Advanced Maternal Age

Overview

What is advanced maternal age?

Advanced maternal age is a medical term to describe people who are over age 35 during pregnancy. Pregnancies have an increased risk for certain complications when the birth parent is 35 or older. Some of these complications are higher rates of miscarriage, genetic disorders, and certain pregnancy complications like high blood pressure or gestational diabetes.

Advanced maternal age pregnancy isn't treated much differently than a typical pregnancy. Your healthcare provider may suggest prenatal testing and monitor you more closely. Being mindful of your pregnancy symptoms and staying healthy becomes even more important when you're over age 35 because your risk for chronic conditions increases.

Despite these risks, people can have healthy pregnancies and healthy babies after 35.

What age are you considered advanced maternal age?

You're considered of advanced maternal age if you will be 35 or older at the time of your due date.

Is advanced maternal age the same as geriatric pregnancy?

Yes, they’re the same. Geriatric pregnancy is an outdated term and most healthcare providers prefer to use the term advanced maternal age.

Is it harder to get pregnant if you are over 35?

Healthcare providers have discovered that the biggest decline in fertility happens in your mid-to-late 30s. A decline in fertility means the quality and quantity of eggs in your ovaries decreases. This doesn't mean getting pregnant after 35 is impossible (it's very possible). It means 35 is the age when fertility starts to decline more rapidly and your chances for complications increase more significantly.

How does advanced maternal age affect my eggs?

You’re born with a set number of eggs. You release an egg at ovulation each menstrual cycle. The older you get, the fewer eggs you have. The eggs you do have are more likely to have chromosomal issues that lead to genetic disorders. A genetic disorder is a condition present at birth.

What are the risks associated with having a baby after 35?

All pregnancies come with risks; however, you or your baby are at increased risk for the following conditions when you are of advanced maternal age:

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

Advanced maternal age is associated with a decrease in egg quality. This means that as your age goes up, your egg quality goes down. "Older" eggs are more likely to cause chromosomal anomalies. A lot of these chromosomal anomalies are what healthcare providers screen for in the first trimester.

Another reason there are more complications after 35 is that your chances of developing most chronic medical conditions increase as you age. Your body simply responds to these conditions differently once you are older. These chronic medical conditions can affect pregnancy and delivery. For example, even a nonpregnant person is more likely to have high blood pressure at 35 than at 25.

What are the benefits of having a baby after 35?

Starting a family is a personal decision, and many people choose to wait until later in life to have children. One of the benefits of having a baby later in life is having more life experience and financial stability. Couples are getting married later than they were decades ago. Assisted reproductive technologies (like in vitro fertilization or IVF) are getting more successful. This means people may delay starting or expanding their families. Studies show the rate of people having their first baby in their late 30s is rising every year.

Diagnosis and Tests

Genetic screening tests are recommended for all pregnancies but are particularly important for people of advanced maternal age. These noninvasive screenings are optional and can detect if your baby is at high risk for certain congenital conditions. Most testing uses blood tests or ultrasound. These tests are screenings, meaning they detect the possibility of a genetic condition.

If a problem is detected in a screening test, invasive genetic testing can be done. These include chronic villus sampling (CVS) and amniocentesis. CVS uses cells from the placenta to diagnose a genetic condition. Amniocentesis involves placing a needle through your abdomen to extract amniotic fluid from inside the womb. This fluid can help diagnose certain genetic conditions.

Management and Treatment

Are advanced maternal age pregnancies treated differently by doctors?

Not really. Healthcare providers typically don't treat you differently just because you are of advanced maternal age. However, if genetic screening tests indicate your baby may have a congenital disorder, your provider may refer you to a maternal-fetal medicine specialist. This is someone who specializes in higher-risk pregnancies. Other times you may have more frequent prenatal visits with your regular provider or have testing done sooner. For example, an earlier glucose screening test (to check for signs of gestational diabetes) or more ultrasounds or fetal heart rate monitoring to ensure that your baby is doing well. If you have other risk factors for preeclampsia, your doctor may recommend that you take a baby aspirin daily throughout most of your pregnancy to decrease your risk of developing this condition.

Your prenatal care is more important as you age just because your risks for certain conditions increases. So, it's more important than ever to attend all appointments or screenings, eat a healthy diet and maintain a healthy weight through your pregnancy.

Outlook / Prognosis

Can I lower my risk of pregnancy complications if I’m older than 35?

