Pregnancy in Late 30s: A Growing Trend with Unique Challenges

ST. LOUIS — Dr. Jacquelyn Means was well aware that being pregnant in her late 30s would come with its difficulties.

“It is definitely more taxing on your body. You feel more fatigued. There are specific complications to be mindful of,” shared Means, a Texas OB-GYN who welcomed her first child at 37 and her second at 39. “Generally, it’s fine, but there are things to keep in mind.”

Like Means, an increasing number of women are choosing to have children later in life. A federal report indicated that in 2023, 21% of all births in the U.S. were to women aged 35 and older, up from just 9% in 1990. This trend of “advanced maternal age” brings heightened risks for both mothers and their babies.

Older expectant mothers face a higher likelihood of conditions such as high blood pressure and obesity, along with an increased chance of pregnancy complications. These women are also more prone to cesarean sections and are at a greater risk of having twins or babies with genetic abnormalities.

But it’s not all doom and gloom. While the risks are greater than average, they remain generally low. Most women in this age group do experience normal pregnancies, and experts believe there are avenues to mitigate risks and prevent issues both before and during pregnancy.

“Moms over 35 can absolutely have a healthy pregnancy and a joyful baby,” advised Dr. Michael Warren, chief medical and health officer for the March of Dimes, a nonprofit organization dedicated to improving maternal and infant health.

Dr. Ashley Zink, a maternal-fetal specialist at the University of Texas Southwestern, likened optimizing one’s health to “building your baby’s first home.”

This process entails adhering to fundamental advice: maintain a balanced diet, stay active, and steer clear of harmful habits such as smoking.

“It’s essential that those good health habits you’ve developed over the years remain in place,” Warren noted. “If you have chronic conditions, it’s crucial those are well-managed. Also, keep up with regular preventive medical care.”

Being in the best possible health is vital, Zink said, highlighting that pregnancy can feel as strenuous as running a marathon.

“Your blood volume increases; that’s more work for your heart,” she explained. “And pregnancy discomfort — all sorts of things — are easier to bear if you’re physically fit.”

Having a medical checkup before attempting to conceive can be beneficial. It allows you to discuss health concerns, manage any relevant conditions, and ensure vaccines are current.

Doctors recommend obtaining a first-trimester ultrasound, which can help measure the fetus’s size, confirm the due date, and check for multiple pregnancies.

Women over 35 tend to produce more of the hormone that prompts ovaries to release eggs, which can lead to the use of in vitro fertilization. This, in turn, increases the chances of twins or triplets, heightening the risk of complications like premature birth.

It’s also wise for older women to consider noninvasive prenatal testing, which can identify chromosomal issues in the fetus, such as Down syndrome. As noted by Stanford Medicine Children’s Health, the risk of Down syndrome climbs significantly with maternal age — from about 1 in 1,250 at age 25 to 1 in 100 for a 40-year-old.

If prenatal testing indicates a potential risk, a doctor might recommend further invasive tests, such as amniocentesis, where a small sample of amniotic fluid is extracted, or chorionic villus sampling, which involves taking cells from the placenta.

Zink mentioned that women can also request a “growth ultrasound” around 32 to 34 weeks into their pregnancy.

“It helps us determine if the placenta is functioning properly,” she said. “Are the fluid levels normal? Is the growth on track?”

Late-term ultrasounds can also detect issues with the fetus.

“When women are pregnant later in life, there’s an increased risk for birth defects, especially cardiac issues,” Warren stressed.

There’s also a higher risk of stillbirth, although that risk remains relatively low.

“As the due date approaches,” he continued, “it’s crucial to be attentive to signs like fetal movement. Are you still feeling the baby move and kick?”

Statistics show that the percentage of deliveries via cesarean section rises with maternal age, with nearly 48% of live births for women 40 and older occurring through C-section according to data from the March of Dimes covering 2022 to 2024. C-sections carry a significantly higher risk of complications, such as infections and bleeding, compared to vaginal births.

Medical reasons for needing a C-section can include chronic health conditions that make vaginal delivery risky, such as diabetes or high blood pressure. Additionally, complications during labor, like delivering an oversized baby — often linked to gestational diabetes — can necessitate a C-section.

Issues with the placenta that can cause dangerous bleeding, either before or during labor, are also more prevalent in older women. (However, such complications are not frequent; for instance, placental abruption occurs in about 1 in 100 pregnancies overall.)

Means delivered both of her children vaginally but faced placenta-related issues. She also dealt with gestational diabetes during both pregnancies.

After the birth of her first child, a daughter, in 2023, some of her placenta was retained and had to be surgically removed, and she consequently had a postpartum hemorrhage. A week after welcoming her son last year, Means experienced severe bleeding that required hospitalization.

“So both of my babies tried to kill me a little bit,” she joked. “Once I got through all those bleeding complications, I’ve been fine… And both my kids are incredibly healthy, so I’m grateful for that.”