I was about to toss out an old medical journal dated April 2012 until I noted one of the articles discussed the risk of stillbirth and maternal age. Dr. Joanne Stone, a high-risk maternal fetal medicine specialist and a member of the Society for Maternal-Fetal Medicine, wrote an article entitled Advanced Maternal Age and the Risk of Antepartum Stillbirth that I think would be helpful to my readers.
Pregnant women over the age of 35 are classified as women with Advanced Maternal Age (AMA) and even without having complications such as high blood pressure, diabetes or other risk factors, are at risk for having stillbirths which is defined as a fetal death after 20 weeks. The average stillbirth rate for pregnant women in the U.S. is 6.2 fetal deaths for every 1,000 pregnant women. However for pregnant women who are ages 35 to 39, the rate increases to 11 to 14 stillbirths and for women 40 and over the number increases even greater to 11 to 21 stillbirths. A significant number of stillbirths occur after 38 weeks begging the question: should women over 35 be automatically induced after 38 weeks?
Labor induction is frequently a source of controversy because the possibility of delivering the baby too soon and an increased risk of a cesarean section. However, it’s a well-known fact that if the conditions in the uterus no longer support the baby’s development or places the baby in harm’s way, delivering the baby is the only solution because the support it can receive in a specialized nursery surpasses the support or lack thereof that it would receive inside its mother’s womb.
So, how do clinicians address the problem? By performing Nonstress tests to document fetal well being. Although it is not a mandated standard of care, based on Stone’s article, women 35 and over should strongly consider receiving a Nonstress test after 37 weeks, especially if it’s their first pregnancy or over age 40. Stone discussed several studies that recommended 38.5 to 39.6 weeks as the best time for AMA women to be delivered. Therefore, pregnant women over 35, especially first-time moms should have a discussion with their clinicians to discuss this matter further.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.