I am excited to have one of the most famous OBGYNs in the United States on today’s show. Dr. Shannon Clark. She’s a double board certified OB/GYN and maternal-fetal medicine specialist focusing on the care of women with maternal and/or fetal complications of pregnancy. She realized her passion for taking care of women with complicated and high-risk pregnancies and subsequently pursued a fellowship in maternal-fetal medicine and masters in medical science at the University of Texas medical Branch in Galveston, Texas, where she is a Professor.
Dr. Aimee: Welcome back to the show, Shannon. It has been great to know you through Babies After 35. I love everything that you’re doing on TikTok and Instagram to raise awareness about growing a family after 35.
You’re also a representative for The American College of OBGYN working to educate about the book Your Pregnancy and Childbirth: Month to Month. I know it’s a great book that talks about the topics in a very simple approachable way. Tell us about the book.
Dr. Shannon Clark: Basically, this is the seventh edition of this book. The book has been out for a while, but they revitalized it to update it to be more modernized. I think having social media and the amount of information that is available through social media surely is a driver about how we even educate through other media sources, like books. Modernizing it to fit that kind of style where people like to get their information.
We have the latest medical information on pregnancy and childbirth, new chapters, we have updated anatomical drawings, and more importantly, we have a lot of information on COVID-19, which is ever-changing. Just as an aside, you can always go to ACOG.org and get more information on COVID-19 and pregnancy as it evolves over time.
The recommendations in this book are supported about ACOG’s clinical guidance. For those of you that are listening that may not know, ACOG is the American College of Obstetricians and Gynecologists, it’s kind of our governing body for how we practice obstetrics and gynecology. So, the recommendations are from ACOG as well as practicing OBGYNs and clinicians. That’s what separates this book apart from other books that may be kind of similar.
Dr. Aimee: That’s great. There are so many people out there that are writing books about pregnancy and childbirth and it’s really good to know that this is a trusted resource. When patients ask me, “Dr. Aimee, what book should I be getting now that I’m finding out that I’m pregnant,” I will now say Your Pregnancy and Childbirth: Month to Month.
Dr. Shannon Clark: It is available on ACOG’s website and you can get it on Amazon as well.
Dr. Aimee: Awesome. Part of the book also talks about best tips for things like diet and exercise. Can you share some of those tips with us?
Dr. Shannon Clark: I think this is a really good resource. To be honest, and I’ve been practicing OBGYN and MFM for quite a few years now, we don’t talk a whole lot about diet. Unless the patient is diabetic, then we get into nutrition and it becomes more important. Just knowing what the basics are, what the basic food groups are, what’s recommended. Staying away from sugar is not a must, even if you’re diabetic, you can still do it in moderation. Just giving you the basics about what the different food groups are, how you can achieve what’s optimal in pregnancy for your diet.
Then as far as exercise, that’s one of the most common questions I get on social media, “What can I do? When can I do it?” Some guidelines on what to do if you’re already in shape and you become pregnant, or if you don’t have an exercise routine and then become pregnant, or if you’re somewhere in the middle, what you should do. If your OBGYN may not have the time to sit down and go through all of that with you, this is a good resource to have to work your way through it and to figure out what’s the best approach for you for diet and exercise.
Dr. Aimee: I love that. Related to discomforts in pregnancy, the book also shares tips and guidance along that. What are some of the most common discomforts that you hear from your patients when they’re pregnant?
Dr. Shannon Clark: They don’t necessarily call it this, but basically they fall into a couple of categories. The first would be pelvic girdle pain. That’s anything in the pelvis. It used to be referred to as symphysis pubis dysfunction or SPD, but now we call it pelvic girdle pain because the pelvis is all interrelated to everything else in our body. Then you think about low back pain and round ligament pain is a big thing because it’s very common in pregnancy. And then lightning crotch, which people don’t really know what that means, but that’s a lot of pain that you get in the vulva and the vaginal area, some of that pressure and the sharp pains.
Those are probably the most common pains and discomforts that you feel in pregnancy. It’s good to know what they are, what’s normal, when to let your doctor know what’s going on, so this book is really helpful for things like that.
Dr. Aimee: So, lightning crotch is a thing. I actually saw a patient the other day for lightning crotch and I didn’t have a word for it. She said, “Dr. Aimee, it feels like someone is cutting me in my cervix.” I was like I wish I had a better way of describing that. Now I know. So, thank you. That’s helpful.
I also want to talk to you about what is one of your greatest passions, educating people about having babies over 35 and how things have evolved. How have things changed for women who are trying to get pregnant over the age of 35?
Dr. Shannon Clark: What’s evolved as far as pregnancy and fertility over age 35? We’re having more people over age 35 and over age 40 who are getting pregnant and who are trying to conceive. We have more people who are delaying childbearing and anticipating delaying childbearing and wanting to know more about their fertility and what may or may not happen, what the risks are of delaying childbearing, and also if you do get pregnant after age 35, especially after age 40, what are the risks then.
