Pregnancy at the age of 38

A Guide to Pregnancy After 35

An OB-GYN shares what to expect and tips to help you have a healthy pregnancy.

While the overall birthrate in the United States is dropping, especially among people in their 20s, there has been a dramatic increase over recent decades in the number of people giving birth at age 35 and older.

“There are many reasons for the trend in delayed childbearing,” says Dr. Robin Kalish, director of Clinical Maternal-Fetal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and the NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns. These include career aspirations, financial security, availability of a wide range of birth control methods, and access to enhanced fertility treatments such as in vitro fertilization (IVF) and egg freezing, she says.

But as people get older, they face an increased risk of medical issues that can potentially complicate their pregnancy. While delivering at age 35 and older is officially considered “advanced maternal age,” Dr. Kalish notes that in reality, there’s no “magic number” for being at-risk for complications.

“A healthy 38-year-old could have an easier pregnancy than a 20-year-old who has multiple medical issues,” Dr. Kalish says. “It’s really a gradual increased risk little by little over age 35, and it’s incredibly individualized.”

Dr. Kalish adds that her over-40 patients usually ask her, “‘Am I too old?’ My answer is almost always, ‘No, you are not too old.’ And then their next question is, ‘Am I high-risk?’ Unfortunately, my answer is usually, ‘Yes.’ But with proper care and monitoring, the majority of women in that age range go on to have a healthy pregnancy.”

Health Matters spoke with Dr. Kalish, who is also an associate professor of Obstetrics and Gynecology at Weill Cornell Medicine, to understand what to expect during a pregnancy after age 35 and to learn tips to help have a healthy pregnancy for you and your baby.

Age and fertility

Fertility gradually decreases beginning at age 32 and even more rapidly after age 37. “You are born with all the eggs you are ever going to have—which is millions,” explains Dr. Kalish. “As you get older, that number decreases. But it’s more than just the quantity of eggs. As you get older, the quality of eggs decreases as well.”

Both affect fertility. While it is hard to pinpoint the exact numbers, by age 40, the chance of conceiving each month is under 10%. By the time you’re 45, it’s about 1%. “In comparison, someone in their mid-20s has a roughly 25% chance each month of getting pregnant,” says Dr. Kalish.

Before getting pregnant

If you’re thinking of getting pregnant, Dr. Kalish encourages everyone—especially those over 35—to schedule a pre-pregnancy visit with their OB-GYN. “A lot depends on a person’s age, their medical history, and their future goals,” she says. “At a pre-pregnancy visit, you and your doctor can come up with an individualized plan and put in place healthy lifestyle habits—like good nutrition and exercise—to help optimize your health for when the time is right to conceive. ”

A pre-pregnancy visit can also be a good time to talk with your doctor about fertility options. “While the biology hasn’t changed over the decades, the technology has changed,” says Dr. Kalish. “There are more options than ever before when it comes to fertility treatments and therapies.”

During pregnancy

A variety of increased complications can occur over age 35, any time from the beginning of a pregnancy to childbirth. “That’s not to say that most people over age 35 will experience these complications, but it’s worth noting that these risks are increased,” Dr. Kalish says.

Pregnant people over 35 are at an increased risk of:

• Gestational diabetes — This type of diabetes only occurs during pregnancy; your chance of developing it increases after age 25.
•  Preeclampsia — Characterized by high blood pressure during pregnancy or after childbirth, preeclampsia is more common among pregnant people who are very young or over age 40.
• Cesarean delivery (C-section) — Older women are at a higher risk for having pregnancy complications that require getting the baby out sooner.
•  Pre-term labor and/or low birth weight — This can be due to many medical reasons that require an early delivery, including the placenta not functioning well and not delivering adequate nutrients and blood supply to the fetus.
•  Stillbirth — This risk is relatively low; however, it becomes more common as a per-son ages.
•  Fetal chromosomal abnormalities — The risk of a chromosomal abnormality that can cause conditions like Down syndrome increases with age.

Many of these complications can be detected with routine prenatal checkups and tests. For example, a blood test can help diagnose gestational diabetes, and your doctor may suggest you monitor your blood pressure at home for preeclampsia. In addition, genetic screening tests (which tell you if you are high-risk or low-risk for a condition) can be used to screen for genetic conditions like Down syndrome, while diagnostic tests like amniocentesis can confirm or rule out a condition.

“It’s important for all mothers to have a robust conversation with their OB-GYN about screening and diagnostic tests, especially when it comes to chromosomal abnormalities,” says Dr. Kalish.

After childbirth

The fourth trimester —the 12 weeks after giving birth—is just as important for a mother’s health as the first three trimesters. Maternal mortality is on the rise in the U.S., especially for women 40 and older, whose death rate is nearly eight times higher than those under age 25, according to the Centers for Disease Control and Prevention. “It’s still rare, but it is a huge focus for academic institutions like ours to understand how to reduce maternal complications and mortality,” says Dr. Kalish.

