Althought your pregnancy won’t be considered high risk just because you are over 35, your age does mean that you might be more likely to have or to develop a problem that results in extra monitoring, tests or treatment. Some conditions develop during your pregnancy, others conditions, such as high blood pressure, make your pregnancy high risk from the start.

Gestational Diabetes

Gestational diabetes is a disorder of sugar (glucose) regulation that occurs specifically in pregnancy. It means that your body’s ability to regulate your sugar levels is not up to the strain of pregnancy.

Normally, sugar levels are regulated by a balance between two hormones insulin (produced in your pancreas) and glucagon (made by your liver). Insulin is released when your blood sugar levels rise after eating, allowing your body to remove excess sugar from your bloodstream. Glucagon is released when your blood sugar levels are low, triggering a rise in your blood sugar levels.

Diabetes And Labor

Women with gestational diabetes requiring treatment are at increased risk of having a large baby the risk depends partly on how well blood sugars are controlled during your pregnancy. If you have diabetes, your doctor will usually estimate your baby’s birth weight before you go into labor, either by feeling your baby through the uterus or using ultrasound. If your baby is normal size, your physician may induce labor at 39 weeks because of the increased risk of fetal complications in prolonged pregnancy in women with diabetes. During labor you will need to have an IV and your blood sugars will be carefully monitored every hour or two. If your baby weighs more than 9-9½1b (4 to 4.5kg) there is a risk that the shoulders may get stuck (known as shoulder dystocia), which increases the chance of a birth injury or other serious complications. Your physician will talk to you about this risk and may offer you a cesarean delivery.

Type Of Diabetes

In gestational diabetes, your body either fails to produce enough insulin to cope with the strain of pregnancy or your body’s cells are resistant to insulin’s action. This is similar to type 2 diabetes (sometimes called adult onset diabetes). Type 1 diabetes, which usually begins in childhood or adolescence is different in that the pancreas doesn’t make any insulin. During pregnancy, your placenta produces a hormone called human placental lactogen (HPL), which makes your blood sugar levels rise. As a result of this, your body has to produce more insulin to maintain normal sugar levels. Gestational diabetes will disappear after your pregnancy is over, but you are much more likely to develop type 2 diabetes later.

How Is It Diagnosed?

Gestational diabetes is initially detected in the third trimester of pregnancy by a one-hour glucose test a screening test to identify women at a higher risk of sugar problems. Women who are found to be at risk then haw diagnostic test called a glucose tolerance test to determine whether or not they have gestational diabetes. This test is very similar to the one-hour test, but you have to get your blood drawn four times instead of just once. Blood glucose levels are checked when you haven’t eaten anything (fasting), then 1, 2, and 3 hours after you drink a second sugar drink. If your blood sugar levels are high after your 3 hour glucose test, it means your body was not able to handle a sugar load and you have gestational diabetes. Different care providers may use slightly different sets of criteria to diagnose gestational diabetes based on your blood test. Some doctors may consider a particular glucose tolerance test result borderline, while others will want to monitor and treat you actively.

Cervical Insufficiency

This is an uncommon condition, sometimes known as cervical incompetence, where the cervix opens (dilates) without you having contractions. Cervical insufficiency can be a cause of miscarriage in the second trimester. If you have miscarried in the second trimester in the past .with out having painful contractions your care provider may recommend you have a cerclage in this pregnancy. A cerclage is a stitch that is placed around the cervix to keep it tightly closed, rather like a drawstring around the neck of a balloon. An alternative to a cerclage, in some cases, is for you to be monitored with a transvaginal ultrasound weekly or every other.

How Is It Treated?

In most cases, gestational diabetes can be treated by adjusting your diet to reduce your carbohydrate in take. Your care provider may suggest you see a nutritionist, who will advise you on what you can and cannot eat. You are likely to be told to eat unrefined, complex carbohydrales such as wholemeal bread, rice and pasta and to avoid cakes, sodas, and sweets. Your care provider will monitor your blood sugar on your new diet. Your blood sugar may have to be tested up to four times a day at home, and you will be expected to do this testing yourself using a simple, handheld glucose monitor. If your blood sugars remain high, you will need to have insulin injections (twice a day injection) or possibly a glucose-lowering pill.

Future Risk Of Diabetes

If you develop gestational diabetes during your pregnancy you are more likely to develop type 2 diabetes later in life. You should be tested for diabetes with a blood test (after another glucose drink) 6 weeks after your pregnancy, and then at regular intervals after that. week. A small ultrasound probe is inserted in the vagina and the cervix is imaged on a screen.

If your cervix shows signs of opening up, your care provider may recommend you have a cerclage at that point. Sometimes changes in your cervix are noted during a routine, second trimester ultrasound. In this case, if you’ve not had a miscarriage before, it is controversial whether placing a cerclage is helpful. Your care provider will review the risks and benefits with you or refer you to a specialist for consultation.

