What is different at advanced maternal age?

[rbp]

DS was born when I was 31. Healthy pregnancy, no complications (other than breaking my ankle, which did complicate the pregnancy but was otherwise unrelated). Now I'm 36 (and 11w pregnant) and will be 37 when I deliver. I asked my OB at my first appointment what was different now that I was AMA, and he didn't have much to say other than the cell-free fetal DNA testing (which I also had with my first pregnancy and will have again next week). 

I've come across a couple of recommendations that I will ask my OB about next week, but I'm wondering if you also have any familiarity with the research or anecdotes. First, taking a baby aspirin to prevent preeclampsia. I heard a story about this on NPR this morning, and it seems that I only have one moderate risk factor (my age). Are any of you taking a daily baby aspirin for this reason?

Also, I've read that stillbirth rates increase after 39w, and the increase is sharper for women over 35. I know it's really early to be thinking about this, but I think the data are more conclusive now than when I gave birth in 2014, and also I'm older, so I'm wondering if this is something I should ask about/push for. 

Thoughts about these things or other things that changed for you over age 35?

[farfalla2011]

I'm having my baby in a couple days, 2 days shy of turning 37. I think the NIPT tests are more highly recommended being AMA, but I don't think anything has been different for me, although this is my first full term pregnancy so have nothing to compare to and I've been watched like a hawk with an MFM until 32 weeks because of my recurrent loss and a test result in the very beginning that was less than ideal. I did take baby aspirin daily until 20 weeks, but that was more due to recurrent loss than AMA. The whole still birth thing scares the ever living crap out of me, but my dr hasn't even brought it up or shown any concern.

[urbancowgirl]

I'm AMA, too (39, will be 40 when baby arrives). I had symptoms of preeclampsia postpartum after my son was born, so the midwives that I see recommended taking a baby aspirin daily, which I started at 10 weeks. I'm not sure whether the aspirin would have been recommended if I didn't have those pre-e symptoms last time. They mentioned that I will have weekly non-stress tests for the last month of pregnancy. They also will not let me go past my due date. Other than that, the midwives that I've been seeing have been very breezy about AMA. I had a consult with an MFM doctor last week and she didn't seem concerned about it, either.

[smock]

I had my second at AMA, and really, nothing was different. I had one OB send me for an early gestational diabetes test, but my regular OB said she generally doesn't do that.

[robinsbff]

I’m AMA this time but wasn’t last time. The only thing that has been different purely because of AMA is the cell free DNA testing at 12 weeks covered by insurance.

I did do the baby aspirin, but that’s because I had pre-eclampsia last time, not sure if it would have been recommended without that previous diagnosis.

[Susie]

I had my babies at 33 and 37, with the same practice.  As far as what changed in my care with #2 -- like you said, cfDNA testing was covered, and they offered that if I preferred, they would refer me out to MFM for my anatomy scan (for whatever the next level u/s was from what they had in-office).  That's really it.  I declined the MFM referral because in-office was easier, I had no risk factors other than age alone, and figured if they saw anything concerning on my regular a/s, then we could refer out.

I was ultimately induced at 39+3, but it was elective.  I had a really fast spontaneous labor with DD at 39+2, and was worried about childcare for her if it happened again (esp. MOTN).  Some doctors in the practice encouraged it, and others actively discouraged it and wanted me to wait for spontaneous labor.  From what I could tell/what was discussed, the induction encouragers were all basing it on it being baby #2, the practical need for childcare, my history of fast, successful vaginal delivery, and probably a little bit their preference to deliver a baby by appointment, if we're all being honest.  By the end I was so stressed about my 3 yo DD that it was welcome relief to just get the induction.  I had heard on these boards that some AMA moms were being encouraged to induce before 40w because of increased stillbirth risk, but it never came up with my OBs as a pro for inducing. 

My monitoring was less in my AMA pregnancy than in my first, because I had GD the first time but not the 2nd.  As AMA, I had no NSTs, and only the practice's regular 9, 12, 20, 32 week u/s's, no 36 week like the first time.  We never talked about specific steps to prevent pre-e, baby aspirin, any of that.  I did have regular cervical checks in the last month (their choice/not mine), but that was because it was baby #2, I was reporting contractions, and again that history of going fast, but not because of AMA.  I also had an extra 1 hr. GD test at 12w (again at a normal 26w) but that was because of prior history of GD, it isn't AMA standard.

[jorja]

I asked my doctor about this because although I’m not AMA now, I will be if we have another.

She said not a whole lot changes significantly until after 40. There are a few things they monitor more closely, but it’s more of a concern at 40+ than 35-40.

I personally would not be comfortable going past my due date at any age. I was scheduled for an elective induction at 39 weeks with my last baby, but ended up being induced before that for hypertension.

[rbp]

Sept 16, 2019 9:31:08 GMT -5 jorja said:

I asked my doctor about this because although I’m not AMA now, I will be if we have another.

She said not a whole lot changes significantly until after 40. There are a few things they monitor more closely, but it’s more of a concern at 40+ than 35-40.

I personally would not be comfortable going past my due date at any age. I was scheduled for an elective induction at 39 weeks with my last baby, but ended up being induced before that for hypertension.

I delivered my first by spontaneous labor at 40+2 (in 2014). I think I became aware of some evidence within the next few months that the risk of stillbirth spikes after 40w, so I may push for an induction between 39 and 40w. I see a practice with only 2 OBs, so I think they only schedule inductions two days a week. 