If you are over 35 and pregnant (or think you will be), there may be some steps you can take now to lower your risk for pregnancy complications:

  • Make sure all your preventative care is up to date.
  • Have any existing medical conditions under control. For example, keeping your blood sugar in range if you have diabetes.
  • Take a prenatal vitamin that includes folic acid.
  • Exercise regularly.
  • Quit smoking or using tobacco products.
  • Stop drinking alcohol.
  • Eat a healthy diet with plenty of fruits, vegetables, lean meats and whole grains.
  • Stay within a healthy weight range.

What are my chances of miscarriage if I am of advanced maternal age?

Your chances of having a healthy baby are still much higher than your chance of miscarriage. If you are between the ages of 35 and 40, your chance for miscarriage is about 20% to 30%. Rates start to rise significantly for people who are 40 and older as they continue to age.

Living With

How do I take care of myself if I am over 35 and pregnant?

You can take steps to increase your chances of having a healthy baby.

Some things you can do if you are older than 35 and pregnant are:

  • Attend all of your prenatal appointments and screenings.
  • Gain a healthy amount of weight during pregnancy.
  • Manage any preexisting or new pregnancy conditions.
  • Reduce your stress levels and get enough sleep.
  • Exercise regularly and eat a healthy diet.

Frequently Asked Questions

Is 35 too old to have a baby?

No, it's not too old to have a baby. The pregnancy rates of people having babies in their late 30s or 40s have increased across all races. Having a healthy pregnancy is dependent on how healthy you are overall, not just how old you are.

Will my baby have a birth condition if I am older than 35?

No, the chance of your baby having a congenital disorder is still small. However, as you get older, the risks of having a baby with a chromosomal disorder increase.

How common are chromosomal problems?

They’re more common as you get older. For example, if you are older than 35, your chances of having a child with Down syndrome increases. According to the American College of Obstetricians and Gynecologists, your chances are:

  • 1 in 1,480 at age 20.
  • 1 in 940 at age 30.
  • 1 in 353 at age 35.
  • 1 in 85 at age 40.
  • 1 in 35 at age 45.

Can I get pregnant at 42 naturally?

Yes, it's possible to get pregnant naturally if you're 42. However, by about age 40, your chances of getting pregnant naturally is about 5% each menstrual cycle.

Can you reverse menopause and get pregnant?

No, once menopause has started, you can't reverse the process. If you are delaying pregnancy or are worried about preserving fertility, reproductive technologies like IVF or freezing your eggs are an option. Pregnancy using donor eggs is another option. Talk to your healthcare provider about these methods or if you believe you are entering menopause.

A note from Cleveland Clinic

Most pregnancies over the age of 35 are healthy and successful. However, it's important to know the potential complications with advanced-age pregnancies. Talk to your healthcare provider about what genetic screening tests they recommend or what you can do to stay healthy if you are older than 35. In most cases, age during pregnancy is just a number. If you maintain a healthy weight, manage any conditions you have and listen to your healthcare provider, you will likely deliver a healthy baby.

Last reviewed by a Cleveland Clinic medical professional on 02/28/2022.

References

  • Barclay, K. and Myrskylä, M. (2016). Advanced Maternal Age and Offspring Outcomes: Reproductive Aging and Counterbalancing Period Trends. (https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1728-4457.2016.00105.x) Population and Development Review. 42: 69-94. https://doi.org/10.1111/j.1728-4457.2016.00105. (https://doi.org/10.1111/j.1728-4457.2016.00105) Accessed 3/1/2022.
  • CDC. First Births to Older Women Continue to Rise. (https://www.cdc.gov/nchs/products/databriefs/db152.htm) Accessed 3/1/2022.
  • March of Dimes. Pregnancy after age 35. (https://www.marchofdimes.org/complications/pregnancy-after-age-35.aspx) Accessed 3/1/2022.
  • National Women's Health Network. What Is a Geriatric Pregnancy? (https://nwhn.org/what-is-a-geriatric-pregnancy-at-35-can-i-have-a-normal-pregnancy/) Accessed 3/1/2022.
  • American College of Obstetricians and Gynecologists. Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy. (https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy) Accessed 3/1/2022.
  • American College of Obstetricians and Gynecologists. Female Age-Related Fertility Decline. (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/03/female-age-related-fertility-decline) Accessed 3/1/2022.
  • Lampinen R, Vehviläinen-Julkunen K, Kankkunen P. A review of pregnancy in women over 35 years of age. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729989/) Open Nurs J. 2009;3:33-38. Published 2009 Aug 6. doi:10.2174/1874434600903010033. Accessed 3/1/2022.

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