With the adjustment of fertility policies, the number of elderly pregnant women (aged over 35) is bound to increase in a short period, and childbearing at an advanced age significantly raises health risks for both mothers and fetuses. To ensure the smooth implementation of the universal two-child policy, protect maternal and infant health, reduce provincial maternal and infant mortality rates, and improve the quality of newborn population, all regions shall strengthen health education on maternal and infant care and eugenics, guide pregnant women in health management, and help them deliver healthy babies safely.
I. Pre-pregnancy Preparation
To give birth to a healthy baby, couples planning for pregnancy shall comply with the following requirements:
1. Choose the optimal childbearing age. The best pregnancy age for women is 24 to 28 years old.
2. Both partners shall adjust dietary structure scientifically and maintain balanced nutrition before pregnancy. Women shall pay special attention to folic acid supplementation.
3. Correct bad living habits and behaviors, including smoking, alcohol abuse, drug addiction, over-fatigue, excessive stress, anxiety and depression. Medical and psychological intervention shall be adopted when necessary.
4. Avoid exposure to toxic and harmful substances, such as mercury, lead, organic solvents, pesticides, formaldehyde and X-rays.
5. Refuse arbitrary medication during pregnancy preparation; all medication must be taken under doctors’ guidance.
6. Both partners shall undergo a comprehensive physical examination to rule out diseases that may increase the risk of fetal malformations. Women shall be screened for pathogens causing fetal malformations, including rubella virus, cytomegalovirus and toxoplasma gondii.
II. Precautions for Advanced-age Pregnancy
Pregnancy at or above 35 years old is universally defined as high-risk pregnancy worldwide. Advanced maternal age adversely affects pregnancy outcomes mainly in the following aspects:
1. Declined egg quality
Women over 35 have a significantly higher risk of chromosomal abnormalities in eggs. Domestic statistical data shows that advanced-age pregnancy is associated with elevated rates of fetal chromosomal abnormalities and birth defects, including Down syndrome, cleft lip and palate, congenital heart disease and polycystic kidney disease.
2. Increased pregnancy complications and comorbidities
Middle-aged women may have underlying internal diseases such as hypertension, diabetes, chronic hepatitis and heart disease, which may be asymptomatic and tolerable in non-pregnant state. However, the increased physical burden during pregnancy, especially in the second and third trimesters, can trigger maternal and fetal complications and even threaten their lives. Some women may also develop gestational hypertension and gestational diabetes without a previous medical history. In addition, advanced-age pregnancy increases the incidence of placenta previa, premature rupture of membranes, postpartum hemorrhage and puerperal infection, which may lead to intrauterine growth retardation, stillbirth and neonatal death.
3. Higher rates of miscarriage, preterm birth and dystocia
The success rate of pregnancy declines with maternal age, and fetal protection is essential for all advanced-age pregnant women. The spontaneous miscarriage rate is three times higher than that of women under 30. With aging, the joints of the birth canal, perineum and pelvis become stiff and less expandable, while uterine contractility and vaginal ductility decrease, resulting in prolonged labor, increased risk of massive hemorrhage and dystocia. Postpartum recovery is also slower for elderly parturients.
4. Uterine scars from previous cesarean section
Women with a history of cesarean section face risks of scar pregnancy and placental implantation in subsequent pregnancy. Scar pregnancy refers to embryo implantation on uterine scars, which may cause massive hemorrhage or uterine rupture and endanger maternal life. Placental implantation means the placenta invades the uterine myometrium, possibly leading to hemorrhage, shock, uterine rupture and even maternal death. Moreover, the cesarean section rate rises sharply in subsequent deliveries, and repeated surgeries increase complications such as postoperative abdominal adhesions and poor wound healing.
Accordingly, women planning advanced-age pregnancy shall follow the precautions below:
1. Undergo a comprehensive physical examination half a year before pregnancy to evaluate cardiac, pulmonary, hepatic and renal functions for pregnancy suitability, and conceive only after professional medical assessment. Supplement folic acid 3 months before pregnancy until the third month of gestation.
2. Receive regular prenatal examinations to screen for high-risk factors such as diabetes, hypertension and hyperthyroidism, and monitor fetal development. Timely treatment or pregnancy termination shall be conducted in case of abnormalities. For women with previous cesarean section, screen for uterine scar pregnancy in early pregnancy, rule out placenta previa and placental implantation in the second and third trimesters, and monitor the risk of threatened uterine rupture throughout pregnancy.
3. Advanced-age pregnant women are eligible for mandatory prenatal diagnosis. Timely conduct screening and diagnosis of birth defects to eliminate fetal malformations as much as possible.
