Alanis Morissette's Announcement - Understanding High Risk Pregnancy

Pregnant with her third child at age 44, Canadian singer Alanis Morissette may have heard about some of the risks that come with having a baby a bit later in life. But women often choose to wait for good reasons, and we hear less often about the benefits of motherhood after 35.

Women who have children at a later age may begin pregnancy with a more stable home and career. Morissette has been married to Mario “Souleye” Treadway since 2010 and has been working on a new album.

A pregnancy after 35 is sometimes called “high risk.” This means the mother has a higher chance of illnesses and the baby a higher risk of birth defects. But it’s important to put the facts in context.

The most likely outcome of a pregnancy for a woman in her 40s, once you get past the first several weeks, is normal.

Morissette, who turns 45 in June, announced her pregnancy with an understated black and white photo on Instagram of her singing — with a baby bump visible in profile. Her caption, “so much NEWness…,” could have also hinted at new music to come.

Forty-something pregnancies are no longer particularly unusual. In 2016, for the first time, women giving birth in their 30s outnumbered women who gave birth in their 20s. And birth rates have gone up the fastest for women over 40, rising 19 percent since 2007.

While it’s understandable for women who wait to have kids to feel nervous about pregnancy, the odds are on their side.

Morissette and her husband had a surprise pregnancy that ended with the birth of their first child, Ever, in 2010, when she was 36. They had a second child, Onyx, in 2016.

Other such celebrities include Janet Jackson, who became pregnant with her first child at 49 and Gwen Stefani, who gave birth to her third child at age 44.

Getting pregnant later makes getting off to a healthy start even more important.

Getting a Healthy Start

Health advice for women of advanced maternal age who are planning on having a baby is not different from advice for other women. It includes:

• Maintaining a healthy diet and body weight, perhaps with the help of a nutritionist
• Staying active with an exercise routine
• Avoiding radiation exposure and certain infections, like the Zika virus
• Assembling a health care and wellness team, perhaps including a nurse midwife and/or a doula
• Understanding your health insurance benefits, if applicable

A mother’s health choices during pregnancy can not only lead to a healthier baby, but they can also affect that baby's health as an adult.

Moms who are vitamin D deficient during pregnancy are more likely to have babies with asthma. There are even studies to show that a mother who exercises and has a healthy diet may help her baby stay healthier as an adult.

Mothers over 35 are generally advised to start on low-dose aspirin to help prevent pre-eclampsia, a potentially dangerous condition involving high blood pressure.

Some moms may find all of this advice overwhelming. In a 2016 advice column answering a question from a stressed-out pregnant mom, Morissette wrote that asking for help can reduce burnout.

“Ask for help: even if it is just someone coming to watch your children for an hour while you shower (luxury!) or eat something nutritious,” she wrote.

Finding the Due Date

In either case, the earlier the ultrasound (12 to 14 weeks is ideal) the more accurate the due date will be. An ultrasound made at 20 weeks is still reasonably accurate, but as the pregnancy progresses the due date is harder to estimate.

To explain why earlier ultrasounds are more accurate, imagine you’re guessing the age of a newborn and a five-year-old child. It’s a lot easier to guess for a newborn, of course, because not all kids grow at the same rate, and a five-year-old could be large or small for their age. It’s the same for babies in the womb, as they tend to develop at the same predictable speed at first, but can grow faster or slower than normal later on in a pregnancy.

There are a handful of other tests that are advised for some or all women of advanced maternal age, including:

• Noninvasive Prenatal Testing, or NIPT, a blood test to screen for potential genetic disorders that is accurate as early as 10 weeks
• Gestational Diabetes Test, which screens for a health condition that can affect mother and child and is usually given about 25 weeks into a pregnancy
• Fetal Non-Stress Test, or NST, a test to monitor the baby's heart health that's called non-stress because it places no stress on the baby. It’s typically conducted later in a pregnancy, often after the 28th week.

These tests can be anxiety-provoking, but most women's results are normal and they end up being reassuring tests.

As with all pregnancies, women over 35 should generally attempt a vaginal birth rather than a C-section. Their risk of needing a C-section is only slightly higher than it is for younger moms.

Talking About Risk

There are two ways to think about the increased risk that comes from giving birth at a later age. The first is to compare the risks at an older age with those at a younger age.

Though many of these risks, like developing genetic disorders, are several times higher at an older age, that doesn’t mean they’re inevitable. It’s important to consider these risks and to look at their likelihood of occurring, rather than comparing them to other pregnancies to understand the bigger picture.

For example, a woman at age 30 has a 1 in 1,000 chance of delivering a baby with Down syndrome. At age 40, a woman has a 1 in 85 chance, but that still means that 84 out of 85 births were normal.

We believe in the whole health and well-being of you and your baby from conception to birth and beyond and are committed to providing you with the best care available. AdventHealth’s goal is to be with parents at every step, from the first trimester through delivery.

To make an appointment or learn more about the places and people who create a nurturing and patient-centered environment, regardless of your age, visit our website.