As this pregnancy was unplanned — unlike that of Sarah Brown, the Chancellor’s wife, who is much the same age — our reader is possibly not taking folic acid. She should: however good a diet is, it is never adequate to provide the additional protection that a pregnancy needs. My view is that she should take folic acid supplements until she is delivered.

Although by doctors’ standards 39 is older than ideal for becoming pregnant, the overwhelming majority of women of this age sail through it without problems.

Older pregnant women who have had high blood pressure, or other evidence of preeclampsia, are more likely to have a recurrence in subsequent pregnancies. Their doctors will keep a watch for swelling in the fingers, hands and feet, and any changes in the urine.

Older mothers should rest more than other pregnant women and avoid unnecessary travel, especially in the first and last three months of pregnancy. On car journeys they should stop to take exercise every 40 minutes; and avoid air travel as much as possible.They should cut back on social activities and have eight hours’ sleep a night. They also need more rest than younger women during the day, and should put their feet up each afternoon throughout the pregnancy, not just in the last few months. These precautions will improve the placental circulation and encourage the growth of the baby.

We don’t know how heavy our reader is but women who are overweight, or conversely, who weigh less than 45kg (7st 2lb), need careful monitoring as they and their babies are likely to have problems. Excessive weight gain in pregnancy is important, but equally too little gain or even weight loss may indicate that the baby is not flourishing. The average weight gain is 12kg (26lb).

Pregnancy in a 39-year-old is more likely to be complicated by diabetes, fibroids, and hypertension. The labour will be less efficient as uterine muscles, unlike wine, don’t improve with age. The chance of other medical problems increases with age. Many of these may affect childbearing. The risk of these, and specific obstetric problems, has been assessed and accorded a score. The total score allows the overall risk to the pregnancy and childbirth to be classified. Those women who are classified as high risk need to be delivered in a larger centre with an efficient neonatal paediatric unit.

The rate of chromosomal abnormalities in the baby increases from just under 1 per cent when the mother is 35, to 7.8 per cent when she is 43. This not only presents paediatric problems but also affects the miscarriage rate. The first ultrasound scan is done around the 12th week, when nuchal fold measurements are taken. The nuchal translucency scan assesses the thickness of the tissue at the back of the baby’s neck and is an indication, but no more, of the likelihood of Down’s syndrome. The other tests for foetal abnormalities — these measure three different substances in the woman’s blood, the alpha foetoprotein (AFP), the unconjugated oestriol and the human chorionic gonadotrophin — are estimated in the 15th to 16th week. A raised AFP may indicate spina bifida or similar troubles; a low AFP sometimes indicates Down’s syndrome. Doubtful results suggest the need for amniocentesis or a CVS (Chorionic Villus Sampling).

A reader has written about her son, a 30-year-old international banker who works for 12 hours a day. Despite the hours and the travel, he enjoys the challenge that his job presents. He is successful, well paid and seems to be popular at work and in his private life. Three years ago his father died and he suffered severe depression that was compounded by the break-up of a long-term relationship. Although more cheerful and the life and soul of any party, he has dream-ridden, restless sleep. Should his mother be worried?

The reader’s son suffered two grief-provoking events within months of each other: his father died and his girlfriend left him. Grief doesn’t have to follow death but can be triggered by any loss, including that of a girlfriend, or even some material object such as a beloved house. One of the problems of cohabiting is that it leads to a series of mini divorces. Death, divorce and debts are notorious for precipitating depression. The son suffered two of these in a short period of time. He was acutely depressed after his father’s death. Now the only obvious symptoms of this are insomnia, vivid dreams and a seeming inability to form long-term relationships with other women.

Grief response should run through five stages. The timing and length of each phase varies hugely. The first is numbness. This lasts for hours, or a week or two, rather than months. Numbness is followed by disbelief. Disbelief or denial usually wears off within a few weeks, or at most months, but there are cases in which it has continued for years. Disbelief and denial is succeeded by universally accepted manifestations of grief. There is a sense of guilt and anger, or both, and hence rows involving family and friends unjustifiably blamed for some aspect of the loved one’s death. The depressed bereaved also display tearfulness, inertia, depression, anger, irritability and feelings of hopelessness. This stage may also herald the start of expensive litigation against doctors, hospitals and others in authority.

After the acute grief has subsided it is replaced by a chronically mildly depressed phase known as chronic grief. Finally, usually within a year, resolution is achieved. The grieving person may remain lonely, still miss the deceased, but is beginning to realise that he or she can establish a new life even if it is one without a lamented spouse, partner, beloved house or treasured collection.

Problems arise when someone’s mood and behaviour sticks in one of the stages. Any depression may be obvious and in need of treatment. In other cases the only manifestation of an arrested grief response may be an apparently unrelated psychiatric or psychological symptom, the cause of which may not be apparent. These symptoms include unwarranted anxiety, or agitation, alcoholism, hypochondria, extravagant spending with any of the other manifestations of depression, or mania.

When dreams are very vivid and life-like they may betray underlying depression anxiety, or could have been caused by sleeping pills or other medication. The son’s present dreams may be as much a symptom of his present frenetic lifestyle as his past grief.

Should her son see a psychiatrist? The first step for him, if his symptoms persist, should be to have a chat with his GP. If there is any persistent depression then treatment may be needed. It would certainly be unusual to be still grieving after three years.

ASK DR STUTTAFORD

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.

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