BRITAIN: Older mothers 100 times more at risk, says expert

EDINBURGH (THE SCOTSMAN), June 22, 2005: FERTILITY passes through three distinct stages during a woman's lifetime, according to a leading scientist who has warned of the dangers of pregnancy later in life. Professor Michael de Swiet, of Queen Charlotte's Hospital, London, said that the "ideal age" to have a baby was between 20 and 30, and delaying that could lead to a 100-fold increase in the risk of fatal blood clots. At about 35, women moved on to the "safe enough" stage, in which they should be aware of the increasing chances of miscarriage, of the child being handicapped - and of their own death. After 45, Prof de Swiet said, women entered a stage where only the "wealthy and healthy" should try for a child. He also warned that older mothers suffered from the "misery factor" as their bodies struggled to cope with carrying a child. While celebrities Geena Davis, Courteney Cox and Elle Macpherson have all joined the ranks of older mothers, Prof de Swiet warned of the "significant dangers" of conceiving "late". A woman over 35 who already had more than one child had nearly a hundred-fold increased risk of dying from a blood clot in her lung compared to the risk to a first-time mother aged 20. A woman over 40 in Britain had the same mortality risk as an expectant mother in eastern Europe - about three times as high as the European average. And by the time women reached the age of 42, more than half of all pregnancies resulted in the loss of the baby, while more than a third of pregnant women over 50 suffered from high blood pressure, Prof de Swiet said. However, midwives and infertility experts dismissed his remarks, saying health was more important than age. One said it was "ridiculous" to tell women to have children before they reached their thirties. Prof de Swiet, who spoke at yesterday's annual meeting of the European Society of Human Reproduction and Embryology in Copenhagen, told The Scotsman: "The ideal age would be something like 25 to 30, maybe even 20 to 30. "If a woman is aged over 40, her mortality risk is about 30 per 100,000. No country in western Europe has an average mortality near that. In most countries, it is about ten or less per 100,000. "If you are going to be 40 and have a baby, you have got to accept a mortality that would be the average in Russia or other eastern European countries. "Women need to be better informed. I'm not really saying that I think women shouldn't have babies over the age of 40. I just think they ought to be aware of the risks. I don't want to play God. It's for people to decide, but they should decide with adequate information." Prof de Swiet said there was an increased risk that older pregnant women would develop high blood pressure "for which the only cure is delivery", meaning babies being born ahead of term. "Everybody knows a baby can survive at 25 weeks [in the womb], but they have an increased risk of being handicapped," he said. During pregnancy, older mothers were prone to what Prof de Swiet called the "misery factor". "I am impressed by how tired and ill older mothers become, suffering from extreme breathlessness, postural hypotension [low blood pressure], syncope [fainting] and palpitations caused by nothing other than pregnancy," he said. However, Mervi Jokinen, the practice and standards development officer for the Royal College of Midwives, said that while age was a factor, there were other considerations. She would never advise a woman not to have a child purely on the grounds of age up to about 48 or 50. "The trend for women is to have children later than they did 25 years ago, but women are now in much better health later in life," Ms Jokinen said. "Somebody who is 45 isn't by nature going to be as fertile as a 20-year-old, but we would definitely discuss it [getting pregnant] with her and do a health assessment. "I would be quite happy with it. I've seen women who thought they were menopausal and hadn't realised they were pregnant. And they have had a perfectly normal pregnancy." Sheena Young, Scottish organiser of Infertility Network UK, agreed that delaying pregnancy meant taking a risk with the natural decline in fertility. "You need to make it clear to people that their fertility is precious and they should not assume they can start trying for a family after 35 and it will all just happen," she said. "But I think it is ridiculous to say to people they should have their children in their twenties." Genetic Key To Pregnancy After 45 A LUCKY set of genes may allow a small percentage of women to get pregnant naturally after the age of 45, scientists said yesterday. Most women are infertile by this time in their lives because of the effects of ageing on their ovaries. But a new study suggests that a few may possess a particular set of genes that keeps their ovaries young. The discovery raises the prospect of a genetic test that could tell a woman if she should risk delaying motherhood. Doctors have been unable to explain cases of women conceiving even in their late forties. One example is Cherie Blair, who gave birth at the age of 45 in May 2000. Two years on she was pregnant again, but miscarried. An Israeli team, led by Dr Neri Laufer, from Haddassah University Hospital in Jerusalem, identified 250 women who had become pregnant naturally after their 45th birthday. Blood samples were taken from eight of these women and used for genetic tests. Their results were compared with those from six other women who had stopped having children at 30. Dr Laufer found that the "super-fertile" women had a unique pattern of gene activity that was not shared by the other group. His team narrowed the search down to less than 50 genes involved in two key processes linked to ovary ageing. One was DNA repair, and the other programmed cell death, or apoptosis - a natural waste disposal system that clears the body of damaged and potentially dangerous cells. "These women appear to differ from the normal population due to a unique genetic predisposition that protects them from the DNA damage and cellular ageing that helps age the ovary," said Dr Laufer, presenting his findings yesterday at the annual meeting of the European Society of Human Reproduction and Embryology in Copenhagen. The women were all Ashkenazi Jews, a sect known for their belief that every new born baby is a blessing. The Ashkenazis discourage the use of contraceptives and often have large numbers of children. But Dr Laufer does not think the super-fertile gene profile is unique to this group. Preliminary findings from a follow-up study of Bedouins, a desert-dwelling Arab people, indicate that they too have women with the late-pregnancy genes. By Ian Johnston Science Correspondent http://news.scotsman.com/