My girlfriend is 45, and she just told me she is pregnant. We would love to have a child together if we knew it could be born healthy. But she is very concerned about the health issues -- her health, the baby's, her ability to regain her physical appearance after childbirth. She has had two children already, when she was 32 and 33. Now she claims she feels that she is physically too old to have a normal pregnancy and give birth to a healthy child. I disagree and told her medical care can improve her chances of having a heathy newborn. I asked her to stop smoking, eat right and avoid alcohol until we make a joint decision. Can you offer any advice on pregnancy in an older woman? She's 5 feet 3 inches and 112 pounds, in good shape now with a nice figure.

-- Ray

Ray, you are right on target with your advice to stop smoking, eat healthfully and avoid alcohol while pregnant -- and that advice is good whether the mom-to-be is 25 or 45! As to whether a 45-year-old can have a healthy pregnancy, the answer is absolutely! Much depends on mom's medical and physical condition before pregnancy -- a healthy, fit 45-year-old will likely do better than an unhealthy, overweight 20-year-old smoker.

Of course, there are risks to both mom and baby as mom gets older. Foremost is the increase in genetic defects such as Down syndrome. As a woman and her eggs age, it is more likely that the egg will be damaged. The risk of bearing a baby with Down syndrome in a 20-year-old is one in 1,400; in a 30-year-old, it's one in 900; in a 40-year-old, one in 100; and in a 45-year-old, one in 25. Down syndrome and many other chromosomal abnormalities may be detected before birth by either chorionic villus sampling or amniocentesis. The risk of an early miscarriage is higher in older women as well, and this is directly related to that increased chance of a chromosomal defect.

Older women also are more likely to have preexisting medical problems, such as diabetes and high blood pressure. If either of these is already present, pregnancy may worsen them. Appropriate management will maximize the chances of delivering a healthy baby and minimize any adverse impact on the woman. Also, the chance of developing either high blood pressure or diabetes for the first time during a pregnancy is higher in women over age 35; again, with good prenatal care, these conditions can be detected and treated without significant consequences to either mom or baby.

You and your girlfriend should make an appointment as soon as possible to see an obstetrician. The doctor will review her medical history, including factors such as smoking, and do a complete physical. She or he will be able to discuss further age-related risks, including those I have mentioned, and advise you on ways to optimize the odds of a happy and healthy outcome. The doctor will discuss the risk of Down syndrome and other genetic defects, the testing available to detect them, and the options available if a test result should prove to be abnormal. With early, good prenatal care and commitment to maintain a healthy lifestyle (no smoking, no alcohol, no illicit drugs; a well-balanced diet and moderate exercise), both your girlfriend and your child will more than likely do fine.