When Heather Coleman delivered her third baby at the age of 39, she wasn’t nervous. “I knew a pretty good amount of what was going to happen,” she says. “I felt confident.”
Her labor and delivery went well and she’s finding that motherhood the third time around has gone relatively smoothly because she feels more prepared.
“Nursing has been way easier this time because I knew what to do,” says Heather. “With my first child, I had no idea what I was doing, but now it’s easier.”
On paper, she was considered to be of “advanced maternal age.” But in real life, she felt strong, energized and supported, just as she had in her two previous pregnancies.
The term “advanced maternal age,” formerly called “geriatric pregnancy,” can carry negative connotations. For decades, it has signified a cut-off age at which the risk of certain pregnancy-related complications increased. But is 35+ really an age to fear when it comes to pregnancy, whether it’s your first child or third?
What is advanced maternal age?
“Advanced maternal age is defined as patients who are 35 years or older,” explains Heather’s provider, Dr. Rachel Tang, an OB-GYN at Atrium Health Women's Care Eastover University OB-GYN. “It is an age that was selected based on evidence showing decreasing fertility and increasing risk of genetic abnormalities in babies born to patients over this age. But the truth is, it’s not like you turn 35 and suddenly your risk increases the next day. It’s on a continuum.”
So, while it’s true that your risk of certain genetic abnormalities increases and your fertility may decrease with age, the changes occur gradually, not overnight.
Why more women are choosing pregnancy later in life
Across the United States and worldwide, more women are choosing motherhood later in life as they pursue career growth, financial stability or personal goals.
“We’re seeing a worldwide trend,” says Tang. “Starting a family is a deeply personal decision and each person has different circumstances that lead them to decide if and when the time is right.”
The age of 35 was historically established as the threshold for advanced maternal age because until that age, the statistical risks of certain tests outweighed the potential benefits. Dr. Michael Finlon with Atrium Health Women's Care Eastover University OB-GYN, who also worked with Heather, says, "Today, with many non-invasive screening options available, this guideline is less rigid, but it still shapes how care is discussed and delivered."
Pregnancy risks after 35
Tang notes that patients over 35 face increased risks of gestational diabetes, preeclampsia, labor complications and cesarean delivery.
Additionally, mothers over 35 may be more likely to enter pregnancy with existing chronic conditions like type 2 diabetes or high blood pressure (hypertension), which can increase the risk of pregnancy complications.
Another factor to consider is genetics. The chances of chromosomal abnormalities and miscarriage gradually rise with age because of changes in how the ovaries function.
“For most patients between 35 and 39, it really depends on how their pregnancy progresses,” says Tang. “We monitor them routinely and if any conditions develop, such as preeclampsia or gestational diabetes, we increase their testing and visits.”
For women 40 and above, the standard of care shifts toward more intensive monitoring in consultation with maternal-fetal medicine providers, including third-trimester ultrasounds and fetal surveillance.
Prenatal care for patients 35+
One common misconception is that prenatal care looks vastly different after age 35.
“The number of OB-GYN visits doesn’t change if it’s an uncomplicated pregnancy,” says Tang. “But if a patient has complications that develop during pregnancy, we may require more monitoring.”
For women 35 and older, Tang says there are some risk-reduction measures OB-GYNs recommend:
- Low-dose aspirin may be recommended to prevent preeclampsia (always check with your OB-GYN before taking a prescription or over-the-counter medication during pregnancy).
- Genetic testing options, such as cell-free DNA blood tests, are available to patients of all ages and are emphasized after 35, but are still optional.
- Genetic counseling is also optional, but it can offer clarity for patients considering their testing decisions.
“It’s a personal decision whether you want to undergo genetic testing or not,” says Tang. “We’re here to provide information on what options are available and support you.”
Heather remembers being offered these options. She chose to undergo genetic testing during her third pregnancy, just as she had during her second. She was supported by Tang and Finlon, both of whom provided open, patient-centered care.
“I decided to get genetic testing with my third pregnancy, just like I did with my second pregnancy,” she says. “Both Dr. Tang and Dr. Finlon were very open and patient-centered. They ensured I knew my options, but I never felt pressured because of my age.”
Planning for pregnancy after 35
If you’d like to conceive later in life, especially for the first time, Tang says preconception counseling can be valuable.
“A lot can affect your fertility, not just your age,” she says. “We factor in your overall health, including preexisting medical conditions, that may affect your future pregnancy. If conception is difficult, we have options like ovulation induction, intrauterine insemination and in vitro fertilization through our reproductive endocrinology colleagues.”
Tang also recommends prioritizing your mental and emotional well-being. Pregnancy at any age can come with emotional highs and lows, but the “35+” label can add anxiety.
“There’s some component of stress and anxiety that’s inevitable because of what patients hear from others,” she says. “That’s why we ask about your physical health, mental health and home support at each visit.”
Making the best decision for you
While pregnancy after 35 does come with some increased risks, it also comes with options and support.
“Starting a family or increasing your family size is deeply personal,” says Tang. “My best advice is to talk with your OB-GYN. Share your concerns and let us help answer any questions you may have. Also, you’re not alone if you’re 35 and up. It’s more common than you think and we’re here to support you.”
Learn more about gynecology and women’s care at Atrium Health.
