Overview

From a biological perspective, there’s a limited window for getting pregnant, spanning from reproductive age through menopause. While that offers many years of opportunity, there’s never a perfect time to have a baby. You might find yourself expecting earlier than planned, or life may lead you to parenthood later than you imagined. Whether you’re in your 20s, 30s, or 40s, age can influence many aspects of pregnancy, like fertility, potential risks, and even emotional or financial readiness.

Many women feel pressure to have children before their 35^th birthday. This idea stems from classifying pregnancy at 35 or older as “advanced maternal age.” Although this label is based on increased statistical risks, this high-risk label can create unnecessary anxiety. Especially considering most pregnancies in this age group are healthy and uncomplicated. There are also real advantages to becoming a parent in your mid-thirties or beyond. In this episode, we’ll explore how pregnancy experiences can vary across ages, what the evidence says about the risks of advanced maternal age, and how you can make confident, informed choices no matter where you are on your journey to parenthood.

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A Note for All Expecting Parents

While this episode focuses on pregnancy over age 35, age plays a role in pregnancy no matter when you conceive. Whether you’re in your 20s, 30s, or 40s, it’s helpful to understand how age can affect fertility, risks, and the overall experience of pregnancy. You may be younger now and considering your future fertility, or you may be planning for your second or third child a few years down the line. This episode is for everyone who wants to better understand how age intersects with pregnancy and how to make informed decisions at any stage.

Defining Advanced Maternal Age

Advanced maternal age is a label applied to mothers who expect to have a baby after their 35^th birthday. Even if you are not 35 now, you may have additional children as you get closer or go over this birthday. While you may not love the term ‘advanced maternal age,’ this is an improvement. Not long ago, doctors used the terms elderly primigravida for a first-time mother 35 and older or elderly multigravida for a mother over 35 with multiple children.

In 1970, the average age of a first-time mother in the United States was 21.4. By 2000, the average was 27.2. That number has remained relatively steady and was 27.5 in 2023 (the most recent year for which data is currently available). While the mean age has not changed much, the birth rate for women 29 and younger has steadily decreased, while the birth rate for mothers aged 30 and older has been increasing. According to ACOG, nearly 19% of all pregnancies in the United States are to mothers aged 35 and older. ACOG notes that observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes—for both the pregnant patient and the fetus—that might differ from a younger pregnant population, even in healthy individuals with no other comorbidities.

For an expecting mother who is 35, labeling her as a higher risk from the start can understandably come along with anxiety and stress. There are also benefits to being a mother in your mid-thirties and beyond. Let’s dive into the research and take a closer look.

The Perfect Age to Get Pregnant

There is never a perfect time to have a baby. Whenever you are pregnant is the perfect time to be pregnant, no matter what your age is. Even if you have a plan of when you want to have children, it is challenging to time that perfectly. If you have more than one child, you may have them closer together than anticipated or much further apart. 

From a biological standpoint, there is a limited window for getting pregnant, from reproductive age until menopause. Menopause, when your menstrual cycles stop, can happen in your 40s or 50s, but the average age is 51 in the United States. Typically, in your late 30s, your ovaries will start making less estrogen and progesterone. In your 40s, you will likely see changes in your periods. On average, by age 51, you officially hit menopause, your ovaries stop producing eggs, and you have no more periods. Even with this limited window, there are several decades that you can biologically get pregnant. 

Pregnancy in Your 20s, 30s, and 40s

Pregnancy in your 20s, 30s, and 40s can come with different considerations, benefits, and challenges. In Your 20s, fertility is generally at its peak, and pregnancy risks are lowest. However, this age group can also face financial instability or limited support systems depending on their life circumstances. In Your 30s, many people feel more emotionally and financially prepared. Your 40s can be a time of strong personal confidence and maturity, although risks are statistically higher. Every age comes with unique strengths, and pregnancy can be empowering at any stage of life.

