.
• Don’t use any drug, even over-the-counter medications or herbs, unless recommended by a healthcare provider who knows you are pregnant.
• Eat healthy foods, including foods containing folic acid and folate (the form of folic acid that occurs naturally in foods). Good sources of folate are fortified breakfast cereals, enriched grain products, beans, leafy green vegetables and orange juice.
• Don’t eat undercooked meat or change a cat’s litter box. Both are possible sources of toxoplasmosis, an infection that can cause birth defects.
• Get tested for immunity to rubella (German measles) and chickenpox before becoming pregnant and consider being vaccinated if not immune. After being vaccinated, a woman should wait one month before getting pregnant.

Remember, pregnancy is a normal, natural state and not a disease. Use some common sense and prepare yourself as best you can. If you find yourself pregnant on either age extreme be happy because, in spite of a few additional risks, there is a tremendous amount you can do to minimize your risks and maximize you and your baby’s health.

Dr. Eaker is an Augusta Ob/GYN and author. He and his wife, Susan, have two teenage daughters.

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