Associated Women's Health Specialists  
     
     

Later Childbearing

Today, more couples are starting families later in life. Older women often worry that their age will affect their fertility and the health of their babies. There is no set age that is unsafe for women to become pregnant. For women aged 35 years and older, the chances of having a normal pregnancy and healthy baby are great — especially if they get good preconception and prenatal care. Even so, older women often have to deal with issues during pregnancy that do not apply to younger women. This pamphlet will tell you more about:
  • Special health concerns during pregnancy for women older than age 35 years
  • The importance of getting good health care
  • Counseling and testing options

If you want to have a baby, discuss any concerns you might have with your doctor. Age need not be a barrier to a safe, healthy pregnancy.
Fertility

All women have some decrease in fertility starting in their early 30s. After that time, it may take longer to get pregnant. Men also have a decrease in fertility as they age.

One reason that women may become less fertile is that ovulation, the release of an egg from one of the ovaries, occurs less often as a woman ages. Another reason may be that an older woman's eggs are not as easily fertilized as a younger woman's. Also, problems such as blocked fallopian tubes and endometriosis are more common in older women.

Birth Defects

Most children in the United States are born healthy. Some women, though, have a greater chance of having a baby with birth defects. They include women aged 35 years and older and those who have a relative or child with a birth defect. Although the risk of some birth defects increases with age, it remains low well into a woman's 30s.

The cause of a birth defect is not always known. Some defects are passed on from the parents (inherited). Some may be caused by factors in the environment. But most are caused by an error in the growth of the egg or sperm. Having extra or missing chromosomes, or parts of chromosomes, usually causes serious problems. Most children born with chromosome disorders, such as Down syndrome, have mental and physical defects.

Risk of Having a Live Baby With a Chromosome Problem
Age
Births per 1,000
20
1.9
25
2.1
30
2.6
35
5.2
40
15.2
45
47.6
If you are in your mid-30s or older and are concerned about your fertility, or if you have not conceived after 6 months of having sex without any form of birth control, you may want to talk with your doctor. With assisted reproductive technologies, it is possible for some women to become pregnant even if they have fertility problems.

Health Problems

Because pregnancy puts new demands on a woman's body, the risk of complications during pregnancy is higher for older women. They are more likely to need to visit the doctor more often, need special tests, and require special care during labor and delivery.

High blood pressure poses risks to mother and baby, including problems with the placenta and with the growth of the fetus. High blood pressure also may worsen during pregnancy.

With increasing age, women also are more likely to have diabetes or to develop gestational diabetes (diabetes that occurs during pregnancy). Women with diabetes are at greater risk for high blood pressure, pregnancy loss, and a condition in which a fetus grows too large (macrosomia).

Doctors rely on a woman's medical history, physical exams, and special procedures and tests to detect problems that may arise. In most cases, couples with risk factors have normal, healthy children. But they still need to be well informed and discuss their plans and any known problems with their doctors.

Genetic Disorders

A couple's risk of having a baby with a birth defect increases with age. Your doctor may suggest genetic counseling. Counseling often is done by a doctor or a genetic counselor (a health educator with special training in genetics, the study of inherited disorders).

Counseling will help you and your partner assess your risks and make an informed choice about getting pregnant or having testing during pregnancy. It involves giving a detailed family history and sometimes having a physical exam along with lab tests. The history and the results of the tests can help the counselor inform a couple of their chance of having a baby with a birth defect.

All women are offered screening or testing for genetic problems. Older women are at increased risk for having a baby with a chromosome problem. Talk to your doctor or genetic counselor regarding the pros and cons of having these tests:

  • Amniocentesis. In amniocentesis, a small sample of amniotic fluid (the fluid in the sac that surrounds the fetus) is withdrawn from the mother's uterus for testing. This procedure can help detect certain birth defects in the fetus during pregnancy, such as Down syndrome or other chromosome problems, and spina bifida. Amniocentesis usually is done at 15–20 weeks of pregnancy.
  • Chorionic villus sampling (CVS). With CVS, a small sample of cells is taken from the placenta and tested. CVS detects some of the same chromosome problems as amniocentesis does. This test can be performed earlier in pregnancy than amniocentesis, often at 10–12 weeks of pregnancy.
Other tests may be done to provide further information.

Being Prepared

Women of all ages should talk to their doctors before trying to get pregnant. This is especially important for women in their 30s and 40s. This will help your doctor find out if you are at risk for certain problems and prevent or treat these problems before they can harm you or your baby.

You also may need certain tests and immunizations before you become pregnant. Your doctor also may suggest some lifestyle changes to help you get ready for pregnancy, such as:

  • Eat a healthy diet.
  • Try to lose weight, if you are overweight or obese.
  • Take a folic acid supplement.
  • Exercise regularly.
  • Stop smoking, drinking alcohol, and taking illegal drugs.
  • Reduce stress.
  • Get plenty of rest.
  • Make sure your immunizations are up to date.
If you already are pregnant, getting early and regular prenatal care may increase your chances of having a healthy baby. Many problems, if found early, can be prevented or controlled.

Finally...

Most women have healthy pregnancies and babies. If you want to have a baby, discuss any concerns you might have with your doctor. Pregnancy and childbirth can be exciting, rewarding events. Age need not be a barrier to a safe, healthy pregnancy.

Glossary

Assisted reproductive technologies: Procedures that involve processing human eggs and sperm or both to help an infertile couple conceive a child.

Chromosome: A structure that is located inside each cell in the body and contains the genes that determine a person's physical makeup.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fetus: A baby growing in the woman's uterus.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Spina Bifida: A neural tube defect that results from incomplete closure of the fetal spine