Pregnant at 44, Alanis Morissette Finds Risks, Rewards That Come With Age

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 there’s another side to motherhood after 35 that we hear about less often: the benefits.

“Women who have children at a later age tend to begin pregnancy with several important advantages,” says Rachel Humphrey, MD, medical director of the AdventHealth for Women Maternal-Fetal Medicine Program.

First, they often have a more stable home and career. Morissette has been married to Mario “Souleye” Treadway since 2010 and has been working on a new album. These moms-to-be are also often driven to take advantage of every health resource and screening they can.

“In general, I find that women over the age of 35 are incredibly focused on doing everything they can to stay healthy,” said Dr. Humphrey, whose practice specializes in treating women with high-risk pregnancies. “These women take our recommendations to heart.”

A pregnancy after 35 is sometimes called “high risk,” 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,” Dr. Humphrey says.

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.

Dr. Humphrey said these trends are reflected in her practice, which tends to include at least one patient in her 50s at any given time. 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.

Dr. Humphrey said mothers should be made aware of the increased risk of complications that come with pregnancy at advanced maternal age, which starts at age 35 and above.

Otherwise, interestingly, these women have less stress than younger moms because they're often in a better spot in their life to handle pregnancy, she said. Women who give birth after 35 are in good company.

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,” Dr. Humphrey says. 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,” Dr. Humphrey says. 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

Dr. Humphrey says some of her patients at any age don't know they're pregnant for some time after conception. But moms who are a little more experienced seem to be more in tune with their bodies, she says.

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, Dr. Humphrey draws an analogy between 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 Dr. Humphrey said most women's results are normal and they end up being reassuring tests.

As with all pregnancies, Dr. Humphrey advises women over 35 to 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.

When it comes time to decide where to give birth, Dr. Humphrey says a hospital with a Level 3 neonatal intensive care unit, or NICU, like AdventHealth for Children, is the best choice for many women of advanced maternal age. Depending on the mother’s individual case, it may be helpful to establish a relationship with specialists, like a pediatric cardiologist.

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 are normal.

Dr. Humphrey sometimes compares pregnancy with a trip down Florida’s Interstate 4, sometimes named among the most dangerous highways in the country.

“But most people on I-4 make it from point A to point B and are fine,” Dr. Humphrey notes. “Potential issues can sound scary, but the majority of women go through a normal pregnancy and I try to emphasize that with patients.”

AdventHealth for Women has specialists, physicians and nurses who create a nurturing and patient-centered environment you, regardless of your age.

When combined with 24-7 availability of a delivery team and AdventHealth for Children's Level III NICU to provide the highest level of care for our tiniest patients, there’s no more comfortable choice for a pregnant mom.

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. Please visit AdventHealth for Women or call Call407-303-4HER to make an appointment or to speak with one of our specialists about your next steps on the path to motherhood.