Pregnancy after age 35

If you are older than 35 and trying to get pregnant, you may have heard that it may be more difficult. However, many women are delaying getting pregnant until their 30s and beyond and deliver healthy babies. There are many steps you can take with your health care provider to help with having a healthy pregnancy for you and your baby.  

What pregnancy complications are more likely for women 35 and older?

As you get older, you’re more likely than younger women to have certain health conditions that can cause complications before and during pregnancy, including:

• Trouble getting pregnant (also called fertility problems). Each woman is born with a set number of eggs. You release an egg each time you ovulate, about 14 days before you have your period. So as you get older, you have fewer and fewer eggs, and the eggs you have aren’t easily fertilized by a man’s sperm. All this makes it harder for you to get pregnant. If you’re older than 35 and have been trying for 6 months to get pregnant, tell your health care provider. He may recommend fertility treatments that can help you get pregnant. 
• Preexisting diabetes. This is when you have too much sugar (called blood sugar or glucose) in your blood. Too much blood sugar can damage organs in your body, including blood vessels, nerves, eyes and kidneys. Preexisting diabetes means you have diabetes before you get pregnant. 
• Gestational diabetes. This is a kind of diabetes that some women get during pregnancy. 
• High blood pressure (also called hypertension). High blood pressure is when the force of blood against the walls of your blood vessels is too high. 
• Preeclampsia. This condition can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches. If you’re older than 40, your risk is higher for preeclampsia than for younger women.  

These health conditions can cause problems during pregnancy, including: 

• Premature birth. This is when your baby is born too soon, before 37 weeks of pregnancy. Premature babies are more likely than babies born on time to have health problems at birth and later in life. 
• Low birthweight. This is when your baby is born weighing less than 5 pounds, 8 ounces.
• Being pregnant with multiples (twins, triplets or more). Older women are more likely than younger women to get pregnant with multiples. This can happen on its own because of changes in your hormones with age, and some fertility treatments make getting pregnant with multiples more likely. Being pregnant with multiples can cause problems during pregnancy, like premature birth, preeclampsia, gestational diabetes and problems with your baby’s growth. If you’re getting fertility treatment to help you get pregnant, ask your provider about treatments that can help you get pregnant with just one baby. 
• Birth defects, including Down syndrome. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or in how the body works. Older women are more likely than younger women to have a baby with a birth defect. 
• Needing to have a c-section (also called cesarean birth). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). Like any surgery, a c-section comes with risks, like infection and reaction to anesthesia. The older you are, the more likely you are to have pregnancy complications that make a c-section necessary. 
• Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy. 

If you’re older than 35, do you need any special prenatal tests?

Because older women are more likely than younger women to have a baby with a birth defect, if you’re older than 35 you may want to have some prenatal tests to see if your baby is at risk.

Screening tests, like cell-free fetal DNA screening or maternal blood screening, check your blood to see if your baby is at risk for certain birth defects. A screening test doesn’t tell you for sure if your baby has a birth defect. It only tells if your baby may be at risk for a birth defect.

If your screening test results show that your baby may be at risk for certain birth defects, you may want to have some diagnostic tests. These tests can tell you for sure if your baby has or doesn’t have a birth defect. These tests include chorionic villus sampling and amniocentesis.

Talk to your provider about these tests to decide if they’re right for you. 

If you’re older than 35, what can you do to help you have a healthy baby?

Even if you’re younger than 35, doing these things before and during pregnancy can help you have a healthy pregnancy and a healthy baby:

Before pregnancy

• Get a preconception checkup. This is a medical checkup to help make sure you’re healthy before you get pregnant. At your checkup, talk to your provider about your overall health, lifestyle and concerns about being able to get pregnant. Also talk to your provider about your family health history, vaccinations you need and medicines you take. Your family health history is a record of any health conditions and treatments that you, your partner and everyone in your families have had. It helps your provider spot any health conditions that run in your family that may affect your pregnancy. Vaccinations can help protect you from certain diseases.
• Get treatment for any health conditions you have, like diabetes, high blood pressure and depression. Make sure your provider knows about any medicine you take for these conditions. You may need to change to a medicine that’s safer during pregnancy. 
• Take a multivitamin with 400 micrograms of folic acid each day. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. Taking folic acid before and during early pregnancy can help prevent birth defects in your baby’s brain and spine called neural tube defects and birth defects in your baby’s mouth called cleft lip and cleft palate.
• Get to a healthy weight. You’re more likely to have health problems during pregnancy if you’re overweight (weigh too much) or underweight (weigh too little). To get to a healthy weight before you get pregnant, eat healthy foods and do something active every day. 
• Don’t smoke, drink alcohol, use street drugs or abuse prescription drugs. Tell your provider if you need help to quit.
• Protect yourself from unsafe chemicals at home or work. Using some chemicals, like cleaning products and paint, may increase your chances of having a baby with a birth defect. 
• Reduce your stress. Your provider can help you find ways to reduce stress so it doesn’t affect your pregnancy.

During pregnancy

• Go to all of your prenatal care checkups, even if you’re feeling fine. Getting regular prenatal care lets your provider check on you and your growing baby. Go for your first prenatal care visit as soon as you know you’re pregnant. Talk to your provider about prenatal tests you may want to have and vaccinations you need. Some vaccinations, like the flu shot, are safe for you to get during pregnancy. 
• Keep up with treatment for any health conditions you have. Make sure your provider knows about any medicine you take for these conditions. You may need to change to a medicine that’s safer for your baby during pregnancy. 
• Gain the right amount of weight. The amount of weight to gain during pregnancy depends on how much you weigh before pregnancy. Talk to your provider about how much weight you should gain. 
• Eat healthy foods, take your prenatal vitamin and do something active each day.  A healthy diet can help you get the nutrients you and your baby need like calcium, folic acid, iron and vitamin D. Taking prenatal vitamins can help you get the nutrients you need.  
• Don’t smoke, drink alcohol, use street drugs or abuse prescription drugs. Talk to your provider if you need help to quit.
• Protect yourself from chemicals at home or work that may be harmful to your baby and reduce your stress.  
• Stay active. Regular physical activity like walking can help lessen discomfort and keep your strength up for childbirth. Talk to your provider about what’s a safe amount of exercise for you.

Last reviewed: April 2020