This is why it’s important to prioritize your postpartum follow-up visit with your doctor. According to the American College of Obstetricians and Gynecologists (ACOG), women should follow up with their obstetric healthcare team within the first three weeks of giving birth for a post-birth assessment and also have a more comprehensive postpartum evaluation by 12 weeks. These visits are to make sure mom is recovering well and baby is healthy. For those who are considered high-risk, check in with your doctor within the first week or two.

If you are experiencing symptoms — such as fever and chills, shortness of breath, dizziness, or brisk, bright bleeding — seek medical attention immediately.

7 tips for a healthy pregnancy after 35

1. Make time for prenatal visits. Find an OB-GYN with whom you feel comfortable having honest conversations. Good prenatal care can be associated with reduced risk to the pregnancy.

2. Take prenatal vitamins. Taking folic acid even before getting pregnant can reduce the risk of some birth defects, such as spina bifida.

3. Get vaccinated. In addition to the COVID-19 and flu vaccines, make sure you are up to date on all your vaccinations before you conceive.

4. Find out if genetic testing is right for you. Depending on your age and medical history, your doctor might recommend certain screenings or diagnostic tests to check for birth defects and/or genetic abnormalities. Talk with them about what’s right for you.

5. Eat well and exercise. This is important for every mom-to-be, no matter their age.

6. Prioritize mental health. Postpartum depression affects up to one in seven mothers, and it is treatable. Have a support system in place to help you navigate the transition to parenthood, and call your doctor if you’re experiencing signs of depression.

7. Don’t forget your postpartum checkup. Postpartum care should be an ongoing process, starting with a check-in around two weeks after giving birth to make sure mom and baby are healthy.

Additional Resources

Robin B. Kalish, M.D., FACOG, is vice chair of obstetrics and the director of Clinical Maternal-Fetal Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns. She is also an associate professor of Obstetrics and Gynecology at Weill Cornell Medicine. Her expertise includes caring for women with medical conditions such as diabetes, hypertension, and lupus as well as women who conceived through in vitro fertilization (IVF) or are pregnant with multiples. In addition, she specializes in obstetric ultrasound and prenatal diagnosis including amniocentesis and chorionic villus sampling (CVS). While not all of Dr. Kalish’s patients are high-risk, she considers every pregnancy unique.

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Read More: Women's Health, advanced maternal age, childbirth, fertility, genetic testing, gestational diabetes, high-risk pregnancy, infertility, infertility treatment, maternal health, OB-GYN, obstetrics, preeclampsia, pregnancy, pregnancy over 35

Pregnancy After Age 35

Written by WebMD Editorial Contributors

In this Article

• What Is Geriatric Pregnancy?
• Geriatric Pregnancy Risks
• Geriatric Pregnancy Benefits
• How Can I Increase My Chances of Having a Healthy Baby?
• How Can I Lower My Risk for Pregnancy Problems?

What Is Geriatric Pregnancy?

Geriatric pregnancy is a rarely used term for having a baby when you’re 35 or older. Rest assured, most healthy women who get pregnant after age 35 and even into their 40s have healthy babies. That doesn't mean you shouldn't think about smart ways to make sure you and your baby stay as healthy as possible during your pregnancy.

Geriatric Pregnancy Risks

Problems can arise no matter how old you are when you get pregnant. But some become more likely when you hit 35, including:

• High blood pressure, which can lead to preeclampsia (dangerously high blood pressure and organ damage)

• Gestational diabetes

• Miscarriage or stillbirth

• Labor problems that require you to have a C-section

• Premature birth

• Low birthweight

• Chromosome disorders in the baby, like Down syndrome

Geriatric Pregnancy Benefits

On the other hand, there’s proof you might be doing yourself and your baby a favor by putting off childbearing until you’re older. Studies have shown:

• Older moms tend to be better educated and have higher incomes, so they may have more resources than younger moms.

• Older moms are more likely to live longer.

• Children of older moms may end up healthier, more well-adjusted, and better educated.

How Can I Increase My Chances of Having a Healthy Baby?

Preconception checkups and counseling. When you decide you’re ready to have a baby, take these steps before you get pregnant.

See your doctor. Get a checkup to make sure you’re ready for pregnancy physically and emotionally.

Get early and regular prenatal care.The first 8 weeks of your pregnancy are important to your baby's development. Early and regular prenatal care can boost your chances of having a safe pregnancy and a healthy baby. Prenatal care includes screenings, regular exams, pregnancy and childbirth education, and counseling and support.

