As women get older, they are at increased risk for a variety of complications especially during pregnancy. These medical conditions are also seen in the general population. These include most importantly, hypertensive complications of pregnancy, gestational diabetes, fetal chromosomal abnormalities, cesarean delivery and a very small increase in risk for maternal mortality. Using donor eggs from women in their mid 20s largely obviates most chromosomal issues but there is still an increased risk of hypertensive disorders and gestational diabetes. The incidence of hypertensive disorders in pregnancy past 40 of age is between 10-20% compared to a risk of between 5-6% in younger pregnant women. Approximately 8-10% of pregnant women over age 40 will develop gestational diabetes compared to only 3% of pregnant women under age 40. The risk of poor fetal growth, preterm labor and delivery, stillbirth and neonatal death are also increased in women over age 40. The incidence of cesarean delivery is higher in older compared to younger pregnant women. The reason for the increased incidence of operative delivery may be related to the increased incidence of medical complications incurred with age. The risk of maternal death increases 4 to 6 fold but it is important to realize that 4 to 6 times a very small number is still a very small number. Although the risks of adverse outcome of pregnant in women over age 40 are higher, the greatest probability is that with effective prenatal care a successful delivery will result.
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