It’s official. More women are now having babies after age 35 than ever before. The “advanced maternal age” woman is becoming more and more the typical patient rather than the unicorn she once was.
Even so, there's still some measure of fear about pregnancy after age 35. It's a common belief that a woman is automatically high risk if she's over age 35 and in need of specialized, highly advanced care during this potentially very complicated pregnancy. But is this really the case? Is the “after 35” pregnancy as risky as we think?
I'm a double board-certified obstetrician and gynecologist and maternal-fetal medicine specialist who works with many high-risk pregnant women. Here are a few things I wish more people knew about having a baby post-35:
1. There is an increased risk for certain complications during pregnancy.
Women older than 35 are at a higher 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 automatically result in complications.
During routine prenatal care, these conditions will be monitored no matter the age of the patient. But they are simply more common in a pregnancy after age 35.
Plus, as we age there's the potential for developing medical diseases; an aging woman 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" because it's the age when the risk of genetic abnormalities starts to increase.
As a woman ages, 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, like Down syndrome, are increased. Unfortunately, these factors have nothing to do with how healthy you are after age 35; these factors are purely due to age alone.
Although this aspect of an older pregnancy is often the most feared, it's a reality that all women after age 35 face. As a result, antenatal testing through a blood test and a detailed ultrasound are recommended for women in this age group. It's also common to offer an appointment for genetic counseling. It's up to each individual, of course, as to what testing is accepted.
3. Otherwise, a healthy woman post-35 should be expected to have a completely normal pregnancy.
After consideration and assessment for the risk of a genetic abnormality, followed by a detailed ultrasound for fetal anatomy, the pregnancy should progress as normal. In this case, the only way a healthy woman older than 35 with no significant pre-existing medical conditions would be considered “different” is due to her age alone.
Of course, it's important to maintain a healthy lifestyle both during the preconception period and during the pregnancy, in order to minimize potential complications.
Some women report having more difficulties with a pregnancy at an older age, and some women report feeling better. Some women report having a harder time recovering after delivery, and some women report bouncing back easily. Every woman is different. The bottom line is that if you're healthy, you should approach your “advanced maternal age” pregnancy with the same optimism that your younger counterparts are expected to enjoy.