If there is something in my life against what I have repeatedly revealed, it has been against the dogmas, those ironclad and indisputable principles transmitted from generation to generation. Although I must accept that some of them are beneficial, such as the constructive religious faith, there are others that generate confusion and discouragement: an example of the latter is the paradigm that reads “High Risk Pregnancy due to advanced age” to refer to pregnancy in women over 35 years. This statement is so similar to saying “he died of old age” when nobody dies from being old, but of a disease or condition with a name, for example, a heart attack, pneumonia, sepsis, etc.

With the increase in the number of pregnant women over 35 years (15-20%) we are learning a lot about this type of pregnancy and the truth is that we see them more naturally and we can say that the prognosis is excellent, not very different from the group of women under 35 years of age. In fact, it has certain advantages in terms of maturity, economic independence, education and family stability

A healthy woman without chronic diseases can not be considered as incapable of having children, the risks are not much greater but the group should be stratified, a woman of 35-40 is not the same as a woman of 41-49, especially if she is healthy .

Maternal disease

Although as a group, women over 35 may have a greater number of medical complications associated with pregnancy due to diseases acquired throughout life (due to aging), the fact is that the fact of being older than that age does not necessarily imply the presence of an obstetric disease or complication. This is a concept that comes from past times, historical moments in which the survival of the human being was quite low (30-40 years) and in which a woman over 30 was considered as a woman over the years and not very suitable for reproduction. Without going very far, only 70 years ago there were very few women over 30 years old having babies and many suffered complications.

How was the woman “from before”? She was submissive, ignorant and sedentary; he did not formally work or contribute to the home economy beyond his administration, the upbringing of children and internal trades (hard work and little value) and had a very restricted social life; they got married young, they had an endless number of children, many of whom died early and the onslaught of time and pregnancies quickly deteriorated. Arrivals at 35 years had suffered a series of changes and physical abuse that did nothing but complicate any other pregnancy, usually unwanted, in that “advanced” age. Pregnancy is not a game, it prints very severe changes in the organic economy of the woman and in spite of everything, she survives him.

From a public health point of view, it was appropriate to establish an artificial cut-off point, 35 years, to generate in the doctor a greater attention and care in these women who traditionally had pregnancies with a greater number of problems. Now, with a growing number of pregnancies beyond the age of 35, and well past the age of 40, we have learned that the concept of years of pregnancy, as a complication marker, was not as accurate.

What diseases does age bring? : aging is progressively affecting all organs and systems and we are becoming increasingly prone to suffer high blood pressure, diabetes, kidney problems, obesity and other common diseases that debut at mature ages

How is the woman of today? Basically we could define it as active, independent, prepared, productive and determined to consciously plan its offspring. In short, she controls her fertility until she considers that her personal, academic and economic goals have reached a certain level that she considers adequate; in this time passes and we easily reach 35 years. This is so true that until a few years ago less than 5% of pregnancies occurred in women over 35 years, but now this figure has tripled and is already approaching 20% ??with a tendency to continue increasing, especially in developed countries . This means that we must prepare ourselves to see and manage pregnancies in women more and more “old women” … and we are already doing it!

Fertility

It is a reality that the fertility of women decreases progressively after 20 years until reaching relatively low points after 35 years. Each month, women in their 20s have a 20-25% chance of becoming pregnant, 30-35% around 15%, 35-40 years at 10%, 40-45 years at only 5% and women at 20%. over 45 years old, a scant 1% per month. However, once a pregnancy is achieved, whether through natural or assisted routes (assisted reproduction is almost a necessity after the age of 45), this effect of age is nullified. The reason for the fall in fertility rates as maternal age progresses is the aging of the ovules: unlike what happens in man – constantly replacing his sperm – the ovules age with their owner and suffer the ravages of time over your genetic load

Fetal disease and abortion

It is also not a secret that as the maternal age advances, so does the risk of spontaneous losses ( abortions ) and babies with chromosomal problems such as Down Syndrome (Trisomy 21); however, the risk is only statistical and when you review it in the appropriate tables you find that the maximum risk of having a baby with chromosomal disorders, in a natural pregnancy, is 8.3% at age 45, which can be translated as a 9 to 1 chance of having a healthy baby.

I do not mean that pregnancy in a woman over 35 (especially if she is over 40 years old) should be taken lightly but once all the medical problems potentially present and carried out have been discarded, the screening tests (eg genetic ultrasound) or diagnosis ( eg Amniocentesis ) to rule out fetal problems almost certainly we will have a pregnancy without problems. After the age of 35 years, it is indicated to inform the patient about the risks of fetal chromosomal disorders and the indication to practice an Amniocentesis if the patient so wishes.

In our practice we inform about the chromosomal risks to every pregnant woman regardless of their age, every pregnant woman has a fetus with malformations until it is proven otherwise