Texas OB-GYN Dr. Jacquelyn Means understood the challenges ahead when she became pregnant in her late thirties.
“It is definitely harder on your body. You just feel a lot more fatigued. There are certain complications to watch out for,” explained Means, who welcomed her first child at 37 and her second at 39. “It’s usually going to be fine, but there are things to be aware of.”
Means represents a growing trend across America. Federal statistics reveal that 21% of all U.S. births in 2023 involved mothers aged 35 or older, a significant jump from the 9% recorded in 1990. This “advanced maternal age” category does present elevated health risks for both mothers and infants.
Expectant mothers in this age group face higher chances of developing conditions such as elevated blood pressure and obesity, along with increased susceptibility to pregnancy-related complications. These women also experience higher rates of cesarean deliveries and are more likely to carry twins or babies with certain genetic conditions.
However, medical professionals emphasize that while these risks exist, they remain relatively small and shouldn’t cause excessive concern. Most older mothers experience normal pregnancies, and healthcare providers offer strategies to minimize risks throughout the entire process.
“Moms over 35 can still have a healthy pregnancy and a happy baby,” stated Dr. Michael Warren, who serves as chief medical and health officer for the March of Dimes, an organization dedicated to improving maternal and infant health outcomes.
According to Dr. Ashley Zink, a maternal-fetal medicine specialist at the University of Texas Southwestern, preparing your body for pregnancy is comparable to “building your baby’s first home.”
This preparation includes maintaining established healthy practices such as consuming nutritious meals, exercising regularly, and eliminating harmful habits like tobacco use.
“Make sure those good health habits that you’ve established over the course of your life are still in place,” Warren emphasized. “If you have chronic diseases, make sure those are well-managed. Make sure you’re getting regular preventive medical care.”
Zink stressed the importance of optimal health because pregnancy demands as much physical endurance as running a marathon.
“Your volume of blood expands; it’s harder work for your heart,” she explained. “And just the discomforts of pregnancy — all kinds of things — are a little bit better tolerated if you’re in good physical condition.”
Medical professionals recommend scheduling a pre-conception appointment to address health issues, treat conditions that could impact pregnancy, and ensure current vaccinations.
Healthcare providers also advise obtaining an early pregnancy ultrasound to measure fetal development, confirm delivery dates, and detect multiple pregnancies.
Women beyond age 35 typically produce elevated levels of hormones that stimulate egg production, and may also rely on fertility treatments to conceive. Both factors increase the probability of multiple births, which elevates the risk of complications including early delivery.
Older expectant mothers might also benefit from non-invasive blood screening tests that detect chromosomal abnormalities such as Down syndrome and trisomy conditions. Stanford Medicine Children’s Health data indicates Down syndrome risk increases from approximately 1 in 1,250 for women conceiving at 25 to about 1 in 100 for those conceiving at 40.
When screening results suggest potential issues, physicians may recommend more detailed diagnostic procedures. These include amniocentesis, which involves extracting a small sample of amniotic fluid, or chorionic villus sampling, where placental cells are collected for analysis.
Zink also suggests older patients consider requesting a specialized ultrasound around 32 to 34 weeks of pregnancy.
“It shows us if the placenta is still doing a good job,” she noted. “Do you have normal fluid? Do you have normal growth?”
Late-pregnancy ultrasounds can also identify fetal abnormalities.
“We know that when women are pregnant later in life, there’s an increased risk of birth defects,” Warren said, particularly heart-related defects.
The risk of stillbirth also increases slightly, though it remains quite low overall.
“As the delivery date gets closer,” Warren advised, “it’s so important to be mindful for those cues like fetal movement. Can you still feel the baby moving and kicking?”
Cesarean section rates climb with maternal age, with March of Dimes data from 2022-2024 showing 48% of births to women 40 and older involved surgical delivery. C-section procedures carry significantly higher risks of maternal complications including infection and excessive bleeding compared to vaginal births.
Medical indications for surgical delivery include chronic conditions that make vaginal birth dangerous, such as diabetes or hypertension. Labor complications, including delivering unusually large babies often associated with gestational diabetes, also necessitate C-sections.
Placental complications that can cause dangerous bleeding are also more common among older mothers. While these issues remain relatively rare, placental abruption affects roughly 1 in 100 pregnancies overall.
Means delivered both children naturally but experienced placenta-related complications and developed gestational diabetes during both pregnancies.
Following her daughter’s birth in 2023, retained placental tissue required removal and she needed treatment for postpartum bleeding. A week after her son’s birth last year, severe hemorrhaging required hospital treatment.
“So both of my babies tried to kill me a little bit,” she said with humor. “Once I got past all those bleeding issues, I’ve been fine … And both my kids are super healthy, so I’m thankful for that.”