4. Maintain a healthy diet, appropriate exercise and regular work and rest. Develop healthy living habits, keep reasonable gestational weight gain through consistent exercise, and reduce the risk of dystocia.
III. Benefits of Pre-marital and Pre-pregnancy Health Care
1. Clarify the health status of both partners and facilitate mutual care and consideration in marriage. For example, women with heart disease need to control sexual life and reduce labor intensity; some severe heart diseases even preclude childbearing, requiring active contraception and more housework undertaken by male partners.
2. Detect early asymptomatic diseases such as infectious hepatitis and open tuberculosis for early treatment, avoiding harm to the individual, partner and next generation.
3. Identify hereditary diseases, block genetic transmission, prevent the birth of defective infants and promote eugenics.
4. Correct physiological defects before marriage or pregnancy, such as male hypospadias and female imperforate hymen. Even some congenital malformations like congenital vaginal atresia can be surgically corrected to enable normal sexual life, though childbearing may be unavailable.
5. Obtain professional health consultation during pre-marital and pre-pregnancy physical examinations, including eugenics, contraception and sexual health knowledge. Professionals help young people select appropriate marriage and pregnancy timing, avoid unplanned pregnancy and unnecessary artificial abortion, so as to safeguard family happiness, offspring health and improve population quality.
6. Differences between pre-pregnancy and pre-marital health care: Pre-pregnancy health care focuses more on maternal and fetal health (such as folic acid supplementation guidance and pre-pregnancy TORCH screening), while pre-marital health care covers a wider range, including physical health assessment of both partners, newlywed sexual life guidance, contraception guidance and marriage and childbearing suitability evaluation.
IV. Folic Acid Supplementation for Neural Tube Defect Prevention
Neural tube defects are severe congenital central nervous system malformations, imposing heavy mental and economic burdens on families and society. As multifactorial genetic disorders, they are caused by a combination of genetic and environmental factors, and all pregnant women face certain risks of fetal neural tube defects.
Global medical consensus confirms that low-dose folic acid supplementation is the most effective measure to prevent neural tube defects. Pregnant women who take 0.4mg folic acid tablets daily from 3 months before pregnancy to 3 months after gestation, together with adequate intake of folate-rich foods, can prevent more than 70% of fetal neural tube defects.
V. Prenatal Diagnosis
Prenatal diagnosis refers to the screening and diagnosis of severe or lethal congenital defects and hereditary diseases in fetuses. Medical institutions providing prenatal diagnosis services must obtain official approval and accept regulatory supervision. Pregnant women with any of the following conditions shall undergo mandatory prenatal diagnosis:
1. Polyhydramnios or oligohydramnios;
2. Fetal developmental abnormalities or suspected malformations;
3. Exposure to teratogenic substances in early pregnancy;
4. Family history of hereditary diseases or previous delivery of infants with severe congenital defects;
5. A history of more than two unexplained miscarriages, stillbirths or neonatal deaths;
6. Advanced maternal age (due date age ≥35 years old);
7. Abnormal screening results.
VI. How to Properly Choose a Delivery Hospital
The choice of delivery hospital is a key concern for all pregnant women. Many prefer Grade A tertiary general or specialized hospitals, yet this may not always be the most appropriate option.
Firstly, all delivery institutions with legal midwifery qualifications in Guangdong Province employ professionally assessed and certified medical staff, capable of handling normal childbirth. Regional high-risk maternal consultation and referral channels are established to ensure timely emergency treatment in tertiary hospitals for pregnant women with severe gestational complications.
Secondly, pregnant women may encounter emergencies such as vaginal bleeding and premature rupture of membranes during pregnancy. Choosing a distant tertiary hospital may delay treatment. Therefore, proximity is a core principle for hospital selection to ensure prompt response to emergencies. In addition, tertiary hospitals generally have heavy patient flow, crowded medical environments, long waiting time and higher medical costs. Secondary medical institutions can provide safe, standardized delivery services with lower costs, shorter waiting time and warmer medical experience for low-risk pregnant women.
In conclusion, pregnant women shall comprehensively consider various factors to select a suitable delivery hospital rationally.
VII. Benefits of Vaginal Delivery
1. Benefits for Mothers
(1) Compared with cesarean section, vaginal delivery involves less bleeding, milder physical damage and faster postpartum recovery.
(2) Endogenous oxytocin produced during labor promotes uterine contraction and fetal delivery, and continues to work after childbirth to accelerate lochia discharge and uterine recovery, enabling mothers to take care of newborns with sufficient energy.
