Advanced Maternal Agie

Pregnancy after 35: Healthy moms, healthy babies

Are you considering pregnancy after 35? Understand the issues for older mothers — and know what it takes to have a healthy pregnancy.

If you're older than age 35 and hoping to get pregnant, you're in good company. Many women are delaying pregnancy well into their 30s and beyond — and delivering healthy babies. Taking special care can help give your baby the best start.

Understand the risks

The biological clock is a fact of life, but there's nothing magical about age 35. It's simply an age at which various risks become more discussion worthy. For example:

• It might take longer to get pregnant. You're born with a limited number of eggs. As you reach your mid- to late 30s, your eggs decrease in quantity and quality. Also, older women's eggs aren't fertilized as easily as younger women's eggs. If you are older than age 35 and haven't been able to conceive for six months, consider asking your health care provider for advice.
• You're more likely to have a multiple pregnancy. The chance of having twins increases with age due to hormonal changes that could cause the release of multiple eggs at the same time. The use of assisted reproductive technologies — such as in vitro fertilization — also can play a role.
• You're more likely to develop gestational diabetes. This type of diabetes, which occurs only during pregnancy, is more common as women get older. Tight control of blood sugar through diet and physical activity is essential. Sometimes medication is needed, too. Left untreated, gestational diabetes can cause a baby to grow significantly larger than average — which increases the risk of injuries during delivery. Gestational diabetes can also increase the risk of premature birth, high blood pressure during pregnancy, and complications to your infant after delivery.
• You're more likely to develop high blood pressure during pregnancy. Research suggests high blood pressure that develops during pregnancy is more common in older women. Your health care provider will carefully monitor your blood pressure and your baby's growth and development. You will need more frequent obstetric appointments and you might need to deliver before your due date to avoid complications.
• You're more likely to have a low birth weight baby and a premature birth. Premature babies, especially those born earliest, often have complicated medical problems.
• You might need a C-section. Older mothers have a higher risk of pregnancy-related complications that might lead to a C-section delivery. An example of a complication is a condition in which the placenta blocks the cervix (placenta previa).
• The risk of chromosome abnormalities is higher. Babies born to older mothers have a higher risk of certain chromosome problems, such as Down syndrome.
• The risk of pregnancy loss is higher. The risk of pregnancy loss — by miscarriage and stillbirth — increases as you get older, perhaps due to pre-existing medical conditions or fetal chromosomal abnormalities. Research suggests that the decrease in the quality of your eggs, combined with an increased risk of chronic medical conditions such as high blood pressure and diabetes, could increase your risk of miscarriage. Ask your health care provider about monitoring your baby's well-being during the last weeks of pregnancy.

The chart below reports the studied risk of genetic problems or aneuploidy based on age and other risks such as stillbirth.  The risks increases with age.  

Increased frequency/risk of: 

 Miscarriage  

Chromosomal Abnormalities 

Placenta Previa   

Stillbirth

Some Congenital Anomalies

Placental Abruption 

Ectopic Pregnancy 

 Gestational Diabetes

Cesarean Delivery 

 Pre-Eclampsia 

Preterm Delivery 

Adapted from: Bianco A, Stone J, Lynch L, et al. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996; 87:917 

Adapted from Up to Date 2009 

(S.Hart Rev 1/09) 

While further research is needed, studies suggest that men's ages at the time of conception — the paternal age — also might pose health risks for children.

Make healthy choices

Taking good care of yourself is the best way to take care of your baby. Pay special attention to the basics:

• Make a preconception appointment. Talk to your health care provider about your overall health and discuss lifestyle changes that might improve your chances for a healthy pregnancy and baby. Address any concerns you might have about fertility or pregnancy. Ask about how to boost the odds of conception — and options if you have trouble conceiving.
• Seek regular prenatal care. Regular prenatal visits help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you. Talking to your health care provider is likely to put your mind at ease.
• Eat a healthy diet. During pregnancy, you'll need more folic acid, calcium, iron, vitamin D and other essential nutrients. If you're already eating a healthy diet, keep it up. A daily prenatal vitamin — ideally starting a few months before conception — can help fill any gaps.
• Gain weight wisely. Gaining the right amount of weight can support your baby's health — and make it easier to shed the extra pounds after delivery. Work with your health care provider to determine what's right for you.
• Stay active. Regular physical activity can help ease or even prevent discomfort, boost your energy level and improve your overall health. It can also help you prepare for labor and childbirth by increasing your stamina and muscle strength. Get your health care provider's OK before starting or continuing an exercise program, especially if you have an underlying condition.
• Avoid risky substances. Alcohol, tobacco and illegal drugs are off-limits during pregnancy. Clear any medications or supplements with your health care provider ahead of time.
• Learn about prenatal testing for chromosomal abnormalities. Ask your doctor about prenatal cell-free DNA (cfDNA) screening, a method to screen for certain chromosomal abnormalities in a developing baby. During prenatal cell-free DNA screening, DNA from the mother and fetus is extracted from a maternal blood sample and screened for the increased chance for specific chromosome problems, such as Down syndrome, trisomy 13 and trisomy 18. Diagnostic tests such as chorionic villus sampling and amniocentesis can also provide information about your baby's chromosomes or the risk of specific chromosomal abnormalities, but also carry a slight risk of miscarriage. Your health care provider can help you weigh the risks and benefits.

Look toward the future

The choices you make now — even before conception — can have a lasting effect on your baby. Think of pregnancy as an opportunity to nurture your baby and prepare for the exciting changes ahead.