We have more patients, more people delaying childbearing, more pursuing IVF, especially after age 40, and having babies after age 40. Education and interest in education about fertility and pregnancy after age 35, and especially after age 40, is much more in demand now because we simply have more people who are interested in that.
Dr. Aimee: What happens to our fertility as we get older, over age 35, and then over age 40?
Dr. Shannon Clark: You’ve taught me about this, too. The decrease in egg quality, which is the genetics of the egg and its ability to join with the sperm and produce a chromosomally normal fetus does decline over time.
We’re born with all the eggs we’ll ever have. As we age, they age, unfortunately, no matter how healthy we are. I’m a prime example, I started trying to have a baby at 39 and then after 40. I had no chromosomally normal eggs except for one that we got through IVF, and that transfer didn’t take. I had no medical problems, I had no medications that I was on, I was at a good weight and I was exercising all the time. It is what it is, I didn’t have any chromosomally normal eggs.
Then you think about how many eggs you have left to actually ovulate and then fertilize, and that declines over time, too. Those are the two biggest things that I think people need to know. Once they’re in the boat of already trying to conceive or if they’re anticipating delaying childbearing, just to get educated on that and know the potential complications that they might have.
Dr. Aimee: Are there different things that a woman, let’s say 25, 30, 35, 40, 45, should be considering before she gets pregnant? Are the considerations different, let’s say for a 25-year-old versus a 45-year-old?
Dr. Shannon Clark: My considerations for having kids when I think of myself at 25 were a lot different than when I was 35 and 40, for sure.
When you’re 25 and you’re otherwise healthy, if having children or starting a family is not an interest to you or it’s nowhere on the radar, I think one thing that we need to do, even at an early age, is just start having those conversations with our OBGYNs. You don’t need to talk about it once you’re ready. Those conversations can start way before that, so you can start getting information over time. I really think it should be something that should be in every well-woman exam. Let’s discuss fertility, not because you’re wanting to have a child, but about the future. Start getting that information as early as possible.
As you start getting past age 35, and especially age 40, if there are any chronic medical conditions, if you are not of a healthy weight, if you’re on medications to treat any chronic medical condition, those are all things to consider. Your medical conditions need to be as best controlled as possible. Trying to play catch up and get under control once the pregnancy has started is not ideal. I’m not saying that it can’t be done, but it can be problematic, especially for things like diabetes, hypertension, and for lupus or any of the rheumatologic types of diseases. Especially if you have kidney disease, that can be very hard to play catch up in a pregnancy.
If you’re anticipating trying to conceive and you do have chronic medical conditions, if you’re on medications, if you’re not of an ideal weight, start addressing that now in order to minimize or mitigate the potential complications you might have once you become pregnant.
Dr. Aimee: I love that you say all of that, because that’s really the same message that I have. A woman should not be asking about her fertility when she’s 39. That’s just not fair to her to be like, “I’m ready now,” and then I have to tell her it’s really hard to get a good egg once you’re over the age of 35 and have that be a shock and a surprise. That’s just not fair.
Dr. Shannon Clark: We drill into patients about pap smears, STD testing, safe sex, breast exams, mammograms. When are we going to start drilling, “Let’s talk about your fertility?”
I have to be honest, part of my story is my personal story. Part of the reason why I’m on social media and doing what I’m doing is because of what I went through myself to get a family. When I was 25, when I was 30, when I was 35, I did not think I wanted to have kids. In fact, I thought I didn’t want to have kids. I was perfectly fine with not having a family. I was ready to go solo and never have a family. Until I met the right person, and everything changed.
Being child-free and choosing that life is perfectly fine, but you might still change your mind. I know I did. Because of that, knowing where you stand on your fertility, there’s nothing wrong with having the conversation and getting more education. All that’s going to do is empower you.
Dr. Aimee: Right. Exactly. A fertility screening should just be up there with cervical cancer screening, breast cancer screening, it should be part of the well-woman check, just like you said. Same with guys, too. Getting a sperm test is so much easier, and freezing sperm is so much easier than freezing eggs, for sure.
Once pregnant, for 35 and up, how is that pregnancy different compared to someone who is 25?
Dr. Shannon Clark: Let’s first talk about why 35 has gotten to be this bad number when it comes to women and individuals who could potentially become pregnant. Yes, your egg quality and quantity do decline over time, but it’s not a one-size-fits-all. It’s not like Dr. Aimee or myself can pull up a chart and it says at 35 you have this many eggs left and at 35 this many are chromosomally normal, at age 40, at age 41, etcetera. It’s not one-size-fits-all. It’s different for everybody.