Maternal Age is Increasing

According to the most recent CDC data overall, more people are having children later in life. Teen birth rates have hit record lows, and birth rates for women in their 20s continue to decline. The highest birth rate was among women aged 30–34, marking the eighth year this age group has led in births. There was a slight uptick in births among women aged 20–24 and early 40s.

The rise in births to older mothers over the decades is due to more than just declining births to younger mothers. It is partially due to the availability of contraception, career opportunities and advancement, improvements in assisted reproductive technology, and changes in social norms and attitudes. This trend is not unique to the United States.

The Organisation for Economic Co-operation and Development (OECD) released a report on the age of mothers at childbirth that includes data from 38 member countries. Most OECD countries have seen the average age of women at childbirth increase between 2 and 5 years between 1970 and 2020. With a few exceptions, the average age at which women give birth is 30 or older. Only Colombia and Mexico have a mean age of women at childbirth below 28. Only seven countries, including the United States, are between 28 and 30. In all other OECD countries, the average age of women at childbirth is at least 30, and in Ireland, Italy, Japan, Korea, Luxembourg, Spain, and Switzerland, the average age is above 32.

Celebrity Pregnancies Over 35

I thought it might be fun to know that many celebrities are having babies in their late 30s and 40s.

• J Lo, twins at 38
• Drew Barrymore 37, 39 
• Gwen Stefani 36, 38, 44 
• Tina Fey 35, 41
• Naomi Watts 39, 40
• Salma Hayek 41
• Uma Thurman 42
• Halle Barry 41, 47 
• Gisele Bundchen, third child at 44
• Hilary Swank, twins at 48
• Janet Jackson, 50

Myths and Misconceptions About Age and Pregnancy

There are a lot of misconceptions about pregnancy and age. Some people think getting pregnant after 35 is nearly impossible, while others assume being young means a smooth pregnancy. The reality is much more nuanced. Although fertility does decline with age, many women conceive naturally well into their late 30s and even 40s. While risks are slightly higher as you age, individual health, prenatal care, and lifestyle play significant roles in outcomes, often more than age alone.

Risks of Advanced Maternal Age

The American College of Obstetricians and Gynecologists greatly influences doctors and medical establishments regarding pregnancy and birth. This is also the information likely informing your care provider. ACOG has frequently asked questions about having a baby after 35. Overall, ACOG notes quite a few pregnancy risks that increase over the age of 35. We will dive into each of these throughout this episode.

Age Stratification in Research 

One thing that stood out to me as I researched for this episode is how study participants are broken into groups by age. This is true throughout all pregnancy research, not only when examining pregnancy over 35. Nearly every study groups expecting moms into age groups 30-34, 35-39, and 40+. In examining the 30-34 and 35-39 age groups, having the cut-off at 35 can skew results more than if you looked at each age separately. This trend in research can partially explain where the magic age of 35 comes from as the age at which the risk for many complications increases. The truth is that nothing magical happens regarding risks on your 35^th birthday.

Relative vs. Absolute Risk

When discussing risks during pregnancy, it’s essential to understand the difference between relative and absolute risks. Relative risk compares the chance of something happening in one group to another. For example, if women over 40 have three times the risk of a particular complication compared to younger women, that sounds dramatic. However, it doesn’t tell you how common the complication actually is. That’s where absolute risk comes in. Even if the relative risk is high, the absolute risk might still be very low. For instance, if the risk of a complication goes from 1 in 10,000 to 3 in 10,000, the relative risk triples, but the absolute risk is still quite small. Understanding the difference between relative and absolute risk gives a more balanced picture of the actual likelihood of something happening.

Overall Increase in Risk After 35

There is a lot of evidence that risks for many complications increase with age. One study of over 385,000 pregnancies found that pregnant women over 35 are at an increased risk of pregnancy complications compared to younger women. This study divided women into ages 18-34, 35-39, and 40+. Statistics from this study are used throughout this episode as we examine individual risks.

