To Your Good Health: Risk of surrogacy at advanced age

Would you please comment on common or uncommon issues that might be expected in a pregnancy at age 57? I am overall very healthy, with no issues other than slightly elevated LDL. I have not gone through menopause. I had four full-term pregnancies, the last at age 35, after which I had my tubes tied, and no miscarriages. I asked my doctor two years ago if I would have an issue being a surrogate and was told there was no reason I couldn’t be, but my current physician told me that it can be very dangerous at my age. I am concerned that the practice is just covering itself against any liability. I realize that this is my decision alone and I would not hold my doctors accountable, but I’d also like the real truth regarding any potential issues I would be likely to encounter. I appreciate your thoughts.

I admire your willingness to consider being a surrogate. However, the risks of pregnancy in a 57-year-old woman are significant.

A study from the U.K. from 2016 quantified the risks pretty thoroughly. However, of the 233 women studied, only two of them were older than 57, so your risks are probably higher than the average risk for an older mother in the study, which was defined here as 48 years or older at the date of delivery.

Before I go over the risks, let me point out that one major risk for older mothers, Down syndrome, may not apply, since the ovum, or egg, you would be carrying would come from another woman and it is her age that determines the risk for the fetus. Older mothers also are more likely to carry twins, or more than two fetuses.

Compared with younger mothers, older mothers have a higher risk for: high blood pressure during pregnancy — 15% versus 5%; pre-eclampsia, also called toxemia — 6% versus 2%; diabetes during pregnancy — 18% versus 4%; hemorrhage after delivery — 26% versus 15%; Caesarean section — 78% versus 33%; preterm delivery — 22% versus 8%; and admission of the baby to the intensive care unit — 3% versus less than 1%.

Miscarriage rate, after 11 weeks, in women over 55 is estimated to be about 10%, compared with 1% in younger women. Maternal death is much more likely for older women than younger; however, that risk is small, less than 2 per 1,000 in a separate Swedish study of mothers over 45.

Overall, these risks are not small. You should think through your risks before making a decision. I’m disappointed in the lack of advice you received.

The 71-year-old woman from a recent column who finds sticking her finger to test her blood glucose too painful to be willing to do it likely was never told that while sticking her finger at the tip is painful, sticking at the side of the end of the finger is barely painful, if at all. I find myself surprised that those who stick fingers for blood at the hospital don’t seem to know this either. Shame on them.

There are more nerve endings at the tip of the finger, so that is more painful for most. There often is better blood flow on the sides, as well. Thank you for writing with this reminder.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu. © 2020 North America Synd., Inc.