*Updated 6/2024
It’s official. More people are having babies after age 35 now than ever before. The “advanced maternal age” patient is becoming more typical rather than the unicorn they once were. Even so, there seems to still be some measure of fear about pregnancy after age 35. It is a common belief that a person is automatically high risk if they are over age 35 and in need of specialized, highly advanced obstetrical care during this potentially complicated pregnancy. But is this really the case? Is the “after 35” pregnancy as risky we think?
If you are planning on a pregnancy after age 35, here are a few things you should know…
1. The after 35 pregnant pregnancy IS at an increased risk for certain complications.
People after age 35 are at an increased risk for developing diabetes and/or high blood pressure, having a multiple gestation, delivering prematurely, having a large or a low birth weight baby, requiring a cesarean section, having placenta previa and experiencing pregnancy loss. This does not mean, however, that your pregnancy is a ticking time bomb. It does not mean that your pregnancy will result in complications.
During routine prenatal care, these conditions are being monitored for no matter the age of the patient, but they are simply more common in a pregnancy after age 35. In addition, as we age there is the potential for developing medical diseases; an aging individual who becomes pregnant is no exception. If you have these or any other pre-existing medical conditions, in addition to being advanced maternal age, you will be monitored more closely during your pregnancy.
2. Age 35 is a “milestone” of sorts because that is the age when a person's risk of having a baby with a genetic abnormality or difference, like Down Syndrome, starts to increase.
Egg quality (the number of eggs that are genetically normal) starts to dramatically decrease after age 37 and particularly after age 40. This means the chances of early pregnancy loss and having a pregnancy with a genetic abnormality or difference are increased. Egg quantity (the numver of eggs available for fertilization) aldo decreases. Unfortunately, these factors have nothing to do with how healthy you are; they are purely due to age alone.
This aspect of an after 35 pregnancy is often the most feared. As a result, it is recommended that people pregnant at age 35 and older get prenatal genetic screening testing through a blood testing (ie NIPT, NIPS, quad screen) and a detailed fetal ultrasound. It is also recommended that an appointment for genetic counseling be offered. It is up to each individual, of course, as to what testing is accepted.
Getting prenatal genetic screening testing is extremely helpful if any abnormalities are found during the fetal anatomy ultrasound that is typically done at 18-22 weeks of pregnancy. In some situations, if the prenatal genetic screening testing shows that the pregnancy is at low risk for a genetic abnormality or difference, no additional testing is indicated. In other situations, it can help us better counsel you about the chance that there is a genetic abnormality or difference if an abnormality is found.
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3. An otherwise healthy individual at age 35 and older with no significant pre-existing medical conditions, low risk prenatal genetic screening testing, and normal fetal anatomy ultrasound should be expected to have an uncomplicated, healthy pregnancy.
After consideration and assessment for the risk of a genetic abnormality or difference occurring followed by a normal detailed ultrasound for fetal anatomy, the pregnancy should progress as normal. In this case, the only reason for being "high risk" may be due to your age alone. and the risks I mentioned earlier. Maintaining a healthy lifestyle both during the preconception period and during the pregnancy is ideal in order to minimize potential complications.
Some people report having more difficulties with a pregnancy at an older age and others report feeling better. Some people report having a harder time recovering after delivery and others report bouncing back easily. Every person and every pregnancy is different. The bottom line is that if you should approach your “advanced maternal age” pregnancy with the same optimism and sense of security that your younger counterparts are expected to enjoy, with the knowledge that extran screeing and surveillance will ve recommended. Education about the risks and realities is key so you are well-informed on what to expect with your after 35 pregnancy.