Doc: Surrogacy at advanced age comes with higher risk
Dear Dr. Roach: 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.
Dear M.V.: 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 (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 percent vs. 5 percent); pre-eclampsia, also called toxemia (6 percent vs. 2 percent); diabetes during pregnancy (18 percent vs. 4 percent); hemorrhage after delivery (26 percent vs. 15 percent); Caesarean section (78 percent vs. 33 percent); preterm delivery (22 percent vs. 8 percent); and admission of the baby to the intensive care unit (3 percent vs. less than 1 percent). Miscarriage rate (after 11 weeks) in women over 55 is estimated to be about 10 percent, compared with 1 percent 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.
Dear Dr. Roach: Are net carbs really a thing? I understand low impact on blood sugar, but not measuring net carbs.
Dear H.C.: The “net carbs” number is normally calculated by taking the grams of total carbohydrates and subtracting the grams of fiber and sugar alcohols. It’s an attempt to look at the effect on blood sugar, and it has modest informational benefit. It can be misleading, because some sugar alcohols (ending in “-ol,” like maltitol and xylitol) do increase blood sugar somewhat, though not as much as sugars (which end in “-ose,” like glucose and sucrose).
I don’t recommend using the term “net carbs.” I think it’s more important to look at ingredients. Avoid large amounts of added sugar and processed starches. Make sure the carbohydrates you take in come mostly from vegetables, fruits, legumes and whole grains. These are the foundations of a healthy diet, and you don’t need to count numbers.
Email questions to ToYourGoodHealth@med.cornell.edu.