Approaching your 35th birthday often triggers concerns about fertility and the pressure to act quickly, especially with outdated terms like “geriatric pregnancy” floating around, which only add to the anxiety and stigma. With that, the notion of a “biological clock” ticking louder than ever has become a reality for many.
However, in recent years, the age at which women are becoming mothers has been steadily increasing, thanks to shifts in lifestyles and advancements in assisted reproductive technologies. As a result, the medical community has begun to adapt and shift toward the term “advanced maternal age” to refer to pregnancy at 35 or older, recognizing the diverse paths women take toward motherhood.
The most recent data from the Centers for Disease Control and Prevention shows an upward trend in the average age of pregnant individuals in the U.S., with women ages 35 and older accounting for nearly 19% of all pregnancies and 11% of first-time pregnancies in 2020.
While starting a family later in life can be accompanied by additional risks and considerations, it’s important to remember that, with proper medical care and support, women can navigate pregnancies at advanced maternal age successfully. By understanding the potential challenges and working closely with their health care providers, women of all ages can have a joyful start to parenthood, regardless of age.
What Is Advanced Maternal Age?
Previously, advanced maternal age was often referred to as a “geriatric pregnancy,” but the term has since been phased out by the medical community. It describes a pregnancy in which the individual carrying the child is age 35 or older at the time of their child’s birth, while very advanced maternal age and extremely advanced maternal age refer to women who give birth at age 40 and over age 45, respectively.
So, why is 35 the age when women are labeled as being of advanced maternal age? That’s because fertility begins to decline during that time, while the risk of complications increases.
Women are born with their lifetime supply of eggs, with approximately 1 million to 2 million at birth. While that may sound like a lot, thousands of eggs die each month after a woman starts her menstrual cycle, leaving not a lot of eggs in the proverbial basket. But it’s not just the quantity of eggs that declines with age, it’s also the quality.
“As age goes on, our eggs get older — the quality of our eggs gets older,” says Dr. Taaly Silberstein, a board-certified obstetrician-gynecologist in private practice in Tarzana, California. As eggs age, the risk of infertility and miscarriage increase. “One of the biggest challenges is that we have a shelf life on our creative eggs,” msays Silberstein.
As women age, the body goes through physiological changes that make getting pregnant more challenging. Women’s fertility gradually decreases beginning around age 32 and more rapidly after age 37, according to the American College of Obstetricians and Gynecologists.
Although 35 is the defining number for advanced maternal age, there’s really no “magic number” when it comes to the associated risks. Your risks don’t suddenly change when you go from 34 to 35. Realistically, the decline in fertility, potential complications during pregnancy and overall health deterioration occur gradually as women age.
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Risks of Advanced Maternal Age Pregnancies
Many women choose to become pregnant later in life because of the potential advantages of waiting to have a child. Later in life, women may have more financial stability and be more settled to provide a stable environment for children. However, pregnancy risks in general increase the older you get. Advanced maternal age may increase the risk for:
— Chromosomal abnormalities.
— Miscarriage.
— Preterm delivery.
— Gestational diabetes.
— Hypertensive disorders.
— Stroke or heart attack.
Chromosomal abnormalities
A chromosomal abnormality occurs at the point when the sperm fertilizes the egg. Generally, errors in genetic sequencing can result more often as you age.
Your baby’s risk for chromosomal disorders increases when you turn 35. In fact, for pregnant people over the age of 35, the risk of having a baby with Down syndrome, a common chromosomal disorder in which an individual carries an extra chromosome, is 1 in 200, while the odds for people under the age of 25 is 1 in 1,400, according to experts.
“We don’t know exactly what the process is, in terms of why it happens,” Silberstein says.
But as women get older, the body’s ability to repair itself, as well as the precautions it takes to prevent these errors from happening, is just not in the same place, she adds.
Miscarriage
The rate of miscarriage, the spontaneous loss of a pregnancy, goes up as women get older.
According to a prospective study of more than 400,000 participants conducted in Norway, the risk for miscarriage was lowest among women ages 25 to 29, and the risk rose rapidly after age 30. In women ages 45 and over, the risk of miscarriage reached 53% in the study.
Often, chromosomal abnormalities can lead to pregnancy loss, particularly in the first trimester, which is the main contributing factor to higher rates of miscarriage.
Preterm delivery
Preterm delivery is defined as a birth before 37 weeks of pregnancy. A full-term pregnancy is considered to be when the baby is born between 39 and 40 weeks.
Premature births often carry risks for the baby, including low birth weight or difficulty breathing. Low birth weight means the baby isn’t as strong, so it could lead to problems feeding and fighting infections. Complications may vary depending on how early the baby is born. Sometimes, infants born preterm need to stay in the neonatal intensive care unit at the hospital for close monitoring and specialized support.
Gestational diabetes
Gestational diabetes is a type of diabetes that can develop during pregnancy. It’s unclear exactly why this occurs, but this is more likely to happen to mothers of advanced maternal age. Children born to pregnant women with gestational diabetes are more likely to suffer from pediatric cardiovascular disease. They also have a higher risk of developing obesity or Type 2 diabetes later in life.
About 2% to 10% of pregnancies every year in the U.S. may result in gestational diabetes, according to the CDC.
Hypertensive disorders
With older age, there’s an increased risk of hypertensive disorders in the mother, including preeclampsia and fetal growth restriction.
