Healthy Focus

Pregnancy After 35: How to Give Your Baby the Best Start

If you’re planning to delay motherhood—or aren’t even sure you want children at all—the number 35 is probably on your mind a lot.

Sandra Boxell, MD, OB/GYN
Paris Women’s Center

That’s the average age when fertility starts to decrease, according to the American Congress of Obstetricians and Gynecologists (ACOG), and it’s unofficially the age when many women think they need to make their final childbearing decisions.

But there’s nothing magical about a woman’s 35th birthday when it comes to pregnancy. The vast majority of pregnancies in 35-plus women are uncomplicated and result in the birth of a healthy child. Having a baby when you’re 35 or older just means that both the mother-to-be and her care provider have to be ultra-vigilant to avoid some of the issues that may come with older motherhood, says Sandra Boxell, MD, OB/GYN with Paris Women’s Center.

Getting Pregnant After 35
Although fertility can start decreasing any time between ages 32 and 37, that doesn’t mean you can’t optimize your chances of conceiving and having a healthy child. The first step is the preconception visit, says Dr. Boxell, who recommends asking your doctor:

  • What are my chances of getting pregnant?
  • What do I need to do before the pregnancy to ensure an optimal outcome?
  • How are you going to watch my pregnancy differently?
  • What screening exams do I need during this pregnancy?

The visit should also include a thorough exam, with a pelvic exam and full history. It’s also important to identify existing conditions that may cause problems with the pregnancy, says Dr. Boxell, such as high blood pressure, obesity and high blood sugar.

In addition, begin taking a folic acid supplement at least two to three months before you plan to try conceiving, to help prevent neural tube defects, says Dr. Boxell.

Dr. Boxell also recommends that older moms-to-be may want to use an ovulation predictor kit right from the start.

“Couples should be counseled in how to use the ovulation predictor kit and when [to use it] . . . for optimum fertility,” says Dr. Boxell. “If everything else is fine, and you don’t get pregnant in six months, it’s time to see a fertility specialist. Don’t wait, because there’s not as large a window as with younger women.”

Healthy Lifestyle
Both before and during your pregnancy, it’s important to maintain a healthy lifestyle overall including a normal BMI (body mass index), regular exercise, a healthy diet and no drugs or alcohol. Dr. Boxell, also cautions against taking supplements, even those generally perceived as safe, without speaking to your doctor first.

Testing Recommendations
In addition to the standard tests associated with pregnancy in the first trimester, a pregnant woman over age 35 may need more frequent prenatal visits or more screenings to rule out fetal abnormalities. Your physician may begin with a nuchal scan, a special ultrasound that can help identify some chromosomal conditions. There are also a number of noninvasive maternal blood tests that have greater than 99 percent accuracy in detecting chromosomal abnormalities.

“For moms over age 35, [these are] something that would be routine,” says Dr. Boxell. “From there, if there is an indication that something is wrong, we may move on to more invasive testing such as amniocentesis.”

These tests are recommended because pregnant women over age 35 have a higher risk of having a child with a chromosomal disorder, such as Down syndrome. Doctors will also watch the mother’s health carefully, says Dr. Boxell because her risk of complications–such as preeclampsia, gestational diabetes and placenta previa–are higher.
“The exciting thing is that we live in America and even those with Medicaid are covered for these screening tests now,” says Dr. Boxell.

Special Delivery
The best preparation for an easier delivery? Get moving! “Cardio [fitness] makes labor and delivery so much easier,” says Dr. Boxell. “Older mothers are at higher risk for C-sections, but staying fit can minimize that risk somewhat. I encourage 30 minutes five days a week, but if I can get moms to do three or four days, I’m happy.”

Dr. Boxell cautions pregnant women not to start a new exercise routine during pregnancy, but also agrees that watching your diet and staying active can maximize your chances of an uncomplicated delivery.

35+ Pre-Conception Checklist
* Preconception exam with your healthcare provider

* Existing medical conditions under control

* Folic acid supplements for at least six months

* Healthy diet and regular exercise

* Ovulation predictor kit

To make an appointment with Dr. Boxell, call 731-644-8225.

Heart Disease Symptoms You Should Never Ignore

Are you listening to your heart? You should. It could literally save your life. Cardiovascular disease is the number one cause of death in the U.S. In fact, one out of four deaths is due to heart disease.

