Study confirms risk of late pregnancy

Gestational diabetes and higher birth weights are among the hazards for women over age 35.

ABU DHABI // The risk of complications from a late pregnancy should not dissuade women from trying to conceive, a leading gynaecologist has said.

Instead, it should motivate them to take preventive measures, said Dr Hind Al Shami, a gynaecologist at the Women's Health Institute at Al Ain Hospital and an author of a new study on the issue.

The research confirmed that women over 35 in the UAE are more likely than their younger counterparts to develop gestational diabetes and have heavier babies, as is the case worldwide. It coincides with a trend towards later marriage and motherhood, and a higher-than-average incidence of diabetes in the wider Emirati population.

Dr Al Shami said weekly pre-natal checkups were even more important in late pregnancies.

"This study gives us a deeper understanding of the situation in our country," she said. "It shouldn't discourage mothers from getting pregnant; on the contrary, it should encourage us to take the necessary precautions as doctors and patients."

The study looked at 888 women who delivered children between April and September 2009.

Women between the ages of 20 and 34 made up about three-quarters of the study, and women over 35 comprised the remaining quarter. A third of those surveyed were Emirati.

The study was carried out by the women's health department at Al Ain Hospital in collaboration with the faculty of medicine and health sciences at United Arab Emirates University, and the results were announced at the 3rd annual Seha research conference last week.

It found that 13 per cent of women in the younger age group developed gestational diabetes, compared with 29 per cent of women in the older age group. The average incidence among all mothers was 17 per cent, compared with between 2 and 10 per cent in the United States.

Dr Al Shami attributed the high rates to the general prevalence of diabetes in the country, affecting nearly 20 per cent of residents.

"Our sedentary lifestyles, including lack of exercise and the food we eat, play a role in all of this," she said. "And as a woman gets older, she is more likely to develop the disease. This is especially true if she has a history of diabetes in her family."

The study also found that later pregnancies were more likely to result in heavier babies. Almost one in every 19 women in the older age group delivered a baby weighing more than 4 kilograms, compared with one in every 58 in the younger group. This is usually a reflection of the mother's gestational diabetes in the child, Dr Al Shami said.

High levels of blood sugar in the mother can lead to high amounts of glucose in the child's blood stream. The baby's pancreas must then produce more insulin to process the excess glucose. As a result of all the high levels of blood sugar and insulin, the baby can put on extra weight. The child's excess weight is one of the complications that may then require specific delivery procedures, such as a Caesarean section.

This was also evident in the study, which showed that 26 per cent of women in the older age group had to deliver by C-section, compared with 18 per cent of their younger counterparts.

In addition, the chances of chromosomal abnormalities increase significantly after a woman is 37, said Dr Saad Ghazal Al Aswad, senior consultant at the department of obstetrics and gynaecology at Tawam Hospital. This could lead to genetic disorders such as Down syndrome.

"Chromosomes are more likely to stick together and do not separate as easily at a later age," he said. "This is particularly true here in the UAE, where there are many consanguineous marriages, and therefore genetic similarities, between couples."

Another potential complication of late-in-life pregnancies is a hole in the child's neural tube that connects the brain to the spinal cord, Dr Al Aswad said. "Neural fluid leaks from the tube, leading to developmental problems in children," he said. "This is known to happen as women start approaching their forties." He said folic acid should be given to pregnant women to prevent such defects,

Dr Al Shami estimated that late pregnancies account for nearly a third of all deliveries at the hospital, compared with just one out of 10 pregnancies two decades ago.

"Women have shifted their priorities. They want to finish their education and establish their careers before they think about having children," she said. "However parents among the local community still encourage their daughters to marry early."

Dr Soaad Al Oraimi, a professor of gender and development at United Arab Emirates University, said most Emirati parents still oppose the idea of late marriage and pregnancy. However, the younger generation has become obstinate.

"Personally, I would prefer that a woman completes her studies and finds a stable job before starting a family," she said. "But it could be years before this happens, and if all women do this it could pose a danger to the country."

According to the most recent figures from the World Health Organisation, the country's birth rate fell from 4.4 children per family in 1990 to 1.9 in 2009. The birth rate for Emirati women in the capital is higher than the countrywide level, at 3.36 children per family. This compares with 1.62 for expatriates in Abu Dhabi.

Studies have shown that the higher the level of education, the fewer children a woman is likely to have, Dr Al Oraimi said.

And in the UAE, where three times as many women as men pursue higher education and only 17 per cent of the population are Emirati, delayed pregnancy can pose a risk to the country's population.

"The more a woman delays her pregnancy, the more difficult it will be for her to conceive," Dr Al Oraimi said. "And in this manner, fertility rate is linked to birth rate. There should be an educational component in the school curriculum that educates young women about the population and how to balance their lives between career and family."

Women do not have to compromise career and education for family, she said. In order for this to happen, however, women will need flexible governmental and institutional support.