Women in the US are having children later and later. “It's not a 25-year-old’s game anymore,” said Dr. Lauren Ferrara, an OB-GYN specializing in maternal-fetal medicine at Mount Sinai Hospital in New York City. The median age of women who gave birth in 2019 was 30 (up from 27 in 1990). And that's part of a growing trend of more women giving birth at 35 or older.
Why? Because they can. Numerous factors are driving women to wait, including soaring childcare costs and a desire to establish a career first (see: pregnancy discrimination and the motherhood penalty). Plus, many women are able to have biological children at older ages. Thanks — in part — to assisted reproductive technologies (ART). Though not all of them need the assist.
But still, getting pregnant and giving birth after 35 isn’t without risks. So we spoke to Dr. Ferrara about that. As well as how to prepare for pregnancy during this time in life, and why the dreaded term "geriatric pregnancy" still exists.
Are we actually 'geriatric' after 35?
“Geriatric pregnancy” is a medical term used to describe a pregnant woman who’s 35 or older. If the phrase feels ageist and makes you want to smash things — perhaps because it reaffirms old-school ideas about women’s roles and suggests women’s bodies basically expire at this age — you’re not alone. “I think it’s ridiculous,” Dr. Ferrara said of the term and its implications.
Pregnancy may indeed become riskier as women age, for both mom and baby. But age is just one factor on a spectrum of considerations. And it doesn’t necessarily stop women from having healthy biological children. Plus, all pregnancy experiences are individual and varied, regardless of age.
“It’s not so much that a switch goes off at 35 or 40,” Dr. Ferrara said. Deciding on 35 as a turning point is actually an “arbitrary threshold,” according to the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine. Some age-related pregnancy risks may not come into play until a woman is 40 or older.
As for the term “geriatric pregnancy,” you might’ve heard it lately because more people are pushing for the term to be retired. Some physicians and medical groups are already doing that. The ACOG, for example, has used the phrase “advanced maternal age” instead.
(FYI: It’s not the only loaded pregnancy lingo. See also: “Inhospitable womb” and “lazy ovary.”)
What’s the biggest thing to consider when trying to get pregnant at this age?
A major consideration is fertility and how you’re going to conceive. That’s because a woman’s ability to get pregnant drops as she ages. Fertility usually starts to decline around age 30. But it’s important not to catastrophize this. Or place the pressure all on your shoulders (men’s fertility also declines with age).
Reminder: Women are born with all the eggs they’ll have in their lifetime (about one to two million). But the number — and quality — of a woman’s eggs goes down over time. And by the time she enters puberty, she might only have around 300,000.
A woman hits her peak reproductive years from her late teens to her late 20s. (See: six seasons of “16 and Pregnant”).
Fertility drops “gradually, but significantly,” starting at 32 and and then “more rapidly” after 37, according to an ACOG committee report. (But note that women of any age can also struggle with infertility.)
Among healthy couples in their 20s and early 30s, one in four women will get pregnant in any single menstrual cycle, according to the ACOG. By 40, that number drops to one in 10.
Some specific studies have analyzed the percentage of women in different age groups who will get pregnant within a year of trying to conceive. One such study, published in 2013 in the journal “Fertility and Sterility,” looked at the pregnancy rates of 2,820 Danish women. It found that 72% of women 35 to 40 got pregnant after 12 months. For women 30 to 34, it was 86%.
“The fertility part, we can't get away from,” Dr. Ferrara said. “Unfortunately, there is a limit with spontaneous conception. That part, science hasn’t gotten us past.” But science has given women more opportunities to get pregnant through ART. Which includes procedures like IVF, egg freezing, pregnancy with donor eggs, and others. It allows women who face challenges to have healthy babies, too.
Think about how many children you’d ideally like to have, Dr. Ferrara said. Because that will play a big role in when you should start trying to conceive. Especially considering that many health institutions and OB-GYNs recommend waiting at least a year to 18 months after delivery before trying to get pregnant again. (Note: that’s the recommendation for women of any age).
“If somebody wants to have four children starting at 39, it’s going to be potentially difficult, at least with spontaneous conception. Not impossible,” Dr. Ferrara said. “There has to be some thought into the number of pregnancies and their planning.”
If you have concerns and/or are 40, Dr. Ferrara recommends meeting with a high-risk OB-GYN. But she emphasized that doesn’t mean you have to see a specialist throughout your pregnancy. Because most general OB-GYNs can take care of women who are over 40, she said.
