DISEASES IN ELDERLY PREGNANT

Maternal and Children Diseases

Certain medical conditions occur more often in women over 40, including diabetes, high blood pressure and thyroid disorders. Fortunately, these conditions can be diagnosed and controlled prior to pregnancy and many medications used to treat these disorders can be safely used during pregnancy. If you currently take medication and you are planning a pregnancy, talk to your doctor. A change in medication or dosage adjustment may be necessary.
If not properly treated, maternal illnesses can adversely affect the fetus.Uncontrolled high blood pressure can restrict fetal growth and, in severe cases,can result in stillbirth, and poor control of the levels of blood sugar during pregnancycan result in abnormal fetal growth. Early prenatal care and judicious use of medication can reduce these risks significantly.
Some of the most common complications among women over 35 are:

• Gestational diabetes. This form of diabetes develops for the first time during pregnancy. Studies suggest that women over age 35 are about twice as likely asyounger women develop gestational diabetes. Women with gestational diabetes are more likely to have large babies at risk of injury during childbirth and problems during the first weeks of life (such as respiratory problems).

High blood pressure. As with diabetes, these women may develop high blood pressure for the first time during pregnancy. This type of high blood pressure or hypertension is often called pregnancy-induced hypertension or, in its most severe form, preeclampsia. Some studies have found that pregnancy-inducedhypertension is more common in women over 35 years.

Placental problems - The most common problem is placenta previa, in which the placenta covers part or all of the uterine opening (cervix). One study found that women who are about 40 years are twice as likely, and women over 40 years, nearly three times more likely, than younger women to have this complication.Placenta previa can cause severe bleeding during delivery that can endanger thelife of the mother and baby. Generally, a cesarean section can prevent serious complications.

•   Premature birth - Women over age 40 are more likely than women between 20 and 39 years of preterm birth (before 37 completed weeks of pregnancy). From 2003 to 2005, 16.6 percent of women over 40 years had a premature delivery, compared with 12.5 percent of women 30 to 39, and 11.9 percent of women aged 20 to 29 years. Premature babies are at higher risk for health problems during the first weeks of life and suffer permanent disabilities. Some studies also suggest that women aged 40 to 49 years may be at increased risk of having a baby of low birth weight (less than five pounds). (The low birth weight can result from premature birth, poor growth before birth or both.)

•   Stillbirth. Stillbirth, is fetal death after 20 weeks of pregnancy. In a series of studies have shown that women over age 40 have two to three times more likely than women aged 20 to 30 years of having a stillbirth. There are well known causes of these tragic losses in women over 40 years.

• Genetic defects-is an unfortunate but incontrovertible fact that as a woman ages, a greater proportion of her aging eggs contain chromosomal abnormalities. At present, some infertility clinics have the technology to eliminate these abnormal eggs, but for most women who become pregnant after the age of 40 years, the riskof having a birth defect increases based on age . Although the general populationof women of reproductive age has a 3% chance of giving birth to a child with a birth defect, after age 40, this risk is between 6% and 8%. The chance of having a baby with Down syndrome is approximately 1 in 365 at age 35. This number increases to 1 in 100 at age 40 and up to 1 in 40 at age 45.

• Pregnancy Loss
  
  Pregnancy loss also increases with advancing age. Approximately 60% ofspontaneous abortions in early pregnancy (first quarter) are due to genetic abnormalities of the fetus. In general, pregnant women experience spontaneous abortions in 15% of the time. After age 40, this incidence nearly doubles. There is also a moderate increase in stillbirths after age 40 due to a combination of medical complications affecting pregnancy and lethal birth defects.

Complications of Labor and Delivery
Complications of labor and delivery that are seen more often in women over 40years include:

- Preterm Labor
- Premature separation of the placenta causing bleeding
- Placenta previa (abnormal placement of the placenta over the opening of the cervix)
- Meconium-stained amniotic fluid (fetal waste in the amniotic fluid that can beharmful if breathed the baby at birth)
- Postpartum Hemorrhage
- Abnormal fetal presentation (breech or other positions other than the position ofhead)

As a result, the rate of cesarean delivery is significantly higher in this age group.