Pregnancy After 35: Experts Tell Us What’s Fact and What’s Fear

Not so long ago, it was almost unheard of for a woman to be pregnant after age 35. Terms like “geriatric pregnancy” were often used to classify women who were expecting at later stages. Now, more and more women are becoming pregnant well into their 30s (and 40s!) and giving birth to healthy babies. Still, some risks are real as you get older, but if you’re planning a pregnancy after 35 (or are already expecting), this is what you need to know for both you and baby to be healthy and happy. 

Why Was Pregnancy After 35 Considered Dangerous?

A baby is a blessing at any age — unless you were 35 and expecting, in which case, you were placed in a different medical category entirely. But why age 35? Well, that cutoff traces back to a 1978 National Institutes of Health (NIH) conference, which labeled pregnancies in women 35 and older as high risk. 

“Pregnancy over 35 was seen as high-risk because studies showed higher rates of miscarriage, chromosomal abnormalities, and complications like high blood pressure or gestational diabetes,” explains Dr. Jaime Knopman, MD, a board-certified reproductive endocrinologist, a leading fertility expert, and Director of Fertility Preservation for CCRM Fertility Clinic in New York. “At the time, prenatal care and medical monitoring were limited, making it harder to manage these risks.” 

Amniocentesis added another level of worry for moms-to-be. “In the 1970s and 80s, amniocentesis became available for prenatal diagnosis, but it carried a risk of miscarriage,” adds Dr. Jennifer Lincoln, MD, a board-certified OB/GYN and the author of The Birth Book: An OB-GYN’s Guide to Demystifying Labor and Delivery.

“Researchers needed to establish a cutoff where the risk of chromosomal abnormalities exceeded the risk of the procedure itself.” At age 35, the risk of Down syndrome (about 1 in 350) was roughly equivalent to the procedure-related miscarriage risk, explains Lincoln, making this a practical clinical threshold.

Have Views About Pregnancy After 35 Changed?

Overall, your pregnancy is going well, and you’re feeling fine — except for some morning sickness that has made you and your toilet bowl besties. But when you go to your first pregnancy appointment and realize the medical staff is referring to you when they say “elderly multigravida” or the dreaded “geriatric pregnancy”, it can make you feel nauseous…again.

Your healthcare providers feel your pain. “That term is outdated and widely considered offensive,” says Knopman. “Modern guidelines use ‘advanced maternal age’ to describe pregnancies over 35, focusing on risk assessment rather than labeling.” 

“I fully believe that terminology matters because it shapes how people experience their pregnancies,” she continues. “Being labeled ‘geriatric’ at 35 can create unnecessary anxiety and even shame. I’d love to see these coding terms get erased!”

Modern medicine has also transformed care for expecting moms, allowing pregnancy to be possible later in life. “Improved fertility treatments mean that we’re seeing more pregnant people at older ages, again changing our idea of what might be a ‘normal’ age to be pregnant,” says Lincoln. And with women comprising about half of the U.S. workforce, it’s become the norm to see career growth come first, and building or expanding their families coming afterward.

Seeing celebs and influencers giving birth in their 30s, 40s (and sometimes 50s!) has shifted public perception. Many are proudly showing off their burgeoning bellies and have given birth beyond 35, like Halle Berry (ages 41 and 47), Hilary Swank (48), Gwen Stefani (ages 36, 30, and 44), Janet Jackson (50), Jennifer Lopez (38), Nicole Kidman (40), among many others. 

How Does Pregnancy After 35 Differ From Pregnancy at 25 — For Both Mother and Baby?

It’s a fact that fertility changes with age. “Getting pregnant naturally may take longer, and miscarriage rates are higher,” Lincoln explains. “Pregnancy complications like gestational diabetes, preeclampsia, and placental issues are more common with advancing maternal age, so we may recommend earlier or additional testing if you fall into this age group.”

Knopman agrees, adding: “Interventions like a C-section might be necessary if you’re older.” That might mean that your doctor will monitor you or require additional testing if you fall in this age group, but don’t worry — many women in their late 30s and early 40s still have uncomplicated pregnancies.

Your own health plays an important part in minimizing the risks that come with giving birth past 35. “Studies adjusting for health status show that healthy older mothers have outcomes much closer to younger mothers than raw statistics suggest,” says Lincoln. “Many of the increased risks diminish significantly, suggesting that optimizing maternal health can mitigate many age-related risks.”

The Risks of Carrying a Baby After 35

Babies born to mothers over 35 do face higher risks of chromosomal abnormalities, including Down syndrome, trisomy 18, and trisomy 13. There's also a slightly higher risk of certain birth defects independent of chromosomal issues. “Babies are at modestly higher risk of preterm birth, low birth weight, and NICU admission,” says Lincoln, adding, “Much of this relates to higher rates of pregnancy complications and medical interventions in older mothers rather than age directly affecting fetal development.” 

Although the rate is fairly low, women over 35 have an increased risk for stillbirth, according to Harvard Health. That’s why some doctors opt to induce a little earlier or will schedule additional ultrasounds in the third trimester.

What Should Women Over 35 Know, and How Can They Best Prepare for Pregnancy?

Regardless of your age, there are some steps you should take if you’re planning to become pregnant. “The most important message is that the majority of women over 35 have healthy pregnancies and healthy babies,” says Lincoln. But the truth is that aging can affect fertility, so maintaining awareness is empowering. “Understanding that fertility declines with age — and declines more steeply the closer you get to 40 — helps with family planning decisions,” she continues. 

Preconception care after 35 includes:

• A preconception visit to your OB/GYN to review medical history
• Updated vaccinations
• Achieving and maintaining a healthy weight
• Managing chronic conditions
• Taking prenatal vitamins with folic acid
• Addressing modifiable risk factors
• Genetic carrier screenings
• A fertility evaluation after six months of trying

Having a good relationship with your OB/GYN matters, too. Says Lincoln: “Working with a healthcare provider who views your pregnancy as normal unless proven otherwise (rather than high-risk by default!) can make a significant difference in your experience.”

For the most part, pregnancy after 35 is healthy, especially when you prioritize your own well-being first. While being aware of potential complications is important, use that information to empower you to have a healthy pregnancy and a healthy baby. 

The image featured at the top of this post is ©New Africa/Shutterstock.com