Getting prenatal care also provides extra protection for women over 35. It lets your doctor stay on top of health conditions that are more common among women who are older when they get pregnant. For instance, your age may increase your risk for gestational diabetes and preeclampsia, a condition that causes high blood pressure along with protein in the urine. During prenatal visits, the doctor will check your blood pressure, test your urine for protein and sugar, and test your blood glucose levels. That lets them catch and treat problems early.

Consider optional tests for women over 35.The doctor may offer prenatal tests that are a good idea for older moms. They can help figure out if your baby is likely to have a birth defect. Ask your doctor about these tests so you can learn the risks and benefits and decide what's right for you.

Take prenatal vitamins. All women of childbearing age should take a daily prenatal vitamin with at least 400 micrograms of folic acid. Getting enough folic acid every day before and during the first 3 months of pregnancy can help prevent defects in your baby's brain and spinal cord. Taking folic acid adds extra protection for older women who are more likely to have babies with birth defects. Some prenatal vitamins have 800-1,000 mcg of folic acid. This is still safe in pregnancy. As a matter of fact, some women need more than 400 mcg to protect against birth defects. Don’t take more than 1,000 mcg (1 milligram) of folic acid without asking your doctor. Women with a history of a child with neural tube defects need 4000 mcg.

How Can I Lower My Risk for Pregnancy Problems?

You deserve the same TLC as your baby. Taking care of yourself will help you manage any existing health problems and protect you from pregnancy-related diabetes and high blood pressure. And the healthier you are, the better it will be for your little one.

Keep up with other doctor appointments. If you have a chronic health problem such as diabetes or high blood pressure, don’t skip your regular doctor visits. Managing your condition before you get pregnant will keep both you and your baby healthy. See your dentist for regular exams and cleanings, too. Having healthy teeth and gums lowers your odds of preterm birth and of having a baby with a low birth weight.

Eat a healthy, well-balanced diet. Eating a variety of foods will help you get all the nutrients you need. Choose plenty of fruits and veggies, whole grains, beans, lean meats, and low-fat dairy products. You should eat and drink at least four servings of dairy and other calcium-rich foods every day. That will keep your teeth and bones healthy while your baby grows. Include good food sources of folic acid, like leafy green vegetables, dried beans, liver, and some citrus fruits.

Gain the amount of weight your doctor suggests. Women with a normal BMI should gain between 25-35 pounds during pregnancy. If you were overweight before getting pregnant, the doctor may suggest you gain 15-25 pounds. Obese women should gain about 11-20 pounds. Gaining the right amount of weight makes it less likely that your baby will grow slowly. It also lowers the risk of preterm birth. And it makes it less likely that you’ll have pregnancy problems like gestational diabetes and high blood pressure.

Exercise regularly. It’ll help you stay at a healthy pregnancy weight, keep your strength up, and ease stress. Just be sure you review your exercise program with your doctor. You'll most likely be able to continue your normal exercise routine throughout your pregnancy. But the doctor can help you figure out if you'll need to scale back or modify your routine.

Stop smoking and drinking alcohol. Like all pregnant women, you shouldn’t drink alcohol or smoke cigarettes during pregnancy. Alcohol raises your baby's risk for a wide range of mental and physical defects. Smoking increases the chance that you’ll have a low birth-weight baby, which is more common in older women. Not smoking can also help prevent preeclampsia.

Ask your doctor about medications. They can tell you what meds are safe to take during pregnancy and while breastfeeding. This includes prescription and over-the-counter medicines, supplements, and natural remedies.

Health & Pregnancy Guide

1. Getting Pregnant
2. First Trimester
3. Second Trimester
4. Third Trimester
5. Labor and Delivery
6. Pregnancy Complications
7. All Guide Topics

Pregnancy after 35 years: how to properly prepare?

In today's world, pregnancy after the age of 35 is regarded as a common situation and is becoming more common every year. This is due to the fact that women first build a career and only then think about the birth of their first child. A second child after 35 years is also common, often in families the oldest child has already reached adolescence when he has a brother or sister. Every woman needs to know about the features, possible risks, planning and proper preparation for pregnancy after 35 years. nine0003

What are the difficulties of pregnancy after 35?

Fertility (ability to bear children) is an indicator that gradually decreases with age. Usually, fertility begins to decline after 30-32 years, depending on the characteristics of the woman's body. However, this does not mean that after 30-35 years, a physiological first pregnancy without any complications is impossible.

Average dependence of fertility on the woman's age

After the age of 35, a woman may have difficulty conceiving. It is important to remember that the age of a man also affects the likelihood of conception and intrauterine development of the fetus. Therefore, if any problems arise, both partners need to undergo a comprehensive medical examination.

If healthy men and women over 35 years of age have regular intercourse without the use of contraception, the chances of conception within 12 months remain quite high. nine0012