According to cardiologist Wayne Gibson, MD, MBBS, MBA, FACP, FACC, Saint Thomas Heart, people who have heart disease often don’t realize it. It is important to recognize the signs of a heart attack and promptly seek medical attention. The quickest treatment of a clot-causing heart attack, the less damage to the heart muscle. These are the top 3 signs of heart disease you should never ignore:

Wayne Gibson, MD, MBBS, MBA, FACP, FACC
Saint Thomas Heart
  1. Chest pain or discomfort This is the classic heart attack symptom, although men and women can experience chest pain differently. “Men are more likely to feel crushing, squeezing, or burning pain. Or, the pain may feel like pressure or fullness in the center of the chest. It may radiate to the neck, one or both arms, the shoulders, or the jaw. Women tend to tend to have non-specific symptoms such right-sided chest pain, abdominal pain, or nausea,” says Dr. Gibson.
  2. Shortness of Breath In women, shortness of breath can occur with or without chest discomfort. Commonly, diabetics only have shortness of breath.
  3. Lightheadedness Feeling lightheaded or dizzy often may occur with these symptoms.

“If you suddenly experience any of these symptoms, call 911 immediately. Minutes count when you are having a heart attack or stroke,” says Dr. Gibson.

Some people who have heart disease never have chest pain, shortness of breath, or lightheadedness. They may, however, experience less obvious, but just as important signs, such as:

Flu-like symptoms or stomach problems, such as heartburn, indigestion, or stomachache. “If you don’t actually have the flu but develop chills, cold sweats, nausea—even cold, clammy skin (this is more common in men)—don’t ignore it,” says Dr. Gibson.

Unexplained fatigue. Women who have heart problems often feel tired, even exhausted, following routine activities.

Unexplained pains. Heart disease can cause pain in the back, neck, jaw, teeth, or between the shoulder blades. If you have any unexplained pain, especially if it comes on suddenly, get it checked out.

Fainting. Although fainting is rare, it may mean your brain is not getting enough blood and therefore insufficient oxygen. Seek immediate medical attention if you do faint.

Swollen feet, ankles, legs. This may be a sign of heart valve problems.

Persistent cough. A cough, especially if accompanied by white or pink-tinged blood, may indicate heart failure.

All of these symptoms may be due to something other than heart disease, so don’t panic but do take it seriously. See your doctor promptly. You should especially pay attention to these symptoms if you know you have risk factors for heart disease, such as diabetes, high blood pressure, or a family history.

“Seek immediate medical attention if you experience any of the symptoms of heart disease, or if you have any other, unexplained symptoms. But don’t wait until you are facing a medical emergency,” says Dr. Gibson.

“Fortunately, simple lifestyle changes can dramatically reduce the likelihood of developing heart disease,” he says.

Talk to your doctor to learn more about your personal risk factors for heart disease. To make an appointment with Dr. Gibson, call 731-644-8226.

To learn more about Dr. Gibson and his practice with St. Thomas Heart at Henry County Medical Center, scan the code below with your phone.

Low-Fat Vegan Blueberry Muffins

Try this low-fat version of a delicious breakfast favorite containing blueberries, which are packed with antioxidants and vitamin C.


¼ cup olive oil (see note)
¾ cup unsweetened applesauce
1 cup soy milk
6 tablespoons maple syrup
1-½ tablespoons vanilla extract
3 cups flour
2 teaspoons salt
1 ½ tablespoons baking powder
2 cups fresh or frozen thawed and drained blueberries

Combine oil, applesauce, soy milk, maple syrup and vanilla extract in a large bowl. Combine flour, salt and baking powder in a second large bowl. Sift or stir well to mix dry ingredients. Pour liquids into flour mixture. STIR to form a batter; don’t beat. Fold in blueberries. Spray muffin tin with nonstick cooking spray. For large muffins, fill one muffin tin; for smaller muffins fill two tins. Bake muffins in a preheated 350-degree oven. Small muffins bake in about 20 to 25 minutes; large muffins in 30 to 35 minutes. Remove from oven. Cool muffins in tins for 2 minutes, then turn out onto wire rack to cool completely. Makes 12 large or 24 small muffins.