Fertility After 35

Research shows there is an age-related decline in fertility. The decrease usually starts at the age of 32, with a dramatic fall after the age of 37. The natural monthly fertility rate is about 25% between 20 and 30 years of age. This decreases to below 10% above the age of 35. 

A study of nearly 2,200 patients examined women’s fertility using donor sperm. Researchers found that after age 30, fertility declined. After 12 insemination cycles, 73% were successful for participants under 31, 61% for 31-35, and 54% for those over 35. We see similar trends in women using assisted reproductive technology to get pregnant. Data shows the percentage of IVF cycle starts that result in live births declines after 35. Until 35, 41.5% are successful, which decreases to 31.9% from 35–37 to 22.1% from 38–40 years, 12.4% from 41–42 years, 5% from 43–44 years, and 1% over 44.

Likelihood of Twins Or Multiples 

While fertility may decline with age, your chance of having multiples increases. Twins or multiples are more common with fertility treatments, but evidence shows that multiples are still more common among older women who are not undergoing fertility treatments or IVF. A study found that follicle-stimulating hormone increases with age, which can lead to your ovaries releasing more than one egg. The paradox of declining fertility but increasing twin rates with advancing maternal age is interesting to look at through the lens of evolution. It would make sense that as you get older and your fertility declines, you release more eggs to have as many children as possible while you still can. 

Gestational Diabetes 

Insulin sensitivity declines, and diabetes is more common in older women. Pre-existing diabetes occurs in .4% of 18-34-year-olds, .7% of 35-40-year-olds, and 1% of women over 40. Gestational diabetes occurs in 1% of 18-34-year-olds, 2.85% of 35-40-year-olds, and 4.86% of women over 40. Although gestational diabetes is more common in older expecting mothers, the rates are still low overall. 

High Blood Pressure and Preeclampsia

Similar to diabetes, older women generally have higher rates of high blood pressure, which occurs in 4.7% of 18-34 year-olds, 7% of 35-40 year-olds, and 8% of women over 40. A meta-analysis showed that preeclampsia, which is characterized by high blood pressure during pregnancy, was more frequent in women over 35. Across 38 studies, including over 10 million births, women aged 35 and older were about twice as likely to develop preeclampsia compared to women under 35. Those in their late 40s are up to nearly four times as likely to experience this complication compared to younger women. Remember, this is a relative risk.

Premature And Low Birth Weight Babies

Babies born with a low birth weight have more respiratory, cognitive, and neurological problems than those born with normal birth weight. Preterm babies have higher risks of heart defects, lung disorders, cerebral palsy, and delayed development.

A study examining these outcomes and maternal age showed a U-shaped association. That means low birth weight and preterm birth were more common with younger mothers and older mothers, and rates were lower for mothers in the middle. Expecting women 40 years or older had the highest prevalence of low birth weight babies and preterm deliveries. This study also compared siblings born to the same mother. The researchers found that being over age 35 was not associated with an increased risk of low birth weight or preterm delivery. Another study noted that the risk of preterm birth increased slightly with age and occurred in 6% of 18-34-year-olds, 6.63% of 35-39-year-olds, and 8.17% of women over 40.

Cesarean Birth

According to CDC data, Cesarean birth also increases with advancing maternal age. Women aged 40 and over were more than twice as likely to deliver by cesarean as women under age 20. The overall cesarean rate is 32.3%. For ages 35-39, the cesarean rate was 40.2%, and for over 40, it was 48.1%. In one study, the rate of emergency cesarean was 8.65% of women ages 18-34, 11.05% of women 34-39, and 14.24% of women over 40. Elective cesarean accounted for 4.37% of women ages 18-34, 8.6% of women 34-39, and 12.67% of women over 40.

Keep in mind that there are a lot of factors that can increase rates of cesarean birth. One is having a breech baby. A breech presentation occurred in 2.61% of women ages 18-34, 3.66% of women 34-39, and 4.57% of women over 40. Another is a previous cesarean delivery. While a vaginal birth after cesarean may be possible, a cesarean is more likely if you had a previous cesarean. Many mothers giving birth after 35 are not first-time mothers. Lastly, your practitioner’s view of the risks associated with age will also play a role in cesarean rates. Keep in mind that there are a lot of contributing factors here.