It has kind of gotten the bad rap that at 35 it just tanks and there’s no way you’re going to get pregnant on your own — and that’s simply not true. There are ways that we can assess and there are things that we can do to see where you stand. Even though I educate a lot about the potential pitfalls of waiting, I also want to balance that with saying there are plenty of people who get pregnant successfully after age 35 and after age 40. What I don’t want is people to be surprised about it or assume they’re going to be okay and not do anything on the front end to try to educate themselves and be prepared.
I’m sure you agree with this. It’s being prepared and being educated so that it won’t be a slap in the face when you’re 40 and you have no eggs left, kind of like it was for me. I don’t want to be a Debbie Downer and make everybody think that I’m putting a big curse on your fertility when you’re 35.
When it comes to pregnancy, the reason why 35 became advanced maternal age or geriatric pregnancy, and all those very sexy terms we call women and people who are pregnant after 35, is because we started doing amniocentesis to check for Down Syndrome, which is one of the more common chromosomal abnormalities that can happen in pregnancy. We found that the chances of having a baby with Down Syndrome were roughly equal to the risk of amnio at age 35. That’s why it was considered advanced maternal age, because of that alone.
Now, there are plenty of 35-year-olds who are perfectly healthy and do just fine. Based on age alone, even if you’re healthy and have no medical conditions, you’re not on any medications, nothing is majorly wrong, you’re still at an increased risk for some things; preterm labor, diabetes, preeclampsia, cesarean delivery, placenta previa or placenta abnormality, abnormalities as far as whether it’s implanting on the uterus.
Those are still things that we have to consider for someone over age 35, regardless of what their baseline health status is. Now, if you add on preexisting medical conditions, medications that you’re on, and other things, then that adds to the risk. That’s something that we need to be aware of as obstetricians and high-risk maternal-fetal medicine specialists.
When I talk to people about pregnancy and the complications, you kind of have to go through a few hurdles. The first is to get the antenatal screening to see what your baseline risk is based on the antenatal screening that you choose to do because there are several things we can do, to see what your risk is of having a pregnancy with a chromosomal abnormality. Once that’s cleared, then we get to the anatomy scan, looking at all the parts of the baby to make sure there’s no major defects or anything else.
Once that is done, then we just look at what the risks are based on your age alone, and then if you have any other chronic medical conditions. Just because you’re older doesn’t mean you’re destined for a high-risk pregnancy. You may still be considered that based on age alone, but don’t be offended by that. Just know that you’re going to have a little bit of extra surveillance based on your age.
Dr. Aimee: I call it VIP, a very important pregnancy. Once you get past 35, you’re just VIP, just a little bit more monitoring, a little bit more checking, and that’s it.
Is there an age where “you are too old to be pregnant”?
Dr. Shannon Clark: It’s an individual choice. You have to think about not only your health as the person carrying the pregnancy, but also the health of the baby, and then longevity. I think about that. I’m not judging anybody that has children later in life than even I did, but I had them at 42, almost 43, I was nine days shy of my 43rd birthday. I think about it. Even though I love them and we’re going to have a great life and all of that, I do think about how old I was when I had them. I’m going to be completely honest, I do think about that.
It’s a personal decision that someone has to make based on what is right for them. I don’t think it’s my job to tell somebody that they’re too old.
Now, if they have medical conditions or they’re not an ideal weight, or they’ve had surgical complications, or they’ve had poor pregnancy history in the past, of course I’m going to give an opinion, because that’s my job to give an opinion based on that. But not just based on their age alone.
Dr. Aimee: Yes. We don’t discriminate against men, men can have babies and be fathers without ever carrying a pregnancy at any age. I love your answer to that.
Right now, obviously, we’re in a pandemic and everyone is concerned about COVID-19. The book that you’re here to talk about also addresses that. Are there special considerations for women over 35 when pregnant related to COVID-19 that they should know?
Dr. Shannon Clark: No. COVID-19 and pregnancy is COVID-19 and pregnancy no matter what the age. Of course, we’re still relatively early. Although it seems like it’s been ages that we’ve been in this, when it comes to research and getting data and finding outcomes with something like this, it takes years to get that kind of data. We won’t know that for sure for probably several more years to come.
As far as we know right now, there’s no difference in adverse outcomes with COVID-19 and pregnancy based on age. It’s just COVID-19 and pregnancy for anyone could potentially not be good, no matter what their age is.
Dr. Aimee: Tell us where people can find you and where they can find the book.
Dr. Aimee: Is there anything else you would like to share with our audience today?
Dr. Shannon Clark: Check out the book. When you go on Amazon, there are some things that you can get as far as additional information to see if it’s the right book for you. I do think, especially because the information is coming from medical professionals, that it really is something that people should consider getting.
Dr. Aimee: Awesome. The title of the book is Your Pregnancy and Childbirth: Month to Month.
Thank you, Dr. Shannon Clark, for taking time out from your extremely busy schedule to join us today on The Egg Whisperer Show. We hope you’ll join us again soon.
Dr. Shannon Clark: Thank you.
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