Pregnancy After 35: Advanced Maternal Age

If you are 35 or older and pregnant or thinking about becoming pregnant, there are some things you should know. At age 35, you are considered to be of advanced maternal age. Your doctor uses this age as a guide to understand certain risk factors you may have that a younger woman may not. These include risks of health problems, pregnancy complications, and birth defects.

Here are some of the special concerns you may have if you are over 35 and pregnant.

Before pregnancy

• It could take longer to get pregnant. You are born with all the eggs you will ever have. By the time you’re in your mid-30s, you have fewer eggs. The eggs you do have left are older and don’t have the same quality as newer eggs. This can make it harder for them to be fertilized.
• You could have other health conditions. Some conditions are more common as you get older. These include diabetes and high blood pressure. Both of these conditions can cause complications during pregnancy.

During pregnancy

• Gestational diabetes. The older you are, the more likely you are to develop gestational diabetes. This is a special kind of diabetes that some women get during pregnancy. Uncontrolled diabetes can cause preterm labor or birth. It can also cause your baby to be too big.
• Preeclampsia. This condition causes you to have high blood pressure during pregnancy. It could also indicate that some of your organs aren’t working properly.
• Being pregnant with multiples (such as twins). Older women are naturally more likely to become pregnant with multiples. Fertility treatments that some older women get can also increase the likelihood. Having multiple fetuses can cause complications during pregnancy. These include preeclampsia, gestational diabetes, and preterm birth.
• Birth defects. The risk of your baby having birth defects increases as you age. Birth defects could include chromosomal abnormalities such as Down syndrome.
• Miscarriage. This is when the baby dies before you reach 20 weeks of pregnancy. There are many causes of miscarriage. Advanced age increases your risk.

At birth

• Premature birth. This is when your baby is born before 37 weeks of pregnancy. Premature babies are more likely to have health problems at birth. This is because the babies didn’t have enough time to develop in the womb.
• Low birthweight. Older mothers are more likely to have a baby that weighs less than 5 lbs., 8 oz. at birth. Babies with a low birthweight are more likely to have health problems.
• Need for a C-section. A C-section, or a caesarean section, is when you have surgery to have your baby. Your doctor opens your uterus and takes the baby out. There are more risks with C-sections. These include infection or a bad reaction to anesthesia. The older you are, the more likely you’ll develop complications that would require a C-section birth.

Path to improved health

There are many things you can do to increase your chances of having a healthy baby when you’re 35 or older.

Before pregnancy

• Get a checkup. Make sure you are healthy before you get pregnant. Get any vaccines you need. Discuss your health history and your family history with your doctor. They may be able to spot a health condition that runs in your family that could affect your pregnancy.
• Get treatment. If you have any health conditions, make sure they are being treated. This includes physical conditions such as diabetes or high blood pressure. It also includes mental conditions such as depression.
• Check your medicines. Tell your doctor about every medicine you take. This includes prescriptions, over-the-counter medicines, and supplements. Some are not safe to take during pregnancy. Your doctor may need to change some of your medicines.
• Take folic acid. Folic acid is a vitamin that helps with growth and development. Take it before you get pregnant and while you are pregnant. It can help prevent birth defects in your baby.
• Maintain a healthy weight. If you are overweight or underweight, you’re more likely to have health problems during pregnancy. Try to get to a healthy weight and maintain it before you get pregnant.
• Stay away from toxic substances. Don’t use unsafe chemicals at home or at work. Don’t use tobacco, drink alcohol, or use street drugs before getting pregnant.
• Reduce stress. Stress can have a negative effect on your body. Learn stress-management skills before you get pregnant so that stress doesn’t affect your baby. 

During pregnancy

• Get prenatal checkups. Schedule regular appointments with your doctor and go to all of them. They will be able to monitor your pregnancy. With regular visits, they will be able to spot any problems earlier. You’ll be more likely to have a good outcome.
• Keep up with treatment. Continue treating any health conditions you had before pregnancy. Make sure your doctor knows what medicines you’re taking. They will know if they are safe for your baby.
• Gain the best amount of weight. How much weight you should gain depends on how much you weighed before pregnancy. Your doctor will tell you what a good range is for you. Eat a healthy diet and be as active as you can.
• Don’t smoke, drink alcohol, or use drugs. Tobacco, alcohol, and drugs can be very harmful to you and your baby when you are pregnant.

Things to consider

When you are of advanced maternal age, your doctor may want to do extra prenatal testing. This will allow them to test for specific abnormalities that you are at higher risk for because of your age. A noninvasive blood test looks at fetal DNA in your bloodstream. It can tell if your baby is at risk of certain chromosomal abnormalities, such as Down syndrome.

Further testing may be necessary if your doctor determines you are at increased risk. It also could include chorionic villus sampling (CVS) or amniocentesis. These tests can diagnose a chromosomal abnormality. But they can also slightly increase the risk of miscarriage. Talk to your doctor about getting any of these extra tests.

Questions to ask your doctor

• What increased risks will I have if I get pregnant after age 35? After age 40?
• If I am otherwise healthy, am I still considered to be of advanced maternal age if I’m over 35?
• Why does age put me at increased risk of complications?
• How old is too old to have a baby?
• Should I get extra testing to measure my risk for complications?
• What can I do to reduce my risks of complications such as preterm birth?
• Testing found that my baby has an increased risk of a chromosomal abnormality. What do I do now?

Resources

American Family Physician: How to Prepare for Pregnancy

The American College of Obstetricians and Gynecologists: Having a Baby After 35: How Aging Affects Fertility and Pregnancy