There are many women who delay pregnancy until they are older. Many women are surprised to hear themselves referred to as being at an “advanced” maternal age at their first prenatal visit. There is no precise age that is considered to be “advanced” when a woman becomes pregnant. The American Medical Association has defined advanced maternal age at 35, and age 45 or older as very advanced maternal age. In 2013, there were over 700 births reported to women over the age of 50.
Pregnancy in women that are 35 years, or older, carries an increased risk for complications, such as ectopic pregnancy, fetal chromosome abnormalities, miscarriage, placenta previa, gestational diabetes, and preeclampsia. There is also an increased risk of delivery by cesarean section. There are also benefits to having a baby at an older age. Older couples tend to be more financially stable and emotionally mature.
Pregnancies in women considered to be at advanced maternal age are managed differently than pregnancies in younger women. For example, obesity and advanced age increases the risk for a woman to develop type 2 diabetes, as well as gestational diabetes. Because of this, it is recommended that these women be screened for gestational diabetes in their first trimester (first 13 weeks of pregnancy), rather than between 26 to 28 weeks. The risk of the baby having chromosomal abnormalities (such as Down Syndrome) should be discussed, as well as the available screenings and testing.
In the third trimester (28 weeks until delivery), performing an ultrasound between 38 and 39 weeks gestation should be considered. This will allow the woman’s physician or midwife to monitor baby’s growth and amniotic fluid volume. A non-stress test and biophysical profile may also be performed twice a week, beginning at 36 weeks gestation. Instructions may be given for the woman to monitor her baby’s movements each day.
There is an increased risk of stillbirth in women over 40. Because of this risk, the woman’s physician may not allow the pregnancy to continue past 39 weeks gestation, inducing labor at that time if labor has not started on its own.
A woman who becomes pregnant at an older age should have a detailed discussion with her physician or midwife regarding her plan of care. With good prenatal care, the risk of developing complications can be reduced, increasing the likelihood of delivering a healthy baby.
Fretts, R. (2017). Effects of advanced maternal age on pregnancy. UpToDate. Retrieved from