By Kim Seidel

Many women today are waiting later and later to start a family. Women over 40 trying to get pregnant face medical risks with their age. Special precautions, however, can be taken to increase chances of conception and ensure a healthy pregnancy.

Getting Pregnant

It's more difficult to conceive after 40, and the miscarriage rate increases with both maternal and paternal age, says Michelle Collins, a certified nurse midwife and an assistant professor of nursing at Vanderbilt University School of Nursing, Nashville.

"My first and only child was conceived after only one month at age 39," says Sue Patton of Basking Ridge, N.J. "Now I'm 43, and I'm having problems conceiving. I've had three miscarriages in the last year, which I'm told is typical at this age."

The miscarriage rate is about 12 percent in women less than 20 years old, and increases to 26 percent in women older than 40, who are at "an advanced maternal age," Collins says. "For women over 35, there is a higher incidence of chromosomal abnormalities; the body's ability to recognize these in an embryo results in the higher miscarriage rate."

While Patton remains optimistic about having a second child, she feels quite surprised at how difficult it has been to conceive again. "Having my first daughter was so easy," she says.

After she had her baby, many OB/GYNs told Patton to start trying to get pregnant again right away. "I thought they were being alarmist," she says. "In my mind, I had all the time in the world."

Patton is not alone. "The biggest mistake women make is not deciding in time to try to conceive," says Dr. Grace Keenan, an integrative health expert and director and founder of Nova Medical in Ashburn, Va. "They miss that window of opportunity when they can be with an aggressive, reproductive entomologist, and have their eggs fertilized by in vitro fertilization (IVF). Many patients assume they can get pregnant without help at 40 and aren't aware of their challenges."

Today, Patton is in the process of IVF. "I'm realistic about the chances, which are not high at my age," she says. "But I don't want to look back years from now and not have taken every opportunity I had."

Medical Risks

Along with difficulty conceiving and an increased miscarriage rate, women over 40 may encounter other medical complications.

A higher risk of developing gestational diabetes and pregnancy induced hypertension may occur for women over 40, Collins says. Other medical risks include an increased chance of having a Cesarean section, developing preeclampsia (a form of toxemia) and placenta previa (where the placenta is implanted in the lower uterus, rather than the upper). "Women over 40 years of age who have chronic health problems, are in poor physical condition or are obese have a greater chance of developing complications, however," Collins says.

When a woman over 40 does conceive, she has an increased chance of complications with her baby, including a higher rate of stillbirth, Dr. Keenan says.

"If a woman is capable of conceiving, then there is the concern that the DNA in her eggs has been damaged over time," Dr. Keenan says. "The logarithmic curve in which a woman's chance to give birth to a child with Down syndrome or other genetic abnormalities begins at about age 38 and continues to increase over time."

For example, the chance of a fetus having Down syndrome in a woman who is 35 years old is one in 250, Collins says. This is up from one in 417 for a 33-year-old. At 40 years of age that same risk is one in 69; at 45 years it is one in 19.

Precautions to Take

With all of the medical risks, one would think women over 40 should turn and run away from pregnancy. This isn't necessarily the case for all women, Collins says. "Life is not one size fits all," she says. "What works for me in my life may certainly not work for another woman."

The key to successfully conceiving and having a baby in your 40s, Collins says, is going into pregnancy with your eyes wide open. The first way to increase your awareness is to schedule a preconception visit with either a physician or certified nurse midwife to discuss all of the implications of pregnancy over 40.

At this visit, a thorough health history is taken. The woman is assessed for any potential problems that may affect a pregnancy. The provider may draw a blood sample to see if the woman is immune to an infection called rubella, for instance, which would be valuable information to have prior to a pregnancy, Collins says.

The woman's social habits, like smoking and using alcohol and other substances, will be reviewed, as well as her nutrition, Collins says. With this information, her provider can help her adjust aspects of her life that may help her to have a healthier pregnancy.

In addition to a preconception visit, it's recommended that women over 40 meet with a professional genetic counselor before becoming pregnant, Collins says. This appointment involves the counselor calculating and explaining genetic risks specifically related to maternal age and family history.

Being in great physical shape is advantageous for any woman over 40 considering pregnancy, Collins says. If a woman of this age is overweight or obese and considering pregnancy, she would be counseled on safe and effective ways to lose weight before attempting to conceive.

Women need to understand that some risks related to advanced maternal age and pregnancy are alterable, such as in the case of an obese woman being more at risk for gestational diabetes, Collins says. And some risks are not alterable, such as the higher risks of chromosomal abnormalities that are strictly related to the woman's age.

"Establishing a relationship with her provider early on, where all issues are addressed and discussed, and the woman has full knowledge to empower her decision making, will help a woman of any age have a healthier pregnancy," Collins says.