Older Population Driving Up Multiple Birth Rate, Related Risks

By John Voket

It may be significantly more complicated, and it is certainly more expensive, but a growing number of local families are putting increasing pressure on high risk pregnancy, reproductive endocrinology and obstetric specialists who are hearing more older women say “super-size me” when it comes to their pregnancies.

That phenomenon is evident at Danbury Hospital where the neonatal intensive care unit (NICU) has already cared for more than 175 babies including six sets of triplets and more than a dozen of the 20 sets of twins expected to be delivered this year, a 50 percent increase in the number of multiples cared for in the NICU last year.

According to Dr Gerard Foy, a perinatologist who works closely with Dr Christopher Sullivan, ob/gyn, Dr Edward James who heads up the NICU, and Dr Mark Leondires, a local reproductive endocrinologist, it was the business of neonatal intensive care that first put Danbury Hospital on the map in the early 1980s.

“In the late 1970s we were getting more interested in getting involved here with high risk pregnancies,” Dr Foy told The Bee in a recent interview from the NICU at Danbury Hospital. “By 1980, the hospital committed to a major program to support that program, which essentially elevated Danbury Hospital from a community hospital to a regional medical center.”

This new program helped keep more high-risk families closer to home, instead of having to refer them to hospitals in New Haven or White Plains, Dr Foy said.

The timing of this development at Danbury Hospital could not have been better as the practice of neonatology and reproductive endocrinology was exploding along with the number of women who were delaying pregnancy into their 30s and even 40s.

Dr Foy said it was this rapidly increasing demand for support among aspiring older mothers that helped excel the number of support services available to this population locally, as well as the very science that helped make these pregnancies occur: reproductive endocrinology.

 

Demands Inspire Advances

Dr Mark P. Leondires, MD, FACOG, who practices in Danbury, said that along with demands for better reproductive medical support, the pharmaceutical industry was also hard at work in the early 80s developing medications and treatments to help older women who tend to release fewer eggs as they grow older, produce and release more viable eggs during a particular monthly cycle.

“With that technology, the process known as in-vitro fertilization became more sophisticated and more effective,” Dr Leondires said. “We had these powerful medications, improving technology and an increasing number of women wanting to access them. And with all these things together, we experienced a rush to get pregnant.”

In the early 1990s, Dr Leondires said it was very common that doctors would “take their chances,” giving fertility medications that helped develop numerous follicles containing eggs during ovulation, and would encourage the hopeful couples to have intercourse or utilize artificial insemination to impregnate the eggs.

“In those early days, that’s where we would more often see the twins, the triplets, and even the quintuplets coming from,” Dr. Leondires said.

Today, the fertilization technology has become so advanced that he advises most patients over age 35 to take advantage of the increased control in-vitro fertilization provides.

“But we’re still not that good,” Dr Leondires admitted. “I still can’t prevent them from having multiples.”

This situation, played out in similar medical practices across the region, and the country, has rapidly increased the number of multiple births, especially among a population of couples who may appreciate getting the entire family they desire all at the same time.

“The dream pregnancy at 30, 35, or 40 is to have twins. That way if they don’t get pregnant again, they’ve completed their family,” he said. “And that puts a lot of pressure on the system, and leads to many ongoing discussions among doctors in the field and their patients.”

Those discussions are due to become even more interesting in the coming months, as a mandate recently enacted in Connecticut takes effect, requiring insurance companies to pay for infertility treatments, but specifically only allowing the transfer of two embryos during the in-vitro fertilization process.

Ultimately, Dr Leondires said, it is society’s increasing obsession with convenience and “having it all” that has driven developments in both the technology and the need for increasing medical coverage required to accommodate pregnancies in older women.

“The pressure has really come from the outside from women delaying childbearing and then wanting to have their complete families as fast as possible — outsmarting their biological clock,” Dr Leondires said.

 

Increased Risks

Dr Sullivan pointed out the increasing risks faced by potential mothers as they transition from their 30s to their 40s and even into their 50s.

“As time goes on in terms of the biological clock, we see a decrease in the ability to become pregnant. So by the time age 35 is reached, there is an exponential rise in the rate of infertility,” Dr Sullivan said. “So when we see patients at or over age 35, we tend to be a bit more aggressive with them if they want to pursue a pregnancy.”

At his practice, Dr Sullivan sees increasing chromosomal anomalies in women as they age. These anomalies can increase the chance of babies being born with conditions from Downs Syndrome to other mental and physical disabilities.

“Those issues are foremost in our minds when were addressing moms going from their 30s to their 40s, and especially as they move towards their 50s,” he said. “The risks to the mom of developing hypertension and diabetes are also increasing with age. So it’s not just the age of the patient, but what happens in pregnancy during that age that we’re looking at.”

As chief of neonatology at Danbury Hospital, Dr James is pleased that his department can offer both the highest level of professional support including the expertise of Drs Foy, Leondires, and Sullivan, but also a tremendous level of cutting-edge technical and medical support as well.

“With the increased rate of multiple pregnancies, the likelihood of a mom delivering prematurely gets higher and unfortunately the number of premature babies we have to care for goes up.”

Dr James said that those pregnancies are still relatively few among the more than 2,400 babies delivered at Danbury Hospital each year, but the Level 3 NICU available to patients there is staffed with highly trained staff from the doctors to the neonatal nurse specialists to the technicians who work hand-in-hand with the direct medical staff to help bring these sometimes tiny new lives to healthy and well-developed condition.

“It’s a group effort to care for these babies,” he said. “And since lung development is such an issue with premature babies, we also have the best of the best cutting-edge ventilators and we are looking at adding even newer ventilation technology in the coming months.”

Another new addition to the battery of technology available to the perinatology experts at Danbury Hospital is a new three-dimensional ultrasound machine that Dr Sullivan is using to help diagnose prenatal abnormalities that until recent years, may have been missed or misdiagnosed from imaging supplied by older ultrasound units.

“The older technologies made it harder for particular abnormalities to be diagnosed, such as deformities of the skeletal system and the hands, face, lower limbs, and feet,” Dr Sullivan said. “Certainly more intricate abnormalities of the spine can be seen using 3-D ultrasound.”

Dr Sullivan said the new technology is also helping to forge new explorations and diagnoses of issues related to internal organs including fetal hearts.

“The machine provides us an image where we are able to literally rotate the image of the heart, and give us the ability to provide the parents a much better idea of exactly what any potential complications may occur in their pregnancy,” he said. “Now we not only can provide an almost absolute picture of what we are dealing with, but we’ll have a much better idea of the procedures we will use to deal with it.”

In the coming years, Dr Sullivan foresees 3-D technology becoming the norm in imaging and diagnosing concerns in advanced age or high risk pregnancy situations.

But in the end, the most successful advanced age pregnancies begin with the best possible physical condition of the mother herself, Dr Foy concluded. Dr Foy said women who are in their 30s and 40s need to begin consulting with a perinatology specialist even before they become pregnant.

“Following an involved and serious discussion about becoming pregnant, if the patient is willing and able I ask them to prepare themselves by getting into the best physical shape possible, eating correctly and taking prenatal vitamins and sometimes other medications,” Dr. Foy said. “By taking folic acid, which has become very popular with women preparing for pregnancy in recent years, it has eliminated so much of the likelihood of malformations in their pregnancy.”

Dr Foy said that thanks to all the expertise and industry advances available to NICU and high risk patients at Danbury Hospital, virtually all of the pregnancies his staff are seeing can be treated with the necessary level of supportive that is both realistic and encouraging for these parents to be.