Preeclampsia is a condition that develops in pregnancy, and is characterized by high blood pressure. This can occur at any point during the pregnancy, and for up to six to eight weeks post-delivery.
“Usually, people go on blood pressure medications or need them for two to five months, and then at some point, the blood pressure comes back down and normalizes,” explains Dr. David Finke, an OB-GYN in private practice at Women’s Care of Beverly Hills Medical Group in Beverly Hills, California.
Other times, he says, this may spark a new baseline hypertension for the patient, and then they’re at that higher baseline for the rest of their lives.
Stroke or heart attack
If the patient develops a rare but serious condition called eclampsia — a condition in which women with preeclampsia develop seizures or coma — or high blood pressure, they may be at higher risk for other health complications.
In extreme cases, having eclampsia or simply having high blood pressure could cause a stroke during pregnancy. This can have long-term health consequences as a result.
Women who develop preeclampsia are also at an increased risk of developing stroke or heart attack earlier in life than someone who doesn’t have that history.
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Care for Advanced Maternal Age Pregnancies
Typically, unless someone has preexisting conditions like diabetes or hypertension, care throughout advanced maternal age pregnancies doesn’t vary much compared to any other pregnancy.
However, a pre-pregnancy risk assessment is often performed, as well as regular testing throughout the pregnancy.
“One thing that we want to make sure of is to be patient-centered,” says Dr. Katherine Bianco, an obstetrics and gynecology physician and director of the Maternal Congenital Heart Program at Stanford Medicine Children’s Health in California. “You really need to understand the culture and background.”
Providers typically discuss a number of lifestyle factors — like smoking, alcohol use and physical activity levels — in a pre-risk assessment.
Once you’re pregnant, health care providers can test early on if you have gestational diabetes, hypertension or other health complications and manage you properly. They’ll help you through the steps to take in order to have a healthy pregnancy and reduce your risk of preterm labor.
Historically, the risk of losing the pregnancy during amniocentesis — an invasive prenatal test of your amniotic fluid to detect chromosome abnormalities, neural tube defects and genetic disorders — increased at age 35. However, amniocentesis has become a lot safer and alternative noninvasive prenatal testing options that require blood drawn from the pregnant mother have become available in recent years, which have lowered this risk.
Care for Psychological and Emotional Aspects
Pregnancy, in general, is full of anxiety.
“For a lot of women, it’s a huge life-changing event that as much as it carries happiness, it carries a lot of anxiety and concern,” Silberstein says. “I want to hear what’s making them worried, because a lot of the time their concerns can be addressed and alleviated.”
There’s a high risk of depression during and after pregnancy is very prevalent. Though the relationship between older maternal age and depression rates during pregnancy isn’t entirely clear, data suggests that postpartum depression rates are significantly higher in women who gave birth between ages 35 to 44 than in younger age groups.
“One of the things that we do is to screen for depression in the first intake and keep an eye on the patients,” Bianco says.
From there, many clinics like Bianco’s at Stanford Medicine Children’s Health have resources to support patients throughout their pregnancy. Resources may include helping patients through acquiring medications or therapy, or referring them to a mental health provider.
With that, it’s important to speak up during visits with your OB-GYN. It’s just as important to find a doctor who is a good listener and who you feel hears and tries to understand your concerns.
Assisted Reproduction and Fertility Preservation Options
There are certain interventions that play a major role in an individual’s fertility, even before a woman gets pregnant thanks to advancements in assisted reproductive technology, namely egg freezing and in vitro fertilization.
Preserving fertility by freezing eggs, clinically known as oocyte cryopreservation, is a good option for someone who isn’t ready to have a family yet. The success rate of freezing eggs varies largely by how many eggs are frozen and at what age you freeze them.
“It’s not a guarantee,” Silberstein says. “Just because you put something on ice doesn’t mean you can use it afterwards.”
National data isn’t collected to determine success rates of freezing your eggs, but recent research from a fertility center in New York reported a 39% overall chance of a live birth from the frozen eggs. The live birth rate was higher among women who froze their eggs when they were younger than 38, and the rate rose to 70% if women under 38 froze and thawed 20 or more eggs.
Once the time is right, women undergo in vitro fertilization, a highly effective fertility treatment and the most common assisted reproductive technology. Once the egg or eggs have thawed, they are fertilized with sperm in a lab and transferred to the uterus.
“There are different kinds of technologies with regards to selection (of embryos),” Silberstein says, adding that a benefit to freezing embryos is that they can be analyzed to determine which are healthy, particularly if either individual is a carrier of a disease before they’re implanted.
The downside: Both egg retrieval and in vitro fertilization are costly procedures and are most often not covered by insurance.
Ultimately, becoming pregnant is a major life event for women of all ages, but for people of advanced maternal age, there’s more to take into consideration. Thankfully, there are options.
“The more information you have, the better off you’re going to be,” Silberstein says. “If you don’t understand, if you have questions or something doesn’t seem like it’s sitting well with you, just ask.”
Silberstein emphasizes the importance of finding an OB-GYN you trust and can confide in.
“Find a doctor who’s going to be willing to just sit there and answer your questions, address things and be straightforward with you,” she adds.
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What Is Advanced Maternal Age? originally appeared on usnews.com
Update 02/27/24: The story was previously published at an earlier date and has been updated with new information.