Certain conditions put your pregnancy at risk, but these are not common and are not necessarily a reflection of your age. Many of these can’t be avoided, but you can learn how to cope with them.

Influence Of Age

As you enter in to the late second and third trimesters of pregnancy, your age will playa factor in your pregnancy in a few key areas, placing you at (slightly) higher risk of complications. The three most common age related complications in later pregnancy are preeclampsia (toxemia), gestational diabetes, and multiple gestations (twins or triplets). Some pregnancy complications are less likely to be related to your age for example, preterm labor and cervical incompetence or insufficiency (in ,which the cervix opens too early.)

Reducing Risk

In general, there is not much you can do during your pregnancy to reduce the rate of these problems. Your risk of preeclampsia, which :s characterized by blood pressure and kidney problems, is closely related to your blood pressure at conception. The lower your blood pressure prior to pregnancy and early in your pregnancy, the less chance that you will develop this condition. Gestational diabetes tends to run in families.

Both high blood pressure and gestational diabetes are more common in women whose weight is higher than their ideal body weight at conception, the risks increase as this baseline weight increases. Maintaining a healthy weight before you conceive will greatly reduce your chances of pregnancy complications, but not eliminate them completely. Multiple pregnancies are also more common in older women, in part because of the increased use of assisted reproductive technologies. Women carrying twins and triplets are more likely to develop both preeclampsia and gestational diabetes. They are also more likely to go into labor early. While this list of possible problems sounds daunting, it is important to realize that most older women will not develop all, or even any, of them.

About 1 in 10 pregnancies result in preterm labor, where the baby is born more than 3 weeks before the due date. The chances of your baby being born prematurely are greater if you’ve had a premature baby before or if you are having twins or triplets. Factors such as a higher soeioeeonornic status, access to good dental care (which prevents gum disease that causes inflammation), and being a non smoker mean you are less likely to deliver too early.

Effect Of Age

Being over the age of 35 only slightly increases your risk of going in to labor too soon. In some cases, this is because there’s a medical reason for inducing you early for example, if you have preeclampsia. Women over 35 are also slightly more likely than younger women to have a condition that increases

the risk of preterm labor. Fibroids (growths in the uterus) are more common in older women, and women with large fibroids may go in to labor early simply because of the size of the fibroid. Women over 35 are also more likely to be having twins, triplets or more, either because of assisted reproductive technology or naturally, and this automatically places the woman at greater chance of preterm labor.

Preventing Preterm Delivery

If you have had a premature baby in the past, there is some evidence that having weekly progesterone shots will decrease your chances of another preterm delivery. However, these injections are not recommended unless the risk of preterm labor is high. It is not clear whether progesterone is helpful in women with multiple gestation or fibroids.

Recognizing Labor

If you notice repetitive tightening of your uterus more frequently than every 15 minutes, you should call your care provider immediately. If you are found to be in labor and you are less than 34 weeks pregnant, your doctor will usually treat you with medication to stop the labor (called tocolytic drugs) and with steroids to reduce your baby’s chances of problems if he or she is born prematurely.

Treatment

Steroid treatment is most effective for your baby 48 hours after your initial treatment, so the first goal of treating preterm labor is to keel you pregnant for the first 2 days. You will be placed on bedrest am: given tocolytic drugs. All of these drugs can have side effects, so unless you continue to have contractions, your doctor will usually stop your treatment after the first 48 hours.

Monitoring

After your initial treatment, your physician may continue to monitor you in the hospital or may send you home, depending on how much your cervix has dilated.

Fibronectin Test

Some doctors may use a test called fetal fibronectin to help determine whether your contractions are a serious cause for concern. A negative test result means your chances of delivering in the next few weeks are low (1-5 percent), and your doctor may then feel comfortable sending you home. A positive test means that your risks are higher, but it is still not certain :hat you will deliver immediately. If you have frequent preterm contractions your doctor may give you terbutiline pills to reduce your symptoms, although this treatment will not reduce the chance that you will deliver preterm.

Risks To You

If you do deliver preterm, the potential risk to you is low. You are more likely to have a cesarean delivery, because preterm babies often lie in a breech or transverse (sideways) position. You are also more likely to have a uterine infection, since infection is one cause of preterm labor.

Risks To Your Baby

In contrast, preterm delivery can be serious for your baby, depending on how early he or she is born. After 34 weeks of gestation, the baby is at low risk of complications due to prematurely. If you go in to labor after this time, steroids and medications to stop contractions are generally not given and delivery is allowed to go ahead.

Less than 28 weeks

Before 28 weeks of gestation, there are serious risks for the baby. One of the main problems is that the baby’s lungs will not be fully mature and this can lead to breathing problems. Other risks include infection, bleeding from tiny blood vessels in the brain, and hearing problems.

Between 28 and 34 weeks

The chances of long-term complications are substantially less after 28 weeks of gestation. However, babies born between 28 and 34 weeks will still need to be admitted to the neonatal intensive care unit (NICU) and may still have breathing problems or other complications.

