What you should know about having a baby after 35

If you are thinking about having a baby in your late thirties or early forties, you are not alone. Even as birth rates decline in the United States, the number of people having babies in this age group is going up. About 20% of women in the United States now have their first child at or after age 35. 

While it may be discomforting to hear phrases like “geriatric pregnancy” or “advanced maternal age,” I hope you’ll remember that most healthy people in this age group have healthy pregnancies, births and babies. 

We certainly don’t want anyone to be fearful if they’re in this age group. It’s important to be informed so we can work together to make sure you’re getting the right care for you and your baby. 

What are the risks of having a baby after age 35?

There’s no dramatic change that happens when someone turns 35. A woman's risk for general health issues and pregnancy-related health issues gradually increases every year — and there's not much difference between 34 and 35. 

Medical research indicates that pregnancy-related risk factors are worthy of additional discussion for pregnant people who are over 35. So, you shouldn’t be surprised if your doctor talks about being at higher risk for certain conditions. 

Physical health risks 

• Fertility issues. A natural decline in egg count and quality may make it more difficult to become pregnant. We recommend those over 35, who haven’t been able to conceive for six months, talk to their health care provider. 
• Gestational diabetes. Gestational diabetes is the type of diabetes that develops during some pregnancies. There is a higher rate of gestational diabetes in people over 35. People will need to maintain healthy blood sugar levels through diet and activity. Your doctor may prescribe medications as well. If not treated, gestational diabetes can lead to a larger than average baby, an increased risk of premature birth and high blood pressure during pregnancy. Gestational diabetes also increases your risk of diabetes in later adulthood.
• High blood pressure. People over 35 are more likely to experience high blood pressure when pregnant, also known as gestational hypertension or hypertensive disorders of pregnancy. This is due to physiological changes, and it can impact both the pregnant person and the baby if not properly managed. Your appointments will include routine blood pressure readings. 

Pregnancy complications

• Cesarean (C-section) births: Due to an increase in other complications, C-section births are more common for birthing people over 35.
• Multiples: The likelihood of having twins or multiples increases with age. Hormonal changes may cause the ovaries to release more than one egg during ovulation. Infertility treatments, which may be more common in birthing people over 35, may also increase the risk of multiple gestations.
• Miscarriage: The risk of miscarriage increases with age. This can be due to several factors such as aging eggs, other medical conditions and hormonal imbalances.  
• Premature delivery: Premature deliveries and low birth rates are also more common in birthing people over 35.
• Stillbirth: The higher incidence of pregnancy loss may be due to other complications, such as a higher rate of chromosomal conditions. 
• Maternal mortality (death): There is an increased risk of maternal complications and maternal death in birthing people of advanced maternal age. Routine prenatal care, recognition of warning signs, and optimizing your health are important to help modify this risk.

Genetic risk considerations

• Chromosomal conditions: Research has shown babies born to someone over 35 have a higher likelihood of certain chromosomal conditions. As eggs age, they are more likely to package the incorrect number of chromosomes. 
  • The incidence of Down syndrome increases with age. 
  • Trisomy 18 or Edwards syndrome is more common when the birthing person is over 35.  

Benefits

Rates of pregnancy over age 35 are increasing, and there is still a higher likelihood of having a healthy baby than the complications above. Many families will cite benefits to having children when they’re slightly older. 

• Financial stability: Older parents tend to have more established careers and therefore more financial security, making it easier to provide opportunities for their children.
• Emotional maturity and experience: People over 35 may have more life experience and emotional maturity to draw upon when parenting their children.

How to prepare before becoming pregnant

It's a good idea to schedule an appointment with a doctor before getting pregnant to discuss a pre-conception plan and ensure optimal health during a pregnancy. If you are healthy overall, a plan may include staying active, eating healthy and taking a prenatal vitamin.

If you are overweight, have diabetes, high blood pressure or another health issue, your doctor may want to devise a plan to address those issues before you become pregnant.

If you are experiencing difficulty getting pregnant, your physician may move more quickly to evaluate you for infertility treatments.

Infertility treatment options

Your provider may recommend testing options to determine the best treatment for you. This can be a combination of blood tests, imaging tests and physical procedures like a pelvic exam for both you and your partner. Based on the cause of infertility, your doctor may suggest one of the following options. 

• Lifestyle changes. A doctor may suggest both people make lifestyle changes such as limiting alcohol and increasing physical exercise. 
• Tracking sex. A doctor may advise you to track your ovulation cycle and have sex around the time of ovulation. 
• Surgery. There are procedures that may help with infertility, for example, surgery to address a sperm blockage. Surgeons can also remove polyps or fibroid tumors that may impact someone’s ability to achieve or maintain a pregnancy. 
• Medicines. There are medications that improve sperm count, and others that can regulate someone’s menstrual cycle and ensure an egg is being released. 
• Intrauterine insemination (IUI). A doctor may place healthy sperm in the uterus during ovulation to increase the likelihood of fertilization.  
• Assisted reproductive technology (ART). ART encompasses a variety of medical procedures to help people conceive children. In vitro fertilization is the most common type of ART in which eggs are fertilized with sperm in a lab. Eggs may be provided by the future parents, or donor eggs and sperm may be used.

What to know during pregnancy

Whether you are in your twenties, thirties or forties, and whether you're having a low-risk or high-risk pregnancy, there are steps you can take to improve your health before and during pregnancy. 

• Avoid alcohol, tobacco and any other Illicit drugs
• Discuss medications you’re taking with your doctor
• Stay within pregnancy weight-gain guidelines
• See your doctor regularly

Screenings to consider

• First trimester screen. A blood test and a nuchal translucency, which is an ultrasound to measure the thickness of the tissue at the back of an unborn baby's neck. 
• Second trimester screen. A blood test known as a serum screening or "quad test" to determine whether the baby is at risk for certain birth defects. 
• Sequential screen. A combination of both a first and second trimester screening
• Non-invasive prenatal testing (NIPT). A DNA blood test that screens for common chromosome abnormalities.

Other diagnostic tests to be aware of are chorionic villus sampling and amniocentesis, which are procedures to provide diagnostic genetic information about the developing pregnancy. These may be recommended based on risk factors and results of other screenings. You will likely be referred for a Level II ultrasound, which is a detailed ultrasound evaluating the baby's anatomy. If you're 35 or older, your doctor may also recommend additional ultrasound exams or fetal testing, especially at the end of your pregnancy.

Depending on your health and any pregnancy complications, you may require increased visits to your doctor or appointments with a specialist. At Minnesota Perinatal Physicians, part of Allina Health, we provide personalized high-risk care for all maternal health concerns, pregnancy complications and fetal abnormalities.

Putting it in perspective

As previously mentioned, there isn't anything really remarkable about turning 35. If you are considering having a baby, the best thing to do is take good care of yourself and your body to prepare for a new life. If you are struggling to overcome pregnancy anxiety, there are mental health professionals who can help.