(3) The coordinated changes of prolactin levels during vaginal delivery facilitate early lactation, while cesarean section delays lactation by nearly 10 hours due to surgical stimulation, pain and unbalanced hormone levels.
(4) Vaginal delivery maintains balanced maternal endocrine status and reduces vaginal atrophy after menopause. In addition, labor pain stimulates the brain to produce endorphins, bringing pleasant and satisfying feelings and enhancing maternal-infant bonding.
2. Benefits for Fetuses
(1) Squeezing through the birth canal excites the fetal respiratory center, helping newborns establish independent breathing rapidly after birth.
(2) Fetal tactile, gustatory, painful and proprioceptive stimulation during delivery promotes the development of the brain and vestibular function, benefiting future motor ability and personality development.
(3) Uterine contraction and birth canal squeezing expel amniotic fluid and mucus from the fetal respiratory tract, significantly reducing the incidence of neonatal asphyxia, pneumonia and wet lung disease.
(4) Labor stimulation promotes the production of abundant immune antibodies in both mothers and fetuses, endowing vaginally delivered newborns with stronger disease resistance.
VIII. Benefits of Breastfeeding
Breast milk is the most natural and ideal food for newborns. The core benefits of breastfeeding are as follows:
1. Benefits for Babies
(1) Provides age-specific nutrients that are easy to digest and absorb, supporting healthy growth and development.
(2) Supplies early immune substances to reduce the risk of infectious diseases, especially life-threatening respiratory and intestinal infections.
(3) Promotes gastrointestinal development and improves the digestion, absorption and utilization of nutrients.
(4) Boosts the development of the neonatal nervous system.
(5) Reduces the risk of metabolic diseases in adulthood.
2. Benefits for Mothers
(1) Strengthens maternal-infant attachment.
(2) Stimulates continuous milk secretion.
(3) Accelerates uterine involution.
(4) Facilitates postpartum body shape recovery.
(5) Reduces the incidence of breast cancer and ovarian cancer.
(6) Improves maternal mental health.
In addition, breastfeeding reduces family economic burden and avoids food safety risks.
IX. Measures to Successfully Initiate and Sustain Breastfeeding
Firstly, choose a Baby-Friendly Hospital for prenatal check-ups and delivery. Such hospitals provide standardized breastfeeding guidance and implement the "Three Early Principles" (early skin-to-skin contact, early sucking, early lactation initiation), the core guarantee for successful breastfeeding. Newborns with medical indications for artificial or mixed feeding can also receive scientific and standardized care here.
After discharge, maternal and child health workers from community health service centers or township health centers will conduct home postpartum visits to further guide breastfeeding methods and precautions. Pregnant women can also consult the hospital’s special breastfeeding hotline for relevant problems.
X. Prevention and Control Measures for Birth Defects
Birth defects are diverse in types, mainly caused by genetic factors, environmental factors, or the combination of both. Advanced-age women planning a second child face higher genetic and environmental risk factors.
In terms of genetic factors, human genetic material becomes more fragile with age. Women over 35 have a sharply increased risk of fetal genetic abnormalities, especially Down syndrome.
Environmental factors in a broad sense include chemical teratogens, radioactive radiation, bad living habits such as smoking and alcohol abuse, malnutrition, vitamin and trace element deficiency, early pregnancy infection, uterine scars and declined reproductive system function. Advanced-age second-child pregnant women have higher exposure rates to these risk factors, leading to a higher birth defect risk than women of optimal childbearing age.
All women have a certain risk of fetal birth defects and need preventive measures, especially advanced-age second-child pregnant women, who shall focus on the following key points before pregnancy:
1. Both partners shall undergo comprehensive medical assessment and fertility consultation, and be screened for local common hereditary diseases (e.g., thalassemia in Guangdong). Start reasonable supplementation of folic acid, vitamins and trace elements 3 months before pregnancy, and maintain a healthy lifestyle, balanced diet and positive mental state.
2. Receive early prenatal birth defect screening and genetic consultation after pregnancy, including serological screening and ultrasonic screening. Serological screening identifies high-risk fetuses of thalassemia, Down syndrome and severe chromosomal abnormalities for early prenatal diagnosis and intervention. Ultrasonic screening detects severe lethal fetal structural malformations, such as severe cardiac malformations, anencephaly, encephalocele, open spina bifida, thoracoabdominal wall defect with visceral ectopia and lethal skeletal dysplasia.
3. Conduct early neonatal disease screening, diagnosis and intervention after birth to prevent lifelong disability. Mandatory neonatal screening items include phenylketonuria, congenital hypothyroidism, G6PD deficiency and hearing impairment. Current medical technology can screen more than 30 kinds of genetic metabolic diseases in newborns.