Preparing for pregnancy later in life

Malaysian women are increasingly having their babies at a later age. This change is reflective of the changing priorities of society, which include personal aspirations, financial stability, and career advancement, as well as factors such as health considerations and second marriages. According to the latest statistics, the proportion of Malaysian women who give birth at the age of 35 and above has increased from 20.2 percent in 2017 to 23 percent in 2022. [Vital Statistics Malaysia 2018. Available at https://newss.statistics.gov.my/newss-portalx/ep/epFreeDownloadContentSearch.seam?cid=190893. Accessed on 23 January 2025, Vital Statistics Malaysia 2023. Available at https://storage.dosm.gov.my/demography/vitalstatistics_2022.pdf. Accessed on 23 January 2025]

Furthermore, this shift has also been swayed by the financial burden of child rearing. Malaysia’s estimated childcare cost, from earliest infancy to university level is approximately RM1.37 million according to the Credit Counselling and Debt Management Agency (AKPK). [https://www.akpk.org.my/estimated-cost-raising-child Accessed on 22 January 2025]. With mounting cost of parenthood and day care facilities, many women have started postponing childbearing in order to achieve better career prospects and subsequently, a more stable home and family.

Dr Gayathri Mariappa, consultant obstetrician, gynaecologist and maternal-fetal medicine specialist; and Dr Farah Leong Rahman, consultant obstetrician, gynaecologist and fertility specialist, discussed this trend and the framework needed to support delayed motherhood.

Having a healthy pregnancy necessitates lifestyle modifications and preconception care. Therefore, it is crucial to maintain a healthy lifestyle, which covers the following: adhering to a balanced diet that includes folic acid supplementation, engaging in regular exercise, and refraining from harmful behaviors such as smoking and alcohol consumption.

In addition, women who are over 40 years of age and become pregnant should undertake early and consistent screenings to identify potential risks, including preeclampsia, cervical insufficiency, gestational diabetes, and undiagnosed medical conditions such as kidney or heart disease. Fathers play an important role in pregnancy outcomes, with factors like smoking and body composition in fathers contributing significantly to both pregnancy and fetal health.           

Risk, risks, risks
Recent research has demonstrated a strong correlation between chromosomal abnormalities and the potential for congenital malformation in children born to women over the age of 40. The risks of congenital malformation continue to increase as the maternal age increases. [https://www.sciencedirect.com/science/article/abs/pii/B9780123708779000979 Accessed on 22 January]

On top of increased risk of chromosomal there is also the risk of decreased fertility because women are born with limited number of eggs and this number drops drastically as they approach menopause. Those planning motherhood later in life should receive counselling and education on age-related fertility decline. Options open to women who plan to have children later include cryopreservation of oocytes or embryos, and oocyte donation (should they lack viable oocytes). [https://www.ncbi.nlm.nih.gov/books/NBK576440/ Accessed on 22 January 2025]

Couples may also opt for assisted reproduction via in vitro fertilization. However, it is important that the men be tested for sperm quality as well, since infertility may arise from the husband.

Should all go smoothly, and an older woman becomes pregnant, it is recommended that she undergoes a non-invasive prenatal test (NIPT) or non-invasive chromosome check (NICC) to determine if the baby has any genetic abnormalities. These tests should be done early to prepare them for any medical emergency or intervention.

As more Malaysian women decide to embrace motherhood later, they can safely navigate this journey with adequate resources and support systems in place. The various treatments for infertility as well as current developments in pregnancy tests and screenings guarantee that age is not an issue in achieving a healthy pregnancy and successful motherhood.