How Old is Too Young and How Young is Too Old?

If the title of this blog is puzzling to you, please bear with me for the time being.

Let’s start from the beginning.

At birth, a baby girl is born with a pool of about 1,000,000 potential eggs in her ovaries. By the time of her first menstrual period, between 11 and 13 years of age in the majority of cases, only about 300,000 can still become potential eggs for fertilization. Between her first menstrual period and the last (menopause) only 300 to 400 eggs become available for fertilization and pregnancy. Nature provides thus ample opportunity to secure the continuation of our species.

Baby males will produce sperm throughout the life of the individual, from puberty on. As the man ages, the quantity and volume of sperm decreases.

For a woman to become pregnant she needs to produce an egg, which she does with each normal menstrual cycle. In addition she must also be able, physically, to carry a pregnancy to term. Her pelvic bones need maturing to allow the safe passage of the baby into the world. Her hormonal functions need to be able to adjust and support a 9 months pregnancy. Psychologically she needs the maturity to care for the infant after birth. In other words, her body and mind need to mature.

Of course this maturity mark varies from individual to individual. Most people agree that the teenage period ends at 19. By that time most women have reached their maturity, both physically and psychologically, to be a mother.

A pregnancy before that time is known as “teenage pregnancy”. Not impossible, but the implications of a teenage pregnancy are multiple. Teen age pregnancy, therefore, is considered high risk and is potentially prone to complications.

Miscarriages, high blood pressure, prematurity, and a score of other complications are common in the teenager. These endanger the future young mother as well as the baby. Because of the young age of the mother these inherent complications are compounded, many times, by social problems like the lack of support in the family, followed occasionally by forced marriages which, in many cases, end in divorce a few months or years later. At other times the presumed father disappears from the picture as pregnancy occurs, which may add to the psychological problems of the teenage mother.

A few years ago we had an epidemic of teenage pregnancies in the US. In the last few years it seems to have stabilized and actually decreased a little. But there are still too many teenage pregnancies, about 26 per 1000 births.

In an ideal world a woman should not get pregnant before she reaches maturity at 19 years of age or so,. Thus, the answer to our question “how old is too young” is: before 19 years of age.

There will be some that will point to a number of “teenage” pregnancies that they happen to know, who had no problem. Unfortunately, as a high risk obstetrician, I could point to many more that were not so lucky.

After 20 years of age, the vast majority of pregnancies are perfectly normal, as everyone knows. Some have problems, but advances in medical care have made such pregnancies safer and safer compared to the past. As recent as 50 years ago, a diabetic patient did not dare to get pregnant. This was true also for a cardiac patient and other women with various medical problems. The management of complications inherent to pregnancy has become safer and safer, and maternal mortality, though not totally eliminated, is a far cry from the hundreds that were dying at the turn of the 20th century.

As our understanding of the physiology of pregnancy improved, we came to learn that the window of opportunity for a safe pregnancy is not unlimited. As a woman ages, her eggs become less fertile and some have chromosomal abnormalities which lead to congenital abnormalities in the infant. As women postponed pregnancy due to career goals and other reasons, we learned that certain complications rise with increasing age of the woman: miscarriages, diabetes, hypertension and other problems are not uncommon. In the second half of the 20th century we learned that 35 years of age is the cutoff between an ideal age to become pregnant and one that becomes more dangerous. Thus women over 35 years of age are referred to as “elderly”, and if that is their first pregnancy they are referred to as “elderly primigravida”. You may not think of yourself as “elderly” before you are even 40. From a pregnancy point of view, nonetheless, you are. By definition you are “high risk”.

Thus, the answer to our second question “how young is too old”, the answer is 35 years of age.

You look puzzled! That’s nonsense, you say. Your grandmother had a child at 48. Your mother had her last child at 44. Right, but statistics are against your thinking. That’s why we have Maternal Fetal Medicine docs who care for the problem pregnancies you don’t hear about. The concept of “Too old to be pregnant” is a fairly new one. Statistics had to be accumulated before we realized what we didn’t know before.

During the last thirty years we have seen an explosion of fertility treatments. It seems almost that whoever wants to get pregnant can do so, thanks to in vitro fertilization, embryo transfer, egg donors and so forth. These are patients challenging the concept of “how young is too old”. They present with new problems and time will tell us how to better manage such patients.

Ideally a woman should be aware of all these facts discussed here. In the real world, at this time, few do. The desire to have a child is too strong to even consider that something can go wrong. Complications happen to other people not to us. Fortunately statistics, no matter where you are in life when you get pregnant, will most likely work in your favor. For that you should be eternally grateful.

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so by email at: dr.aladjem@gmail.com

You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a recurring post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.