Chromosome Abnormalities

The technical term for a chromosomal abnormality is aneuploidy. A chromosome abnormality happens when a baby is born with a change in the number or structure of their chromosomes. Down syndrome (also known as Trisomy 21) is the most common chromosome abnormality. This occurs when there is an extra copy of chromosome 21. According to ACOG, the risk of having a baby with Down syndrome is 1 in 1,250 at age 20; 1 in 1,000 at age 25; 1 in 714 at 30; 1 in 294 at age 35; and 1 in 86 at age 40.

A study of over 15,000 expecting mothers from 19 to 52 found that chromosomal abnormalities increased exponentially with age. They looked at the results from a CVS or amniocentesis; these are invasive tests to check for chromosomal abnormalities. The incidence rate of Down’s Syndrome was 11.34 out of 1,000 cases at the age of 35, 15.41 cases at the age of 40, and 37.04 cases at the age of 45. Trisomy 18, also known as Edward’s Syndrome, showed an incidence rate of 1.89 out of 1,000 cases at the age of 35 years, 5.14 cases at the age of 40, and 37.04 cases at the age of 45. 

If you are over 35, that statistically increases your risk for a chromosomal abnormality. As a result, your care provider will likely offer additional testing options. Genetic testing starts with a non-invasive screening test to detect risk,. That may indicate the need for an invasive test to diagnose a condition. Be sure to discuss the risks and benefits of any tests with your doctor or midwife, as well as your options and the timing of when specific tests are available. Many of these tests have a particular window of opportunity for the most accurate results. See this episode for Your Guide to Prenatal Testing.

Miscarriage and Stillbirth 

A study based on Danish health registries had a huge sample size of over 1.2 million pregnancies. When examining maternal age and fetal loss, they found more than one-fifth of all pregnancies in 35-year-old women resulted in fetal loss. At 42 years of age, more than half of the intended pregnancies (54.5%) resulted in fetal loss. Fetal loss included miscarriage, ectopic pregnancy, or stillbirth. Miscarriage accounted for 80% of fetal losses. I know those numbers are huge. To put those numbers into perspective, the percentage of miscarriages in the 25-29 age group was 8.14%. This increased to 9.53% from 30-34 to 12.1% in 35-39 year-olds, 15.76% in 40-44-year-olds, and 27.29% in women over 45.

A systematic review of women over 35 found the risk of stillbirth increases with age. Another systematic review found more than 80% of the studies demonstrated a statistically significant increase in the risk of stillbirth among women over the age of 35. In countries with good prenatal care, the actual increase in risk was still fairly small. For example, even in the most extreme case where the risk more than doubled, the chance of stillbirth went from about 18 in 1,000 to around 40 in 1,000. That’s still a low overall number. Another study found stillbirth in .47% of 18-34-year-olds, .61% of 35-39-year-olds, and 0.81% of women over 40. 

All of these stats on stillbirth can be a little mind-numbing. Stillbirth is one of the stats constantly thrown around when you hear about getting pregnant after 35. Let’s put this into perspective. Are you at an increased risk if you are over 35? Yes. Please keep in mind that the actual risk. Even if you are in your late thirties or your forties, is still low overall. I don’t want you to think that the majority of older women are having stillbirths. The majority of older women have healthy babies. 

Maternal Mortality

A meta-analysis including over 30 million births found that mothers over 40 had about 3 times the risk of maternal death compared to those under 40, and mothers over 50 had a dramatically higher risk. These are still very rare events. In 2023, the CDC reported that women 40 and older had about 5 times the risk of dying from pregnancy-related causes compared to women under 25. That number may sound scary. Even in this higher-risk group, the actual rate was just under 60 deaths per 100,000 births; that’s less than 1 in 1,700. Maternal death is rare, but the risk does go up with age.

