Advanced maternal age: Pregnancy after 35, timeline & tips

We want to acknowledge that while this terminology serves a medical purpose, it can still be a bit disconcerting to hear phrases like “advanced maternal age”, and “geriatric pregnancy”. It’s important to note that the vast majority of AMA pregnancies have healthy outcomes, and this label’s main function is to provide the best possible testing and care for you and your baby. How you choose to talk about your pregnancy is up to you — we’re just here to unpack the science.

In this article, we’re going to go over some of the risks and complications associated with AMA, along with what’s available to you in terms of care and lifestyle adjustments to lower those risks and have the healthiest pregnancy possible.

What is advanced maternal age?

First things first, AMA is defined as being pregnant at the age of 35 or older [1]. This distinction exists for purely biological reasons. Around age 30, fertility (the ability to get pregnant) typically starts to decline. By your mid-30s, this decline tends to speed up. By about age 45, fertility has declined so much that getting pregnant naturally may be difficult. 

This decline in fertility is linked to female egg quality which also can also affect pregnancies in the over 35 group. [2]. In particular, the risk of pregnancy loss increases for those in this age bracket [3]. We’ll go into more detail on that later on.

What is a geriatric pregnancy?

 The term “geriatric pregnancy” has been previously used to talk about any pregnancy where the mother is 35 years and older. The American Psychological Association and the American College of Obstetricians and Gynecologists have since advocated for the discontinuation of this term and recommend that “advanced maternal age” be used instead. It’s a more accurate term to describe pregnancy since our fertile years begin in our teens and usually end around our late 40s or 50s at menopause (when periods stop altogether) [1, 2].

How common is it to have a baby after the age of 35?

While these terms may make you feel a bit like an outsider, it’s becoming more and more common to get pregnant at an advanced maternal age. About 20% of all pregnancies in the U.S. happen after the age of 35, and about 11% of all first pregnancies are in women age 35 and older. There is a global trend reflecting this increasing age at first pregnancy as well [4]. 

There are plenty of reasons that you may want to wait to have kids and take more time to prepare for pregnancy, including (but not limited to):

• Focusing on your career
• Creating more financial stability
• Wanting more life experience
• Finding the right partner 

The decision to have a child is a personal one — your priorities, your timeline, your goals, and ultimately, your choice. However, it’s important to have all the facts, and unfortunately, there are also a few extra risk factors to consider for those in the AMA category. Let’s take a closer look…

What are the risks with an AMA pregnancy?

First things first, the most likely outcome of an AMA pregnancy is a healthy baby. All of the risks mentioned below are present in all pregnancies, but they do gradually increase as we get older. Some of the risks of an AMA pregnancy include:

Multiple pregnancies: Hormonal changes in the ovaries as they age mean they are more likely to release more than one egg cell per month. This may result in twins (or more). Though multiple pregnancies can be perfectly healthy, they do increase the risk of preterm birth [2].

Miscarriage: Unfortunately, the risk of pregnancy loss increases as we get older. After the age of 45, the risk increases more rapidly. This is mainly due to the higher chance of chromosomal abnormalities. [5]

Gestational diabetes: Those in their 40s are more likely to develop gestational diabetes during pregnancy. This condition comes with its own risks, including increased risk of preterm birth, your baby growing larger than usual, and increased risk of later developing type 2 diabetes [6, 7].

Gestational hypertension: There is also an increased risk of developing high blood pressure during some AMA pregnancies [6].

Placenta complications: AMA may increase the risk of complications with how your placenta develops, which may lead to low birth weight for the fetus. There is also an increased risk of preeclampsia, or placental abruption (when the placenta starts to detach before birth) [6].

Chromosomal abnormalities: Having a baby when you’re older than 35 does increase the chances of having a baby with a chromosomal abnormality, such as Down syndrome or Patau syndrome, but the overall chances of this remain low [6].

Ectopic pregnancy: This is when a fertilized egg cell implants and begins to grow outside the womb. While still comparatively rare, the chances of ectopic pregnancy do increase, with 2% of pregnancies for the over 35 group resulting in being ectopic [8].

Stillbirth: Unfortunately, the risks of stillbirth increase if you’re over 35, but rest assured, the overall risk is still low. To put this in context, for pregnancies without diabetes mellitus or high blood pressure, in the over 40s age group, only 0.3% end in stillbirth [6,9]. 

Now, we know how overwhelming this can sound. These numbers are based on population statistics, and every individual’s pregnancy is unique. It’s important to know the facts, but remember age is only one factor at play. Talk to your doctor if you have concerns about risks associated with AMA, they’ll be on hand to provide the proper testing and treatment necessary to support you and your baby’s health [2].

What are my chances of miscarriage if I am over 35?

No pregnancy is without risk of miscarriage. For those under 35 years, the risk of pregnancy ending is 1 in 10 for early or first trimester miscarriage. This risk does increase for those over 35, with 2 out of 10 pregnancies typically ending in miscarriage. This risk gradually increases as we age, with more than 5 in 10 pregnancies ending in miscarriage for those aged 45 and over [3]. 

Why are there more complications if you’re over 35 and pregnant?

This all may seem a bit unfair — we don’t have much control over the biological aging process in our bodies, and after 35, the risk of certain conditions that affect pregnancy does go up. It’s an unfortunate fact that people over 35 are also just generally more likely to have health complications like diabetes and high blood pressure, both of which can develop during pregnancy and lead to complications. Keep in mind that while health conditions aren’t the only cause of complications during an AMA pregnancy, taking care of yourself and monitoring your health becomes even more important.[2].

How is an advanced maternal age pregnancy treated?

While there’s no “treatment” for AMA (we can’t turn back the clock), your healthcare provider may recommend certain screenings to assess your risk for some or all of the conditions listed above. Some of these, like hypertension or diabetes, can be managed with certain medications and lifestyle adjustments. Prenatal screening and diagnostic testing are also available to assess any potential chromosomal abnormalities. Overall, it’s important to get your prenatal appointments scheduled and stick to them to be sure you’re getting the care you need [2].

How do I lower my risk of complications?

No matter your age, there are some lifestyle changes you can make to prepare for, or support, the healthiest possible pregnancy, including: 

• Take folic acid supplements
• Avoid alcohol, tobacco, marijuana, and other substances
• Eat a healthy diet that works for your body and lifestyle
• Exercise regularly
• Limit your caffeine intake
• Avoid any exposure to toxic substances like lead or other chemicals that may be present at certain work sites
• Avoid foods that aren’t recommended during pregnancy, like raw fish, deli meats, and unpasteurized cheese
• Make sure you’re up-to-date on routine check-ups 

[10]

Overall, speak with your healthcare provider about your current lifestyle, medical history, and any medications you’re currently on to find out what guidance applies to your situation. In addition, you may be able to access prepregnancy counseling where a healthcare professional can assess your current circumstances and chart the best path forward with your doctor [2].

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