What are the risks during the pregnancy?

Raised Blood Pressure

Roughly 1 in 10 women over the age of 40 will develop raised blood pressure in pregnancy and 1 in 50 will develop pre-eclampsia (raised blood pressure and protein in the urine). You can help reduce this risk by maintaining a healthy diet during pregnancy and partaking in 30 minutes of exercise a day (e.g. swimming, walking etc.). Your individual risk will be assessed, and you may be offered a low dose of aspirin to take throughout your pregnancy to reduce the risk of pre-eclampsia even further (roughly 15%). Every time you see a Midwife or Doctor your blood pressure will be monitored, and you should provide a urine sample to screen for protein at every antenatal visit

Diabetes in Pregnancy

Diabetes is a condition that can occur during pregnancy where the amount of sugar (glucose) in the blood stream is too high. Glucose comes from starchy foods, such as bread and rice. It complicates 2-5% of all pregnancies and is usually diagnosed in those who are overweight and/or are aged 40 years and above. You can help reduce your risk by maintaining a healthy diet during pregnancy, please ask your midwife for more details, and partaking in 30 minutes of exercise a day.

Your urine will be screened for sugar every time you attend an antenatal clinic. If you have sugar present on 2 or more occasions you will be offered a formal glucose test. You may be offered additional diagnostic testing for diabetes depending on any other risk factors present (e.g. previously affected pregnancies, weight, personal or family history, and ethnicity).

Venous Thrombosis

Thrombosis is a blood clot in a blood vessel (a vein or an artery). Venous thrombosis occurs in a vein.

Venous thrombosis is not common in pregnancy or in the first 6 weeks after the birth of your baby. However, the risk for venous thrombosis for women over 40 years, is 1 in 500. This is ten times more likely than for women who are the same age but not pregnant. Although age alone is not a reason to take medication to prevent blood clots throughout your pregnancy, your individual risk will be considered, and you may be offered injections to thin the blood before or after the birth of your baby.

Small or Big Babies

Women aged 40 years or over are at a higher risk of having smaller or lower birth weight babies. You will be offered routine additional growth scans during your pregnancy. These are normally carried out at roughly 31 and 37 weeks of pregnancy. If there are any concerns about the size of the baby, a doctor will be asked to review you.

Induction of labour

Women aged 40 years and above are recommended induction of labour at around 39 to 40 weeks gestation rather than when the pregnancy goes beyond 41 weeks. This is because recent data has shown a small increase in the risk of stillbirth (baby dying before it is born). The risk at 41 weeks gestation is 1 in 463 births for women 40 years and over, compared to 1 in 1449 births for women under 35 years old. It is important to remember the risk of a stillbirth is very low.

At the Whittington Hospital you will be referred to see your Obstetrician at around 16 weeks to discuss the recommendations and your wishes. If your pregnancy is healthy and you agree to be induced between 39-40 weeks, as recommended, your community midwife will book this for you at 39 weeks. At this appointment, an internal vaginal examination will be offered to assess your cervix and offer you a membrane sweep. This might encourage you to go into labour without the need for an induction of labour. Should you choose to decline induction of labour further fetal assessment will be offered weekly in the maternity assessment unit from 39 weeks until delivery.

Please see patient information regarding induction of labour.

Can I deliver on the Midwifery led unit (Birth Centre)?

If you are otherwise healthy and the pregnancy remains low risk you can deliver on the Birth Centre, with intermittent monitoring of the baby’s heartbeat.