There are many reasons women may delay pregnancy. According to the American College of Obstetricians and Gynecologists, there is an upward trend in the average age of pregnant individuals worldwide. 

Approximately 19% of all pregnancies and 11% of all first pregnancies are currently in those over age 35 in the United States. In 2020, the average age for first births was 27.1 years compared with 21.4 years in 1970. 

If you are pregnant or planning a pregnancy over age 35, you may have many questions or concerns about pregnancy and childbirth. 

Definition of geriatric pregnancy

We define advanced maternal age (formerly geriatric pregnancy) as those who are 35 years or older at their estimated delivery date. Historically, pregnancies at this age or older are considered at higher risk – for patient and fetus – for various reasons.

Increased risk factors for pregnancy at age 35 or older

While pregnancies at age 35 and older are considered high risk, not all will face the same challenges. Potential risks are on a continuum and increase with age. Medical studies divide these age ranges and their associated risks into five-year increments. 

"At Nebraska Medicine, we look at age as only one component," says Teresa Berg, MD, Nebraska Medicine maternal-fetal medicine doctor. "We consider everything that may be going on in your life that could complicate your pregnancy and then make plans based on all the variables." 

Increased risk factors exist for a variety of reasons, including:

• The development of age-related diseases, such as high blood pressure, obesity or diabetes
• As the number of eggs decreases with age, the remaining eggs are at higher risk of disorders that can affect fertility and chromosome abnormalities
• Lower fertility rate

Potential complications include an increased risk of:

• Gestational diabetes
• Cesarean delivery
• Preterm birth
• Miscarriage and stillbirth
• Fetal growth
• Chromosomal abnormalities and congenital malformations
• Multiple pregnancies (twins)
• Preeclampsia, especially over age 40

Pregnancy care over 35: What to expect

What to expect for pregnancy care and screening depends on your age, health history, and other factors. Your doctor will consider all risk factors when developing your individualized care plan.

Depending on your situation, expect to discuss:

• Ultrasounds: At a minimum, one in the first trimester, one at 20 weeks, and one in the third trimester (detailed ultrasonogram). Women over 40 with risk factors may receive ultrasounds every 4 to 6 weeks
• Potential prenatal DNA screening, genetic counseling or diagnostic testing
• Antenatal fetal surveillance: tracing heart rate, fetal activity and amniotic fluid (once or twice per week)
• Preferences for labor and delivery
• If you have two or more risk factors, your doctor will most likely recommend daily, low-dose aspirin to reduce the risk of preeclampsia

"Although there is an increased risk at or over age 35, we still see the majority of women deliver at term with babies that thrive," says Dr. Berg. "There are more decisions to be made, but typically these women approach with the readiness and education they need to start or expand their family."

Preparing for your pregnancy

If you're planning a pregnancy over age 35, look closely at your current health and any medications you are taking. If you have a chronic health problem, address it with your doctor. Ask them how you could make pregnancy safer and healthier. 

"We support our patients by treating the whole person," adds Dr. Berg. "We discuss not only all physical aspects but also things like their support system and mental health. We walk them through what to expect at every stage of pregnancy and guide them through it."

Tips to keep in mind:

• Unless you have a chronic illness or a medical condition, you may not need to see a maternal-fetal medicine specialist. It is common to stay with your obstetrician and only consult with a high-risk specialist if and when needed 
• If you're at risk of early delivery, try to get your house ready earlier to feel prepared
• If or when complications occur, know that there is nothing you did (or didn't do) that caused them
• Consider attending one of our childbirth education classes and pregnancy and postpartum support groups

Nebraska Medicine Olson Center for Women's Health has a team of maternal-fetal medicine specialists with specialized expertise in managing high-risk pregnancies. If you're new to Nebraska Medicine and need to schedule a new pregnancy appointment, please call 402.559.4500.