The risk of placental problems
By Hallie Levine Sklar
While placental problems are relatively rare during pregnancy, the risk shoots up once you hit the big 4-0. If you get pregnant past that age, you have a 10-fold increased risk, compared with women younger than 30, of placenta previa—a dangerous condition in which the placenta does not move up and away from the opening of the uterus during pregnancy; this can cause severe vaginal bleeding and activate premature labor. The main reason? An older uterus is less hospitable to the drastic bodily changes of pregnancy.
“The uterus is required to grow from the size of a small pear to a huge watermelon in nine months, which requires an enormous level of blood flow,” Dr. Stillman says. “Vascular disease is ubiquitous as people age, whether it’s in the heart or in the vagina, and it gets more and more difficult as a woman gets older for her uterus to keep up with the rapid growth of pregnancy.”
Lauren B. Cohen, a New Jersey lawyer who is the second oldest woman in the United States to give birth to twins, at age 59, spent two months in the hospital before giving birth to her twins at 31 1/2 weeks due to complications from placenta percreta, an incredibly rare condition in which the placenta actually breaks through the walls of the uterus and attaches to another organ such as the bladder.
“My doctors said my uterine walls had been weakened, due to age, a past C-section, and the stress of carrying twins,” Cohen explains. During the C-section, she hemorrhaged so much from her placenta that she required a transfusion of 33 units of blood. The twins—born two months premature at just over 3 pounds each—have suffered no long-term health problems, but they have developmental delays.
The risk to baby
Babies born to over-40 women like Cohen are not only more likely to be born early but also more likely to have birth defects. One Columbia University study found that 2.9% of women older than 40 have babies with birth defects, compared with 1.7% of all women younger than 35. Of these, cardiac issues are the most common: Another study found that heart defects were four times more common in infants of women over 40, compared with those age 20 to 24.
“It could have something to do with egg quality or with the fact that older women may have undiagnosed and untreated diabetes or hypertension, which could affect growth and contribute to birth defects,” explains Randy Fink, MD, a high-risk OB-GYN in Miami.