As more women choose to have children later in life, pregnancy at 35 and beyond—often referred to as “advanced maternal age”—has become increasingly common.
While many women over 35 experience healthy pregnancies, this stage of life introduces unique challenges. Understanding these risks can help women take proactive steps to ensure a smooth pregnancy journey.
Advanced maternal age is typically classified as 35 or older at the time of delivery, while women over 40 are often considered “very advanced.”
This trend has become more widespread as women delay childbearing due to career, education, or personal reasons.
Advances in reproductive technology have also played a role in enabling women to conceive later in life. While postponing motherhood offers benefits like financial stability and emotional maturity, it comes with added risks.
The shift toward later pregnancies has been influenced by better access to education, expanded career opportunities, and personal choices. However, this delay means more women face decisions about starting families in their late 30s or early 40s.
Despite the challenges, most women over 35 can anticipate a healthy pregnancy. Still, certain risks become more common with age.
For instance, older mothers are more likely to experience hypertension and diabetes, which can complicate pregnancy and lead to premature birth or the need for a caesarean section.
Fertility also naturally declines with age due to a decrease in egg quality and quantity, potentially leading to difficulties in conceiving. The risk of miscarriage increases as well, particularly for women over 40, due to changes in egg quality and hormonal fluctuations.
Multiple pregnancies are more likely in older women, especially those undergoing fertility treatments. While this can bring excitement, it also demands careful monitoring due to associated risks.
Placenta problems, such as placenta previa or placenta abruption, are more common, though rare. Additionally, older mothers face a higher likelihood of requiring a C-section or encountering ectopic pregnancies.
Fetal and neonatal risks
Fetal and neonatal risks also rise with maternal age. Chromosomal abnormalities, like Down syndrome, become more likely as egg quality diminishes. Preterm births and low birth weights are also more common, though modern healthcare often supports these babies effectively.
Unfortunately, the risk of stillbirth increases after age 35, particularly beyond 37 weeks of pregnancy. However, with proper prenatal care, the majority of pregnancies proceed smoothly.
Preconception health is critical for women planning to conceive after 35. Achieving a healthy weight, avoiding smoking and alcohol, and taking folic acid are essential steps. Managing existing health conditions like diabetes or hypertension can also improve pregnancy outcomes.
Prenatal care
Once pregnant, routine prenatal care becomes vital. Regular checkups help monitor for conditions such as high blood pressure, diabetes, and fetal growth issues.
Early ultrasounds and genetic screenings can identify potential complications, while gestational diabetes screening and low-dose aspirin may be recommended to manage risks.
Fetal monitoring and careful timing of delivery are also crucial to minimising complications, with labour induction often advised by 39 weeks for women over 40.
Embracing older parenthood
Despite the higher risks, many women over 35 enjoy smooth pregnancies and healthy children. Staying informed, maintaining a healthy lifestyle, and working closely with healthcare providers are key to navigating this journey. Children of older parents often benefit from the wisdom, financial stability, and emotional maturity their parents bring to the table.
Ultimately, the decision to have a baby later in life is deeply personal. With careful planning and support, women over 35 can successfully embrace the joys and challenges of pregnancy and parenthood.
Dr Joan Okemo is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi