Understanding the risks of advanced maternal age

This post was written by Kara Davidson, NP, Maternal-Fetal Medicine.

In the United States and around the world, more women are waiting to have children. We see it with Hollywood stars and European royalty, but it’s also true for those pursuing a professional goal or financial stability. Whatever the reason for waiting, most women will have no problems getting pregnant or maintaining a healthy pregnancy. In this post, I’ll answer some common questions on the topic, and outline some of the slight differences for women expecting at advanced maternal age.
 

What is advanced maternal age?

Advanced maternal age (AMA) refers to a pregnant woman who is 35 years of age or older at the time of delivery. Age 35 is not too old to have a baby; however, there are risks women should be aware of. 
 

What are the risks of AMA and how are they managed during pregnancy?

There are several things women who wait to conceive should be mindful of, including:

• Reproductive challenges – The quality and number of eggs you have declines with age, making it more challenging to get pregnant. If you are having problems getting pregnant there is reproductive technology that may help. You should discuss this with your OB provider.
   
• Increased risk of miscarriage and genetic abnormalities – Your OB provider should discuss these risks and offer genetic screening before the end of your first trimester.  This is usually a simple blood draw.
   
• Multiples, such as twins and triplets – This is more common as age advances. Your OB provider may offer an ultrasound in the first trimester, which can help identify multiples and allow for a plan of care to be developed early to help prevent potential problems.
   
• Fetal malformation – As age increases, so does the risk for fetal malformation. A detailed anatomical ultrasound may be offered. This ultrasound looks at additional parts of the body that are not typically viewed in a basic ultrasound.
   
• Gestational diabetes – This condition is more prevalent in those aged 35 and older. This form of diabetes is found only in pregnancy. A glucose tolerance test will be recommended. For those with a history of obesity or gestational diabetes in a previous pregnancy, this should be completed in the first trimester.
   
• Complications with blood pressure – There is an increased risk for blood pressure problems, such as preeclampsia, to develop in pregnancy at AMA.  Your provider may recommend taking a daily low-dose aspirin to help reduce this risk. This is typically started at the end of the first trimester.

Risks progressively increase at age 40 and older. 

Additional monitoring may be recommended if problems develop during pregnancy or if you have certain health conditions existing before pregnancy, such as type 1 or type 2 diabetes, hypertension or obesity. 
 

What are the additional recommendations for those aged 40 and older?

Fetal growth abnormalities, such as growth restriction and large-for-gestational age (macrosomia) are more common with mothers of AMA. Therefore, a growth ultrasound is suggested in the third trimester.

The risk for stillbirth is also increased, so weekly monitoring is suggested some time in the third trimester. This will help to regularly evaluate your baby’s well-being.

Delivery timing is recommended in the 39th week. This is the ideal time to deliver to help reduce the risk for stillbirth and give your baby a healthy start after delivery. A vaginal delivery is recommended. It is safe and appropriate as long as there are no other reasons that would require a cesarean section (C-section).
 

Can I lower my risk of pregnancy complications if I’m older than 35?

Preexisting health conditions such as high blood pressure, diabetes and being overweight increase the risk for problems during pregnancy. It’s important to work with your primary care provider to manage these issues prior to your pregnancy. It is also important to stop smoking, stop drinking alcohol, eat a healthy diet, take a prenatal vitamin that includes folic acid and exercise regularly.

Once you are pregnant, it is important to attend all prenatal appointments and complete screening tests. Most women of AMA will have no problems maintaining a healthy pregnancy. Good health before pregnancy helps to decrease risks during pregnancy.

See a list of services Parkview offers expecting mothers, including our Nurse Midwife Program and Family Birthing Centers.

 

 

*These recommendations are based on the joint consensus of committees from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

Obstetric Care Consensus Number 11, August 2022