[catbear]

I'm pregnant with my third now (12 weeks along). I was 30 for my first, 33 for my second and I'll be 36 when I have this one. With my second, I had postpartum pre-eclampsia which sent me back to the hospital for magnesium about 4 days after delivery. Because of this, my current pregnancy is high risk. Starting at 12 weeks, I was advised to alternate taking 1 or 2 baby aspirin every day (the US standard is one but apparently they take 2 in Europe and have possibly better results). Studies find this is one of the few things that actually reduces the chance of developing pre-eclampsia. My risk factors are also higher this pregnancy also because I am older. I don't believe they have all women who are AMA take aspirin, but it is definitely something worth asking your OB.

Due to AMA, I also had the fetal DNA testing (which I've never had before). Not sure if there is anything else that they are doing specifically related to my age though.

[rbp]

One of the physicians interviewed in the NPR report said that 86% of her patients meet the criteria for daily baby aspirin. I found this number shocking, but I think she treats mainly high-risk patients.

[patches31709]

Sept 16, 2019 9:14:21 GMT -5 robinsbff said:

I’m AMA this time but wasn’t last time. The only thing that has been different purely because of AMA is the cell free DNA testing at 12 weeks covered by insurance.

This has been my experience as well. I was 32 when I had my DD, and will be 36 when my second is born. I did see my practice's MFM for a few visits early on, but I believe that was because my first was 9 weeks premature and not because I'm AMA. 

[robinsbff]

Oh yeah, I meant to add I’m already scheduled for a repeat c-section at 39w,2d but that’s because I had one the first time. They did say they prefer to schedule at 39 weeks for patients my age, so assume it would be at 40 weeks otherwise.

[chocolatepie]

I will be 41 when I deliver my first.

- At my OB practice, weekly NST are standard with AMA, though I don't know if that is over 35 or over 40.
- 2 anatomy scans (18 & 22 weeks) with MFM was standard due to age.
- My insurance covered the NIPT test and wouldn't if I was under 35
- Weekly midwife visits started at 32 weeks; they said under age 35 start weekly at 36
- They will not let me go over 39 weeks

ETA: My fertility doctor had me start baby aspirin during IVF and my OB has me staying on it until 36 weeks. Not sure if the connection is age or IVF; it's delicious and orange flavored so I never bothered to question them much LOL

[pickel]

Aside from everything hurting? LOL
I had DS at 32 and am now having twins at 37. There hasn't been much difference with regard to baby aspirin, NIPT, etc. due to age, but some additional dr visits due to multiples.

[starburst]

I had my first at 37 and my second at 40. With my second, they would not let me go past my due date and I had weekly NSTs starting around 34 or 35 weeks.

[lessel]

I did the daily baby aspirin until third trimester. I'm honestly not sure if it was because I was AMA or I had an early miscarriage in the few months preceding getting pregnant with DS2...or maybe both. I also had a scheduled c/s with DS2. (DS1 was failed induction and c/s at 41w and change.)

[sunflower17]

My first pregnancy I was 35 and delivered at 36 and now I’m 37 and will deliver when I’m 38. Cell free dna among other genetics were offered. So last time they made me do the glucose test twice and I passed both times, I had ultrasounds with high risk MFM and they went overboard if you ask me. My US were always perfect and they kept “checking for growth because AMA”. At the end I actually refused a few weekly ultrasounds because it got really expensive (my insurance stinks). My BP crept up at the end and I was put on meds at 36 weeks and induced at 38 weeks.

This time around (I’m 18 weeks)I did the cell free dna etc. They told me to do the baby aspirin to prevent pre-eclampsia since last time my BP elevated at the end. I’m assuming they’ll do all the other crap too.

[boiler717]

I took baby aspirin for pre-e prevention and I did not develop it. I was glad I did.
In your situation I would personally advocate for induction at 39w.

[sparty04]

I just turned 37 a few weeks ago and will be induced next week (at 39+4). I’ve been monitored by a high risk dr for a blood issue that is unrelated to my age (many ultrasounds & bloodwork), but other than doing the nipt bloodwork and my dr not wanting me to go over 40 weeks, I haven’t done anything differently than my other pregnancies. No aspirin or any other meds out of the ordinary.

[gastro]

I had my third at AMA (at 38). The OB at the get go was pushing for a 39week induction. This was due to AMA but also my second was 10lbs + and had shoulder dystocia and fractured collarbone. When I got diagnosed with GD it was clear I would be delivering at 39 weeks by induction. Of course things did not go to plan and baby came early at 36 weeks (induction due to decelerating heartbeat at stress test).

Free genetic testing and stress tests towards the end of pregnancy which I did not have with my other two. No aspirin - I doubt they would suggest it unless you have pre eclampsia before?

Edit: way more scans too...

[doglove]

I have no baseline since this is my first (and only) but I am 38 and have had the cell free testing and also my level 2 ultrasound at a MFM. No other differences that I can tell so far. I am 21 weeks along.

[osulori]

Things that were different with baby #2 (38) vs baby #1 (32):

-growth scan around 29 weeks due to higher risk for placental insufficiency
-weekly NSTs starting at 37 weeks
-induction in 39th week due to aforementioned risk of placenta issues

The last two ended up being moot points-I ended up with gestational hypertension and weekly NSTs starting around 34 weeks, with induction at 37 weeks. We would have induced at 39w5d otherwise.