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Dr. Jacquelyn Means understood the challenges of being pregnant in her late 30s. “It is definitely harder on your body. You just feel a lot more fatigued.
There are certain complications to watch out for,” said Means, a Texas OB-GYN who had her first child at 37 and her second at 39. “It’s usually going to be fine, but there are things to be aware of.”
Like Means, a growing number of women are choosing to have babies later in life. A federal report indicated that 21% of all births in the U.S. in 2023 were to women aged 35 and older, a significant increase from 9% in 1990. This trend of 'advanced maternal age' elevates risks for both mothers and their babies.Older pregnant women face a higher likelihood of conditions such as high blood pressure and obesity, which can lead to complications during pregnancy. They also experience increased rates of cesarean sections and are more likely to give birth to twins or infants with genetic abnormalities.
However, experts emphasize that while risks are higher for older mothers, they are generally low and manageable. Most women in this age group have normal pregnancies, and there are various strategies to lower risks and prevent complications before, during, and after pregnancy.
“Moms over 35 can still have a healthy pregnancy and a happy baby,” stated Dr. Michael Warren, chief medical and health officer for the March of Dimes, a nonprofit organization dedicated to improving maternal and infant health.
Before conception, optimizing health is crucial, according to Dr. Ashley Zink, a maternal-fetal specialist at the University of Texas Southwestern. She likens this preparation to 'building your baby’s first home.' This involves adhering to well-established health practices such as maintaining a balanced diet, staying active, and avoiding harmful behaviors like smoking.
“Make sure those good health habits that you’ve established over the course of your life are still in place,” Warren advised. “If you have chronic diseases, ensure those are well-managed and that you’re receiving regular preventive medical care.”
Being in good health is particularly important, Zink noted, as pregnancy can be as demanding as running a marathon.
“Your volume of blood expands; it’s harder work for your heart,” she explained. “And just the discomforts of pregnancy — all kinds of things — are a little bit better tolerated if you’re in good physical condition.”
A preconception checkup can be beneficial, allowing discussions about health concerns and ensuring vaccinations are up to date.
During pregnancy, it is advisable to consult with a doctor regarding prenatal tests and scans. Medical professionals recommend a first-trimester ultrasound to assess the fetus's size, confirm the due date, and check for multiple fetuses.
Women over 35 often produce more hormones that stimulate egg production, and many may utilize in vitro fertilization, increasing the likelihood of multiple births, which can elevate the risk of complications like premature delivery.
Additionally, older mothers might consider noninvasive prenatal testing to screen for chromosomal abnormalities such as Down syndrome. The risk of Down syndrome increases significantly with maternal age, rising from about 1 in 1,250 for a woman conceiving at age 25 to approximately 1 in 100 for a woman conceiving at 40.
If screening indicates potential risks, further invasive diagnostic tests may be recommended, such as amniocentesis or chorionic villus sampling.
Zink suggested that older women inquire about a 'growth ultrasound' around 32 to 34 weeks of pregnancy.
“It shows us if the placenta is still doing a good job,” she said, noting the importance of monitoring fluid levels and fetal growth.
Late-term ultrasounds can also identify potential issues with the fetus.
“We know that when women are pregnant later in life, there’s an increased risk of birth defects,” particularly cardiac defects, Warren remarked.
Although there is a higher risk of stillbirth, it remains relatively low.
“As the delivery date approaches,” Warren advised, “it’s crucial to be attentive to cues like fetal movement. Can you still feel the baby moving and kicking?”
The incidence of cesarean deliveries rises with maternal age, averaging 48% for women aged 40 and older, according to the March of Dimes, which examined data from 2022 to 2024. Those undergoing cesarean sections face significantly higher risks of maternal complications such as infection and bleeding compared to those delivering vaginally.
Medical indications for cesareans include chronic health issues that complicate vaginal birth, such as diabetes or high blood pressure, as well as complications during labor, such as delivering a very large baby, often linked to gestational diabetes.
Placental complications, which can cause dangerous bleeding during labor, are also more prevalent among older women. Such issues, while concerning, are relatively rare; for instance, placental abruption occurs in about 1 in 100 pregnancies overall.
Means, who delivered both of her children vaginally, encountered placental issues and gestational diabetes during her pregnancies.
After her first child was born in 2023, some of her placenta was retained and required removal, leading to treatment for postpartum hemorrhage. Following the birth of her son last year, she experienced severe bleeding and required hospitalization.
“So both of my babies tried to kill me a little bit,” she humorously remarked. “Once I got past all those bleeding issues, I’ve been fine … And both my kids are super healthy, so I’m thankful for that.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