Think of that meeting as more of an info-gathering session. It’s an opportunity to find out if there are certain things you might be at a higher risk for and if you’d need to be closely monitored.
Besides fertility, what are other risks to consider with pregnancy at 35+?
Miscarriage rates… About 10% to 20% of all known pregnancies end in miscarriage. These rates increase progressively as women get older. A study of about 420,000 pregnancies in Norway concluded those rates are 16.7% for women who are 35 to 39 and 33.2% for women who are 40 to 44.
C-section rates… They may become more common as the age of a pregnant woman increases because risk factors associated with the need for a C-section tend to increase with age. For example, a population study of birth certificates from Washington State found women younger than 35 had a 26% cesarean delivery rate. While nearly 36% of women who were aged 35 to 40 had C-sections and 43% of women over 40 C-sections. But Dr. Ferrara said that older age doesn’t necessarily raise the risk. Some women at this stage might have an elective C-section out of concern. “The older you are, you’ve probably heard more stories about birth trauma,” Dr. Ferrara said. And women who have invested heavily in — and undergone the grueling process of — IVF may see a C-section as a more predictable option, Dr. Ferrara said. In some cases, doctors “may act a little bit quicker” and recommend C-sections in older patients who develop certain medical issues, including high blood pressure and preeclampsia. Those conditions can lead to long-term risks and may be more difficult to “bounce back from,” Dr. Ferrara said.
Medical complications… This age group is at a higher risk for developing gestational diabetes, placenta previa, preeclampsia, and pregnancy-induced high blood pressure when compared to younger women.
Chromosomal abnormalities... Think: Down syndrome and Edwards syndrome. At age 25, the risk for Down syndrome in the baby is about one in 1,250 to 1,400. At 40, it’s closer to one in 100. And Dr. Ferrara said genetic testing for these conditions, and others, have improved substantially since they were first introduced, and that they “should be offered to every woman, not based on her age.”
Stillbirth... The risk of stillbirth increases with maternal age. The stillbirth rate for women younger than 35 was 6.2 per 1,000 births, according to data from the National Center for Health Statistics' 2001 to 2002 perinatal mortality and natality files. That number rose to 7.9 per 1,000 births in women ages 35 to 39 and 12.8 per 1,000 births in women 40 and over.
Got it. Is it true that pregnancy at 35+ is also more uncomfortable?
It depends. Some women, after learning that they’re high-risk due to their age, might worry more. Or they might internalize that they’re “old” and can’t get through the pregnancy easily. “They’re made to think that,” Dr. Ferrara said.
Some women over 35 may report feeling achier during pregnancy. Things like back pain, pelvic pain, and/or pelvic pressure, Dr. Ferrara said. (Though pregnant women of any age could experience these discomforts). Also, just general wear and tear on the body over time can make anything bother you more (see: bending down to plug in a charger). Let alone growing an entire human inside you.
“Certain things hurt more when you’re a little older,” said Dr. Ferrara. “I don't want to be 20 [again]. But I wish my back was 20.”
That’s not to say everyone will have a hard time. Dr. Ferrara said she’s seen older patients breeze through their pregnancies with very few physical complaints. She attributes that, in part, to people having more awareness around health and wellness than 30 years ago. And also to a big shift in mindset around age.
“Our perception of age is not the same,” Dr. Ferrara said.
She pointed to the fact that in the 80s, the characters on ‘The Golden Girls’ represented life in your 50s. But now, the range of that experience has been redefined, thanks to stars like Jennifer Lopez who headlined a Super Bowl halftime show at 50 (and also more recently educated us all on breakup revenge).
Any benefits to having children later?
Yes. Several studies have found that there may be some benefits — for the whole family — when parents have children at an older age. For one, women who delay having children are more likely to earn more money over the course of their careers. Research suggests that children of older parents (older mothers, in particular) may perform better at school and at work, and may exhibit fewer behavioral and emotional issues than children born to younger parents. Another study found that women who gave birth to their last child later in life may live longer. See: 'Kids keep you young.'
Age is certainly a big factor in fertility and pregnancy — but it’s not the only one. So although the number of candles on your birthday cake might hint at what your experience could look like, it won’t dictate it. Because no two pregnancies are alike. Arming yourself with information — and some extra life experience — could give you a better sense of what to expect.
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