Limiting Your Risks

You can take many steps at any age to make yourself and your baby as healthy as possible during your pregnancy and reduce your risk of potential complications. The more you can do to improve your overall health, the better. This includes being healthy before getting pregnant, eating healthy whole foods, ensuring you stay hydrated, and taking a high-quality prenatal vitamin. Prioritizing activities like getting adequate sleep and regular exercise can also greatly benefit your health. Anything you do to keep yourself healthier will reduce your risk of complications and positively benefit you and your baby during pregnancy and birth. This is true whether you are 28 or 38. 

Why This Information Matters at Any Age

Understanding how age impacts pregnancy isn’t just for people currently over 35. If you’re in your 20s or early 30s, this information can help you make long-term decisions about family planning and set realistic expectations. You may have more time than you think. Or you may want to take proactive steps now if you hope to conceive later in life. Being informed helps you prepare emotionally, physically, and medically, no matter when you become a parent.

Benefits of Being an Older Mother 

There is never a time when everything in your life will align to have a baby at the perfect moment. I support you being pregnant at any age, especially if you are over 35. Although some risks increase, being an older mother also has many benefits. 

A review of pregnancy in women over 35 years of age found that being well-prepared for pregnancy seemed to be a characteristic more typical of older pregnant women. This is because being considered “at risk” causes women anxiety, which they try to ease by preparing themselves for pregnancy and seeking information. By listening to this podcast, you will be well-prepared regardless of your age. Not everyone pregnant is willing to do the work to get educated.

The more life experience you have should translate into you being wiser. As we age, we tend to be more patient, which can be a tremendous benefit as a new parent. A study found older maternal age was associated with less frequent use of verbal and physical sanctions toward children and fewer behavioral, social, and emotional difficulties in children.

Being an older parent may mean a longer life span. Research shows that women who had their last child after 33 were twice as likely to live to the age of 95 as women who had their last child before they reached 30.

If you have kids later, you may have more time to build your career before becoming a parent. This can lead to higher income and more financial stability. This can reduce financial stress with having a baby, allow you to take more time off, and give you more financial resources. 

Breastfeeding rates tend to be higher in older mothers. Younger mothers aged 20 to 29 are less likely to breastfeed (79.9%) than mothers aged 30 years or older (84.9%). There is so much you can do to prepare for breastfeeding during pregnancy. See this page for all of the Pregnancy Podcast breastfeeding resources.

A study in Sweden found that having a baby at an older age is associated with positive long-term outcomes for children. Researchers found that individuals born to older mothers, including those at the oldest ages, are taller, remain longer in the educational system, are more likely to attend university, and perform better on standardized tests than their siblings born when their mothers were younger.

Part of this has to do with trends in improving health and education overall. For example, a woman born in 1980 who had a child at age 20 would have given birth in 2000. If she had chosen to have a child at age 40 instead, that child would have been born in 2020. A lot changed over those 20 years, from medical advancements in prenatal care to improvements in education, technology, and social support systems. These shifts can create real advantages for children born to older parents today.

Keeping Everything in Perspective

It is crucial to remember that while there are some increased risks of getting pregnant over the age of 35, the absolute risk for most complications remains low. It is understandable that being labeled as advanced maternal age can come with some anxiety and stress. Keep in mind that the vast majority of women having babies in their 30s, 40s, and even early 50s have healthy babies.

Talk to Your Doctor or Midwife 

As always, bring any questions or concerns to your doctor or midwife. If your due date falls after your 35th birthday, ask how your age might affect your prenatal care or the genetic tests that may be offered or recommended. Being 35 or older means your provider may monitor your pregnancy more closely. This is not to alarm you, but to ensure the best outcome. The good news is that prenatal care is more advanced than ever. With modern screening tools and close observation, care providers can catch potential issues early and respond quickly. While being an older mother may come with a few extra check-ins, it also means you are likely to receive more personalized attention. You should have confidence that you have an expert by your side every step of the way through your pregnancy.

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