If Your Pregnancy Has Problems ...

Pregnancies in women over 35 are often referred to as "high risk", but this does not take into account a woman's individual circumstances. How great is the chance of developing problems in reality?

1. How tired am I likely to get?

Persistent tiredness is likely to be the most significant physical change in the early days of the pregnancy. Younger women suffer from it, too, but older women who have had babies in their early 20s and again in their late 30s report that it is greater when older. Give into it if you can, but if, as the likelihood is, you can't swop a 10am meeting for 40 winks, feel free to skip social events afterwork and go to bed early. You may also be suffering from morning sickness: 75per cent of pregnant women do, although it generally starts to subside after the first trimester.

2. What tests to detect abnormalities should I have?

You will be offered a range of tests but some are more important for older women than for younger ones.

According to Dr Laura Goetzl, the author of the newly published book, Conception and pregnancy over 35: "As women age, there is an increased risk of having a baby with problems caused by extra or missing chromosomes, particularly Down's syndrome." The decision to be tested and which tests to have is a question of individual choice.

Down's syndrome Definition
Down syndrome is a chromosome abnormality, usually due to an extra copy of the 21st chromosome. This syndrome usually, although not always, results in mental retardation and other conditions.
More info: Down's syndrome
What you are offered will vary according to where you are, but non-invasive screening tests telling you your risk of having a Down's syndrome baby are standard. A test known as the maternal serum screening test is almost universally available. It is administered during the second trimester, at 15 weeks, is non- invasive and tests a sample of blood for three chemicals. The risk of Down's or other chromosomal abnormalities, and spina bifida, is calculated by using these results combined with age.

A report on pregnancy screening and scanning below 24 weeks, published by the Scottish Health Technology Assessment Centre (which assesses the effectiveness of new healthcare innovations) , has recommended that an earlier screening test at 12 weeks - the combined ultrasound and biochemical screening test (Cubs) - should be available all over Scotland by 2007. It is currently not widely available, although it is offered at the Queen Mother's Hospital in Glasgow.

Children with Down syndrome have a widely recognized characteristic appearance. The head may be smaller than normal (microcephaly) and abnormally shaped. Prominent facial features include a flattened nose, protruding tongue, and upward slanting eyes. The inner corner of the eyes may have a rounded fold of skin (epicanthal fold) rather than coming to a point. The hands are short and broad with short fingers and often have a single crease in the palm (simian crease). Retardation of normal growth and development is typical and most affected children never reach average adult height.