Pregnancy After 35

By Jeffrey Boyle, MD Dec 26, 2016

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Is 50 the new 30 in pregnancy? Having a baby after age 35 is certainly becoming more common. The percentage of U.S. women having babies after 35 is increasing.

There are lots of reasons why, including waiting to get married, second marriages, better contraceptive options and choosing additional education and career opportunities before having children. The good news is that most patients getting pregnant after age 35 do well and have healthy babies. However, there are some risks to be aware of.

Getting Pregnant

The ability to become pregnant begins to decrease starting at age 32 and decreases more rapidly after age 37. Women become less fertile with age because they are born with a limited number of eggs and, with time, these eggs become less healthy and decrease significantly in number. It is also harder for these eggs to become fertilized.

Older women are also at greater risk of acquiring medical conditions like endometriosis, pelvic infections, polyps, obesity and fibroids that can lower the chance of becoming pregnant.

Miscarriages

Women over 35 have a higher risk of miscarriage once they become pregnant compared to younger women. These miscarriages occur because of a greater chance of genetic problems like Down syndrome but also from lower quality of eggs and abnormal hormone function. Most of these miscarriages occur between six and 14 weeks gestation.

Ectopic Pregnancy

An ectopic pregnancy occurs when the embryo implants in the fallopian tubes instead of the uterus. Women 35 and older are at an increased risk of ectopic pregnancy compared to younger women because they have had more time to develop pelvic infections and scar tissue in the tubes.

Fetal Loss

Being pregnant at a later age also increases your chance of a stillbirth. These fetal deaths are usually babies with normal anatomy and chromosomes and the cause is unexplained. Fortunately, the risk overall is small, between 1 and 2 percent, for women over 35.

Health Risks

Older women are more likely to have pre-existing medical problems before getting pregnant such as high blood pressure, heart disease, kidney disease and obesity. Because of this, women having babies after age 35 are at higher risk of preeclampsia, gestational diabetes and complications during the pregnancy. Diabetes in pregnancy is also associated with a higher chance of large babies and cesarean delivery.

Chromosome Abnormalities

As a woman ages, the chance of having a baby with a chromosome abnormality increases. With time, the eggs in a woman’s ovaries become exposed to different stresses that can cause the chromosomes in the eggs to divide abnormally, resulting in missing, damaged or extra chromosomes.

The most common chromosome abnormalities associated with maternal age over 35 are Down syndrome, Edwards syndrome and Patau syndrome. Only a few pregnancies carrying an extra or missing chromosome will go to term with most resulting in a miscarriage in the first trimester.

Birth Defects

The risk of having a baby with a birth defect is low for the general population but the risk increases slightly for older women. The most common is a birth defect of the heart.

Twins

Twins are more common in women over age 35, even with natural conception. Fertility medications have also been associated with an increased risk of a multiple pregnancy. Interestingly, patients over 35 who are having twins have no more complications than younger patients.

Preterm Birth

Several studies show that patients over age 35 have a higher risk of preterm birth and low birth weight. Babies born premature can have serious medical problems throughout their lives.

C-section

Women 35 and older are more likely to need a C-section for delivery than younger women. This occurs because of the increased frequency of medical complications, more inductions, higher incidence of breech presentation, and more frequent abnormal labor patterns. Older patients also have fewer successful VBACs (vaginal birth after cesarean) and a higher risk of uterine rupture.

Lowering Risks

There is not much we can do about our age, but there are some actions you can take to improve the chances of having a healthy baby. These include:

  • Schedule a checkup with your doctor or midwife before becoming pregnant
  • Stop smoking, drinking alcohol and taking illegal drugs
  • Talk to your doctor about the safety of the medications you are currently on and if there are other options for you
  • Make sure your diabetes or hypertension are under good control
  • Eat a healthy diet
  • Take prenatal vitamins that contain at least 0.4 milligrams of folic acid daily to help reduce the risk of birth defects
  • Exercise regularly
  • Lose weight if you are overweight

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