With the gradual implementation of the “comprehensive two-child” and “three-child” policies, the proportion of senior pregnancies among women in China has increased significantly in recent years, and by 2020, the proportion of senior maternal age in China has reached 15.8%. The International Federation of Obstetrics and Gynecology defines the age of delivery ≥35 years as advanced pregnancy. Because of the decreased conception rate of advanced women and the increased risk of miscarriage, fetal malformation, pregnancy complications and complications, advanced pregnancy has become a serious challenge in the field of reproductive health in China.
Why does fertility decline in older women?
1. the incidence of infertility in women increases with age. the incidence of infertility in women aged 20-24 years is only 6%, while it rises to 30% in women aged 34-39 years and up to 64% in women aged 39-44 years. the pregnancy rate in women aged 46 years basically tends to 0%. The decrease in follicle number and egg quality are the primary factors of female fertility decline, while uterine diseases that affect the environment for conception such as fibroids, adenomyosis and endometrial lesions also increase with the age of women.
2. The live birth rate of women decreases and the miscarriage and fetal malformation rates increase with increasing age. The spontaneous abortion rate is about 40% among pregnant women aged 35-44 years, and up to 60%-65% above 45 years; in terms of live birth rate, it is 19.2% for women aged 38-39 years, while it is only 1.5% for women aged >44 years, and the live birth rate decreases even more significantly for women aged ≥45 years, which is only 2‰. Meanwhile, the risk of neonatal birth defects such as Down syndrome and pediatric cerebral palsy also increases with maternal age.
The incidence of chronic hypertension, diabetes mellitus combined with pregnancy, gestational diabetes mellitus and gestational hypertension are 2.7 times, 3.8 times, 10 times and 1.89 times higher, respectively, among pregnant women aged around 45 years compared to those aged 25-29 years. Women who become pregnant at age 40 or later face a higher risk of stroke and heart disease.
What can be done to improve the risks associated with pregnancy at an older age?
1. Pre-conception assessment. Couples planning to become pregnant, especially women of advanced age with underlying medical conditions, should be evaluated for suitability for pregnancy. The Department of Obstetrics and Gynecology at Peking University Hospital has provided fertility counseling, preconception examinations and other related services. If women aged ≥35 years who have been trying to conceive for more than 6 months are still infertile, it is recommended to visit the Fertility Center for a comprehensive fertility examination and treatment. Infertility tests include ovarian reserve function assessment (age, sex hormones, anti-Mullerian hormone and ovarian sinus follicle count under ultrasound), tubal patency examination, pelvic organ structure examination and endocrine examination. At the same time, the male partner’s fertility should be understood and semen analysis should be performed.
2. Eat a reasonable diet and promote a healthy lifestyle. ①Supplement folic acid. It is recommended to start taking folic acid orally from 3 months before conception and continue until the second trimester or throughout pregnancy, taking a daily dose of 400-800ug to prevent fetal neural tube abnormalities and anemia during pregnancy. ②Balanced diet, reasonable exercise, and keep away from toxic and harmful substances. Balanced intake of three major nutrients: carbohydrates, proteins and fats, and supplementation of vitamins and minerals; because the incidence of pregnancy complications and complications is higher in overweight or obese women, it is recommended to improve diet and increase exercise to reduce body weight from before pregnancy; stay away from the environment of tobacco, alcohol, radiation and excessive formaldehyde in work and life, and minimize participation in gathering activities to avoid the occurrence of influenza A, influenza B and Avoid infections of influenza A, influenza B, new coronavirus and other infectious diseases.
3. Regular perinatal health care. Older pregnant women should establish a health care manual in early pregnancy, have regular pregnancy and delivery checkups, and follow doctors’ instructions for health care.
It should be especially emphasized that the most suitable age for women to have children is 25-29 years old. It is recommended that young couples should make good family plans while actively responding to the national policy call to encourage childbirth and reasonably arrange the time of childbirth. For senior women, it is important to understand the risks of pregnancy at an advanced age and take early measures to actively address them to ensure the health of the mother and child.
