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Parenthood at an older age

Starting a family was furthest from Celia’s mind when she got married at 30. She was a banker and her career was going at full steam then. She was happy with living a ‘double-income-no-kids’ life .Having a baby would mean the end of  cosy  tete-a tetes, candle-light dinners and twice-yearly holidays. She was not willing to give up this sort of life style. 

But things took a turn after she hit 35. “My husband and I had a serious talk about where our lives were heading,” she shared. “After much soul-searching, we decided that parenthood was something we really wanted and we did not want to regret missing out on it.”

She tried to conceive for about six months without success. This was when she decided to see me. After the initial consultations and investigations, Celia was found to have multiple fibroids, a condition where there are benign growths in the muscle wall of the womb. These were removed successfully by key-hole surgery.

Four months after the surgery, she was overjoyed when I showed her an ultrasound image of a foetus with its heart pulsating inside her womb after her period was overdue for 2 weeks. Her pregnancy progressed smoothly and she delivered a healthy girl by Caesarean section in December last year.

Like Celia, more and more Singaporean women are starting a family late when they are in their mid-30s or older. Studies show that these mothers have more problems during pregnancy compared with their younger peers.

There is an increased risk of miscarriage, most of which occur in the first trimester. About 10 percent of pregnancies for women in their 20s end in miscarriage. The risk rises to 20 percent after 35 and 35 per cent after 40.

An older mum also has a higher chance of having an abnormal baby from chromosomal defects. The most common is Down’s syndrome, when affected children have varying degrees of mental retardation and physical birth defects.  The risk of a mother having a baby with Down’s syndrome increases from 1 in 1250 at the age of 25 to 1 in 400 at 35.

There is also an increased incidence of coexisting medical conditions such as high blood pressure, diabetes and gynaecological problems such as ovarian cysts or uterine fibroids as in Celia’s case. These conditions have a negative impact on the the pregnancy outcome. For example, untreated diabetes can cause birth defects and miscarriage. Poorly controlled hypertension can result in stillbirth.

Other complications that are more common in pregnant women over 35 include multiple pregnancy, placenta previa (low lying placenta), premature birth, intrauterine growth restriction and stillbirth. There is also an increased incidence of induced birth, assisted delivery using forceps or vacuum and Caesarean birth.

Although Celia’s pregnancy was relatively smooth, she was monitored very closely during her prenatal period. To couples who have not embarked on the journey of parenthood, Celia has this to say:” Don’t wait too long to try. Fertility and pregnancy is not as easy as you would like to think. Allow ample time for the unexpected. Watch your biological clock!”

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