Later Age Pregnancy
It is no longer unusual for women to wait until they are in their late 30s or early 40s to have their first child. Many women have successful pregnancies into their early 40s, but there are increased risks associated with later-age pregnancies.
How Can I Prepare?
Here are some things you can do to decrease the likelihood of complications:
- Educate yourself about the increased risk of genetic disorders (chromosomal abnormalities) and tests you may consider having during pregnancy to detect them. Meeting with a genetic counselor should help figure out which tests should be administered.
- Make sure any existing medical condition (e.g., high blood pressure, diabetes, thyroid disease, obesity) is in a stable, controlled state before considering pregnancy. Discuss pregnancy with your doctor and how it might affect your current medical condition.
- Be sure to take prenatal vitamins with folic acid before you get pregnant to help prevent neural tube defects, particularly spina bifida.
What Are The Risks?
Infertility: The chance of getting pregnant in a given month decreases as you get older, and your risk of miscarriage rises. If you are older than 35 and have been trying to get pregnant for more than six months, you should talk to your health care provider about a fertility evaluation and possible treatments. Conditions that may contribute to infertility in women include endometriosis, failure to ovulate, uterine fibroids (benign growths in the uterus), blocked fallopian tubes, and male fertility.
Increased risk of genetic abnormalities: As women age, their eggs do not divide as well, and genetic problems can occur. The most common genetic disorder is Down syndrome. Down syndrome is caused by the presence of an additional chromosome that causes intellectual disability and defects of the heart and other organs. While the risk is still relatively low, it does go up significantly at age 35 and older. If 1,000 33-year-old women are tested, five of them will have a baby with abnormal chromosomes. If 1,000 40-year-old women are tested, 25 will have a baby with a chromosome problem. The risk continues to rise as women get older.
There are two tests now available for detecting chromosome abnormalities relatively early into the pregnancy: amniocentesis and chorionic villus sampling (CVS). These tests do create a slight risk for miscarriage. There are also non-invasive screening tests that look at the levels of biochemical markers in your blood and ultrasound measurements. Abnormal results indicate an increased risk for Down syndrome, and diagnostic tests (amniocentesis or CVS) is usually recommended. If you choose to have the testing done and there is an abnormality, you will have to decide if you want to continue or terminate the pregnancy.
Loss of Pregnancy: A woman older than 35 has a higher risk of miscarriage than younger women. For a woman over 40, the risk more than doubles compared to a woman in her 20s and early 30s. Most of the time, these miscarriages result from chromosomal abnormalities, and these abnormalities are more likely in women over 35.
Health problems during pregnancy: Common medical conditions in women over 40 include diabetes and high blood pressure. If you have one of these conditions, you will be more susceptible to problems while you are pregnant. Even if you don't have these conditions, older women are more likely to develop gestational diabetes and pregnancy-related high blood pressure. Additionally, there is a higher risk of placental and bleeding problems during pregnancy.
Pre-eclampsia: The risk of pre-eclampsia and eclampsia is greater in women having their first baby at a later age. The reasons for this are not well understood. In some cases, it happens as a result of having diabetes or high blood pressure before getting pregnant. Pre-eclampsia is a serious complication that can occur during pregnancy. It may cause high blood pressure, swelling of your face and hands, and protein in your urine. Subsequently, it can impair your nervous system and cause seizures, stroke, or other serious complications.
Labor Problems: The risk for having labor problems increases for women over 35 and even more for women over 40 who are having their first child. Studies have shown that older women have a greater chance of prolonged second stage labor and fetal distress. This increases the likelihood of a forceps or vacuum-assisted vaginal delivery or a C-section. Older women also have a higher risk of stillbirth.
Multiple Births: The incidence of having twins or triplets is increased in later life pregnancy even without infertility drugs. Multiple-birth pregnancies are considered higher risk.
Things To Do To Promote A Healthy Pregnancy
Although having a baby at a later age may put you at higher risk for complications, the majority of older women have healthy babies. Once you have educated yourself about the potential risks, you can turn your focus on all the things that go with a healthy pregnancy at any age. These include proper nutrition and diet, good prenatal care, and preparation both emotionally and financially for your baby and the care that will be needed.
There can be advantages to waiting until you are older to have a baby. Older women and men often find that they are more patient and realistic in coping with the challenges of a new baby than they would have been earlier in life. Likewise, they may have a greater appreciation of the joys of parenthood. Having established their careers, they may feel like they have more time to devote to the baby.
Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.