Hello, friends! We are on the final 3 of 9 questions for your prenatal health, so let’s get going! As a refresher, the last questions are listed below:
7. Are there immunizations / vaccinations that I may need now or when I get pregnant?
8. How old is “too old” to get pregnant?
9. How do I know if I am ovulating regularly or if my eggs are healthy?
7. There are several vaccines you can get prior to conception to protect your health (and indirectly your baby’s – health mom = health baby, after all) during your pregnancy. these include:
- Pneumonia (only recommended for adults 19-49 years old with certain risk factors)
- Meningitis
- Hepatitis A and B
- Haemophilus Influenzae Type b (Hib)
The CDC recommends several vaccines for pregnant women, including:
Tdap: Protects against tetanus, diphtheria, and whooping cough. The CDC recommends getting this vaccine between 27 and 36 weeks of pregnancy, ideally earlier in the third trimester. The Tdap vaccine increases antibodies in the mother, which are then passed on to your baby to give your baby protection. – Of note, I also recommend that any other adults or children who will be spending time with your baby also receive this vaccine in order to prevent them from exposing your baby to the risk of whooping cough.
Flu shot: Can be given before or during pregnancy, depending on the flu season.
COVID-19: If you are pregnant and haven’t received an updated COVID-19 vaccine.
RSV: If you are between 32 and 36 weeks pregnant between September and January. The Pfizer RSV vaccine (Abrysvo) can be given during pregnancy, or you can give your infant a dose of nirsevimab after birth.
You should definitely ask your provider about current recommendations which may vary depending on your underlying medical conditions, the geographic area in which you live, and the risk for exposure to any of the above infections.
8. We know that < 35 years old is the optimum age for conception (fecundity). That age range is also associated with less risk for miscarriage, less risk for genetic abnormalities, and less risk for many of the complications that are associated with “advanced maternal age” (sounds awful, right?). No matter that our overall health has improved during the last century, and no matter how good we look on the outside, our ovaries and overall physiology do not care – our ovaries deliver the healthiest ova (eggs) when we are younger, our uterus will do the best job of carrying a baby, and our bodies carry our babies to term with the least risk of complication.
That being said, you still have an excellent chance to conceive (your chance for miscarriage will increase slightly every year from 35 until 40, then increase more rapidly until you reach menopause). Your chances of having a baby with a genetic abnormality also increase after 35 with a greater rate of risk after 40, that is why we used to begin offering more invasive genetic testing for all patients 35 or older. Now we are able to offer non-invasive testing for all pregnant women (a simple blood test) with is fairly accurate and which, if abnormal, may lead to your provider offering you amore invasive diagnostic test.
As for “too old” to try to get pregnant, we know that the risks to you AND your baby increase quite a bit if you are 40 or older. These risks include miscarriage, birth defects, chromosomal abnormalities, gestational diabetes, gestational hypertension (high blood pressure), pre-eclampsia, preterm birth, cesarean delivery, and stillbirth. If you are over 35, and for sure if you are over 40, your doctor will likely recommend additional testing and care throughout your pregnancy.
9. The best way to know if you are ovulating regularly is if you are menstruating on a monthly basis. Typically, your monthly flow is an indirect reflection of an ovulation that did not result in a pregnancy. If you are not sure you are ovulating, you may want to try an OTC (over the counter) ovulation kit, which you can find at most drug stores. That will help you to time sex for optimal results. If you have been trying to get pregnant for 12 months without conception (having sex regularly with a healthy male partner and especially during your ovulatory phase, which is usually cycle days 10-14 in a woman with 28-30 day cycles), you may want to see a gynecologist. Some primary care providers may be able to initiate an appropriate work-up and even begin initial treatment, but you may eventually need to see a specialist.
As for “are my eggs still good?”, your age is the best determinant of quality. As noted above, your egg quality begins to decrease at age 35, which is why your risk for chromosomal abnormalities begins to increase at that age.
I hope I’ve been able to address some of your prenatal and pregnancy care questions, I see these frequently in my clinic so I know you must have them, too. I look forward to hearing what other questions and concerns you may have about all things related to the divine feminine!
Until next time, remember to Listen, Be Present, and Believe!
