If you're pregnant after age 40, you may have visions of being the only old lady in the obstetrician's waiting room or taking some sort of specially made geriatric prenatal vitamins. You're hardly alone, though — women over 40 are giving birth at a rate nearly double that of two decades ago. According to the most recent statistics from the Centers for Disease Control and Prevention, there were 5.6 live births per 1,000 women aged 40 to 44 in 1990 and 10.6 live births per 1,000 women 40 to 44 in 2008. And though you do have extra health risks as a more mature pregnant woman, you don't need to take beefed-up supplements. Just be especially diligent about taking the prenatal vitamins and supplements recommended for all expectant moms.
Being over 40 increases your risk of having a baby with a genetic disorder, such as Down syndrome or other chromosomal abnormalities. You can't do anything about genetic mutations that occur more commonly in older eggs, but you can do something to prevent another common type of genetic defect: neural-tube defects such as spina bifida or anencephaly. Neural-tube defects can severely affect your baby's spine or developing brain. To reduce the risk by up to 70 percent, take folic acid supplements, at least 600 micrograms per day, starting the minute you realize you're pregnant — or, if you're planning ahead for pregnancy, in the months beforehand.
Bone loss actually begins as early as your late 20s or early 30s, so getting adequate amounts of calcium and vitamin D in your diet is essential. By early menopause, between 5 and 25 percent of women have osteoporosis. Taking your calcium and vitamin D, which is essential for calcium absorption, should be near the top of your supplement schedule. Your baby will take the calcium he needs from your bones if you don't supply enough in your diet, so get at least 1,000 milligrams of calcium per day either in your diet or through supplements. The last thing you want is to end your pregnancy with less bone mass than when you started — you'll need strong bones to keep up with your new little one. Calcium might help reduce complications common in older moms, such as pregnancy-induced hypertension and preeclampsia. Take 600 international units of vitamin D per day.
Women over age 40 are likely to be in perimenopause, the time period of between 4 and 10 years before your periods stop altogether. During this time, women often experience heavier-than-normal menstrual bleeding, either because of hormonal imbalances and fluctuations or because they have uterine abnormalities such as fibroids or endometriosis. Heavy bleeding depletes your iron stores, so you might be anemic at the start of your pregnancy. Taking your prenatal iron pills is essential if you want your baby to start life with enough iron in his system. Prenatal iron also helps keep you from becoming fatigued or weak, two problems that occur on their own enough in pregnancy. Low iron levels might also cause preterm delivery or low birth weight. Over-the-counter prenatal vitamins normally supply between 27 and 30 milligrams of iron.
Most Americans, pregnant or not, don't get enough omega-3 fatty acids in their diet. Found mostly in fatty fish such as salmon, herring, sardines or trout, omega-3 fatty acids might have some benefit during pregnancy on fetal neural development. Taking supplements is an easy way to get the fish oil you need, especially since pregnant women should restrict their intake of fish to no more than 12 ounces per week, due to the potentially harmful effects of methylmercury that accumulates in fish. A review of studies conducted by Polish researchers found that high-risk pregnant women — a category you fit into if you're over 40 — who took fish-oil supplements were less likely to deliver before 34 weeks. Ask your doctor for information on a beneficial dose of fish oil.
A standard over-the-counter prenatal vitamin will supply some but not all of the vitamins and minerals all pregnant women need, including vitamin C, B-complex vitamins, zinc and copper. A good diet is still your best insurance policy against nutritional deficiencies. If you have trouble swallowing prenatal tablets, look for chewable brands. The iron in prenatal vitamins can cause constipation, but drinking plenty of water and eating fruits and vegetables daily can help prevent this. Some women get queasy after taking prenatal vitamins; taking them at night might keep you from noticing this side effect.
Suzanne Robin is a registered nurse with more than 25 years of experience in oncology, labor/delivery, neonatal intensive care, infertility and ophthalmology. She also has extensive experience working in home health with developmentally delayed or medically fragile children. Robin received her RN degree from Western Oklahoma State College. She has coauthored and edited numerous books for the Wiley "Dummies" series.