Pregnancy After 35: Weighing the Risks and Benefits

Starting a family after age 35 is a growing trend that has its benefits and risks. For couples that wait, many believe that the benefits outweigh the risks: they feel better prepared emotionally and financially and more established in their careers.

Erik Schulte, MD, an obstetrician/gynecologist at Nebraska Medicine — Bellevue, says he makes sure his patients understand the risks if they decide to start their family after age 35.

According to the National Health Statistics Report: Fertility of Men and Women Age 15 to 44 Years in the U.S.: National Family Growth, 2006-2010, the number of couples giving birth to their first child between the ages of 35 to 44 was 36 percent in 1975 and rose to 40 percent in 2010.

“Couples need to know that not everyone has a healthy outcome,” says Dr. Schulte. “The fact is, the longer you wait, the greater the risks and the more difficult it is to become pregnant. You are born with a set number of eggs that decrease in quantity and quality as you get older.”

So if you are approaching 30 and are considering putting childbirth on hold, here’s what you need to know.

• According to the American College of Obstetrics and Gynecology, fertility starts to decrease at age 32. At age 35, you have a 52 percent chance of pregnancy unaided. That number drops to 36 percent at age 40 and 5 percent by age 45.
• Your chances of having a multiple birth increases as you delay pregnancy.
• Studies show women over 35 are more likely to have induced labor, a diagnosis of fetal distress, the need for epidural anesthesia, forceps or ventouse delivery or require a caesarean delivery.
• You are at increased risk for a premature or low birth baby, birth defects and genetic abnormalities. For instance, the risk for Down’s syndrome is one in 900 for all women. By age 35, however, the risk for Down’s increases to one in 356 and by age 40, to one in 94.
• Older women are more likely to have prediabetes, hypertension or to be overweight. These conditions put you at higher risk for complications, therefore, you and baby will require more frequent screenings and tests.
• Your risk for miscarriage increases by 40 to 50 percent in women after age 40.

Several types of screening tests are available to help identify potential problems early. These include an ultrasound of baby and a blood test that screens for chromosomal abnormalities A chorionic villi sampling (CVS) test is more accurate and involves taking a sample tissue from the placenta; and an amniocentesis that involves taking a sample of amniotic fluid from the baby.

There are advantages to knowing about potential problems before you give birth. “If we know in advance, we can recommend you deliver in a tertiary care center which is better equipped to handle high risk births,” says Dr. Schulte.

Advance planning and preparation are key if you are planning a pregnancy later in life. “The most important thing you can do is to begin having conversations with your doctor early on so you will understand the risks and so you can fine tune your body to reduce risks for you and your baby,” says Dr. Schulte. Dr. Schulte recommends the following tips to get your body ready:

• Eat a healthy diet that is low in fats and carbohydrates, which will help decrease your risk of developing high blood pressure and diabetes during pregnancy.
• Begin taking prenatal vitamins with folic acid.
• Lose weight if you are overweight.
• Exercise regularly.
• Do not smoke, drink or take drugs.

“Even despite some of these increased risks, it is important to remember that most babies born to older mothers are healthy,” says Dr. Schulte.

To schedule an appointment with Dr. Schulte, call 877.763.3001.