Placenta Previa

This term means that your placenta is covering the baby’s exit path the cervix. Placenta previa is often found early in pregnancy at ultrasound but resolves on its own in 95 percent of cases by the third trimester. However, if your placenta remains in this position in to the third trimester you will need to have a cesarean delivery to prevent serious bleeding. Until your placenta previa goes away your care provider may want you to avoid placing anything in your vagina, which precludes having sex.

Preeclampsia

This condition, also sometimes called toxemia, is a potentially serious form of high blood pressure. Women with mild forms of preeclampsia have blood pressures that begin to rise in the last few weeks of pregnancy. But unlike a simple rise in blood pressure, preeclampsia also affects other organs in your body, such as your kidneys and your placenta. Women with preeclampsia have extra protein in their urine, which can be detected by urine tests. No one knows what causes this condition to develop. There is no cure except for having your baby.

Symptoms

Warning signs of preeclampsia in the third trimester include headache and swelling of the hands and face. If you notice unusual swelling or if you develop a headache that is not relieved by acetaminophen, see your care provider for a blood pressure check.

Treatment

If you develop preeclampsia close to your due date, your care provider will probably recommend immediate delivery. If you develop preeclampsia while your baby is premature, your care provider may place you on bed rest in the hospital, to give your baby time to mature. You will be monitored for signs of worsening preeclampsia with frequent blood tests and blood pressure monitoring. Bed rest will lower your blood pressure and help your baby grow as much as possible. Sometimes the condition becomes severe, blood pressure rises uncontrollably, blood tests may become abnormal, kidney function may be affected, and in some cases seizures (eclampsia) may occur. In such cases, immediate delivery is almost always recommended. Since preeclampsia affects the placenta. some babies will not grow as well as they should and may not be able to tolerate labor. For this reason the chances of a cesarean delivery are higher than usual.

Multiple Pregnancy

As women get older, it becomes more common for them to have twins or triplets (or even more). In part, this is because the ovaries of older women sometimes release more than one egg per cycle. Older women are also more likely to become pregnant with the help of assisted reproductive technology, which increases the chances of twins or triplets. Although a multiple pregnancy can be an amazing gift, there is a higher risk to both the mother and the babies in these special situations, and all multiple gestations are carefully monitored.

Testing For Abnormalities

Multiple gestation complicates testing for genetic abnormalities early in pregnancy. First or second trimester serum screening for down syndrome is considerably less accurate in twins, and cannot be used at all in triplet pregnancies. Many women decide either to forgo testing or go directly to conclusive testing by chorionic villus sampling or amniocentesis. Testing for abnormalities is further complicated if an abnormality is found in only one twin. Choices must then be made about continuing the pregnancy or attempting to reduce the pregnancy to a single baby.

Risk To The Mother

With multiple pregnancies, there is a greater risk of preeclampsia (two to three times higher than with a single pregnancy), a slightly increased risk of gestational diabetes, and a 50 percent higher rate of cesarean delivery. With triplets, the risk of gestational diabetes soars, and almost all women deliver by cesarean. Later in pregnancy, multiple gestation results in more maternal discomfort and weight gain­typically 35-451b (16kg-20.5kg).

Risks To The Babies

Multiple gestation creates several risks for the babies, the main one being preterm labor. Half of twin pregnancies will have delivered by 1 month before their original due date, although the risk of very early preterm delivery (before 28 weeks) is low approximately 4-5 percent, Triplet pregnancies are at a much greater risk of preterm labor almost all triplet pregnancies will deliver before 37 weeks and 12 percent will deliver before 28 weeks. As well as the risk of preterm delivery, twins and triplets are more likely than single babies to be growth restricted in the uterus . There is also a small chance that one may die around the time of birth. Although this risk is relatively low (less than 3 percent), most doctors will monitor the babies frequently during the third trimester by regular ultrasound scans to check growth, and nonstress testing to check the babies well being. Most doctors also recommend delivery of twin pregnancies by 38-39 weeks.

Labor

The risk of cesarean delivery increases with twins for several reasons, First, there is an increased chance that the first twin will be in a breech position (feet or bottom first). In these cases, cesarean delivery is recommended. Second, there is an increased risk of placental problems and low birth weight in one or both of the twins, decreasing the chances that they will be able to tolerate labor. However, if your first twin is in a head down position, and the twins are about the same size, you should be able to try to have a vaginal delivery. Even if your second twin is in a feet first position, a breech delivery can usually be accomplished quickly and safely because the way has already been paved by the first twin. Most hospitals have monitors that can track each twin’s heart rate separately throughout labor. For triplet pregnancies, doctors usually recommend that the babies are delivered by cesarean section.

Preterm Labor Signs

Signs of preterm labor can include any of the following. If you experience these signs, you should call your care provider at once.

• Abdominal pain that comes and goes (contractions). If your contractions are more frequent than every 15 minutes or painful, call your care provider.
• Pelvic pressure.
• A significant increase in vaginal discharge.
• New onset diarrhea.