Baby panic: why are the risks not being told as they are?
I am a healthy 37 year old woman, in a stable relationship and only beginning to discuss starting a family with my partner, with no firm decision made either way. Should I panic at my forthcoming February birthday hastening me towards 40? Should I start to swallow folic acid with growing anxiety? Well, reading many newspapers over recent years, I should be planning my family with great haste or be deemed irresponsible, career-hungry and selfish. (Incidentally, nobody seems to have anything to say about my similar-aged, professional male partner.)
England’s Chief Medical Officer (CMO) Prof Dame Sally Davies recently spoke at a debate, offering remarks about the ‘shift to have children later’ (you can read the Guardian’s report on this, on 17/1/14, here). Women are repeatedly told that they are at a higher chance of facing these problems if they try to conceive over the age of 35 years. Any women who has ever picked up a newspaper or women’s magazine in recent years won’t fail to have noticed the often cited figure of 1 in 3 women over the age of 35 years will fail to conceive within one year. Is this true?
The research, from where this reportedly originated, is a 2004 paper published in Human Reproduction. The author, Leridon, concluded that 66% of women starting to try to conceive at age 35 years will have a conception ending in a live birth within 1 year. In other words, 1 in 3 will not have conceived. Louis Henry originally gathered the data used in that study, which was collected on the French population between 1670 and 1830, based on parish registers. So, this figure was obtained from birth records from 1700’s France. As others have noted (including David James, Clinical Co-Director of Women’s Health, in a BBC radio 4 programme), an issue with this approach is that it includes women not trying to conceive and/or not having sex. These data were also collected at a time when life expectancy was not comparable to contemporary Western societies, and had no modern antibiotics or healthcare.
The Daily Mail wrote that Prof Twenge ‘controversially claimed’ that the chances of conceiving in one’s late 30s was not that different to one’s early thirties. Prof Twenge looked to research on modern populations, which excluded those with diagnosed fertility problems (for example, endometriosis). Dunson and colleagues found 86% of women aged 27-34 years conceived within 12 months compared with 82% of women aged 35-39 years. This is not a significant difference, and it showed fewer than 1 in 5 women in their late thirties were not pregnant within one year, which is not 1 in 3. These newer data are now reported in guidance on fertility by the National Institute for Health and Care Excellence (NICE). Perhaps the Daily Mail might refer to NICE as controversial?
I resent science being misrepresented in the media, particularly over very personal issues affecting the everyday realities of ones life. Getting science reporting wrong about the Mars Rover, for example, is all kinds of annoying, frustrating and limiting to the public’s understanding of such wonderful scientific achievements. However, getting the science wrong over health-related issues can raise anxieties in people over short and longer terms. There should be an ethical duty to report accurate science, given the potential harms poor reporting can cause.
Fertility specialist, Lord Robert Winston, has spoken about the risks, but suggested they are not ‘major risks’. He also, rather importantly, points to advantages of having a baby later, including being more likely to be in an established relationship, be more secure and be healthy (given improvements in population health).
We are happy to consider evidence as part of the background of our huge decision, but we need access to accurate, non-judgmental, non-gender biased and up-to-date evidence.
To learn more, visit the NICE website for guidance on fertility.
researchtheheadlines.org 
Karen, its no big deal to have a baby in late thirties..I had my daughter when I was 32. But the problem is that older you are, harder your body takes the hit. It takes more time to recuperate. I am still reeling under the after-effects of pregnancy and it’s been like more than 2 years. I have seen my younger female friends who had their child under 30 and they took less time to recuperate. Hence, the advice that have a child early.
Karen quotes “Prof Twenge looked to research on modern populations, which excluded those with diagnosed fertility problems”. Of course, if you exclude couples with infertility, then the fertility rate of those remaining will be higher than in couples with diagnosed infertility. What is needed to interpret those data are the rates at which infertility is diagnosed. This is likely to be higher at older ages. Menken J, Trussell J, Larsen U. in Science. 1986 Sep 26;233(4771):1389-94. said “Direct evidence on age patterns of infecundity and sterility cannot be obtained from contemporary populations because such large fractions of couples use contraception or have been sterilized.” and “results imply that a woman in a monogamous union faces only moderate increases in the probability of becoming sterile (or infecund) until her late thirties.” But this is not the same as no rise in infertlity, and over the age of 40, the increase is much greater.
Another important point is highlighted by Nybo Andersen et al BMJ. 2000 Jun 24;320(7251):1708-12. They point out that “At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age.”
It is not just a question of getting pregnant, but of having a healthy pregnancy and baby.
As an obstetrician, I know that physiologically women in their 20s tolerate childbirth and child rearing physically more easily than those in their 40s. But I don’t think women who delay childbearing are selfish, arguably every parent is selfish because we don’t have metaphysical evidence of children queuing up waiting to be born. We have children because we want them, not because the child wants to be born. If a woman because of her personal circumstances doesn’t wish to conceive until later in life, then I think it is only reasonable that she be informed that (a) she may not be able to conceive (and of course this applies to some extent at every age, but when you are younger you have longer to try and to get treatment if needed) and that (b) she can improve her chances of a good outcome by attention to optimising weight, blood pressure, diet (including folic acid) etc.
Of course, Karen should not panic. But if concern about having a healthy pregnancy at an older age encourages her to make herself as healthy as possible, then this surely is a good thing.
The article attempted to focus on one very particular issue: the misuse of the false and simplistic ‘1 in 3 over the age of 35….’
The comments by the above individuals point to either anecdotal evidence (which is not in keeping with the spirit of this blog site) or to research relating to a different issue. However, thanks to Philip for pointing to an evidence-base on wider concerns. Perhaps this could be the focus of another blog post from us in the future.
There is an excellent article called “Does maternal age affect pregnancy outcome?” which has just come out in this month’s BJOG (Cohen WR BJOG 121:252-254). Well worth reading and relevant to many of the issues raised by Karen.