Next Steps: Download

Read the article

This article was designed to be viewed and distributed as a PDF. Please download the PDF for easiest reading.          

WHAT IS ADVANCED MATERNAL AGE

Advanced maternal age (AMA) is the medical term to describe a woman who is pregnant over the age of 35.1 Many women are delaying pregnancy into their thirties and later with success, but there are certain risks that you should discuss with your

physician. Even though being pregnant at any reproductive age is not risk-free, there are more risks for both mother and baby when you are over 35 years old. A preconception discussion and plan with your physician can help mitigate these risks. It is important to receive prenatal care to ensure the safest pregnancy possible.

INCREASED RISKS OF AMA PREGNANCY

Miscarriage

All women are at risk for miscarriage. However, this risk increases when women are over the age of 35. Risk of miscarriage in women ages 20–30 is 8.9% versus 74.7% in women over age 40.2

Genetic abnormalities

The overall risk of having a baby with chromosomal abnormality is small, but the rates increase with maternal age. The most common abnormality is Down syndrome or trisomy 21. At age 20, the risk of having a baby with Down syndrome is 1 in 1,480 pregnancies, versus 1 in 353 pregnancies at age 35, versus 1 in 35 at age 45.3 Prenatal screening and diagnostic tests are available and offered for all pregnancies. Genetic testing is available to screen mother, father, and fetus for common genetic disorders. Having a discussion with your physician is important.

Other risks4

  • Fetal anomalies, such as heart defects,
  • Intrauterine growth restriction resulting in babies that are smaller than average,
  • Preterm birth (delivery before 37 weeks, which may lead to health problems for the neonate),
  • Stillbirth,
  • Multiple gestation pregnancy (twins, triplets, etc.),
  • Gestational diabetes and type 2 diabetes,
  • Hypertension/preeclampsia,
  • Placenta previa (placenta lies over the cervix, blocking the exit for baby during delivery),
  • Placental abruption (separation of the placenta from the uterus before delivery), and
  • Increased risk of C-section.

The Osteopathic Family Physician Patient Handout is a public service of ACOFP. The information and recommendations appearing on this page are appropriate in many instances; however, they are not a substitute for medical diagnosis by a physician. For specific information concerning your medical condition, ACOFP suggests that you consult your family physician. This page may be photocopied noncommercially by physicians and other healthcare professionals to share with their patients.

HOW DOES BEING OF AMA CHANGE MY PREGNANCY CARE?

Additional monitoring and medication may be recommended during your pregnancy to ensure the health and safety of you and your baby. Additional ultrasounds can be used to check for any abnormalities and assess amniotic fluid volume during the pregnancy due to the increased risk of intrauterine growth restriction in AMA pregnancies.1

Nonstress tests (NSTs) or biophysical profile (BPP) testing may be used once or twice weekly after 36 weeks to monitor fetal wellbeing.1 Testing may begin earlier in the pregnancy if other conditions are present. During the NST, a machine that can monitor contractions and the baby’s fetal heartbeat for 20 minutes or longer will be attached to you. This can give the physician information about how your baby is doing.

You may be asked to start a low-dose aspirin (“baby aspirin”) 81 mg starting at 12 weeks, which can help reduce the risk of preeclampsia or high blood pressure in pregnancy.5 This medication may not be appropriate for all women, so be sure to consult your physician before beginning any medication during pregnancy.

CAN I DO ANYTHING TO DECREASE THE RISKS OF AN AMA PREGNANCY?

It is important to know that most pregnancies progress without any issues when you are over 35 years old. There is simply an increased risk of pregnancy complications with increasing age. Receiving regular prenatal care can help identify and treat these problems that may arise during pregnancy. You may even want to talk to your physician before you become pregnant to make sure you are doing everything you can to optimize your health before you become pregnant.

SOURCE(S):

  1. Management of pregnancy in women of advanced age - UpToDate. Accessed March 15, 2022. https://www.uptodate.com/contents/management-of-pregnancy-in- women-of-advanced-age?search=advanced%20maternal%20age&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H1

  2. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population-based register linkage study. BMJ. 2000;320(7251):1708- 1712. doi:10.1136/bmj.320.7251.1708

  3. Having a baby after age 35: how aging affects fertility and pregnancy. Accessed March 15, 2022. https://www.acog.org/en/womens-health/faqs/ having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy

  4. Effects of advanced maternal age on pregnancy - UpToDate. Accessed March 15, 2022. https://www.uptodate.com/contents/effects-of-advanced-maternal-age-on- pregnancy?search=advanced%20maternal%20age&topicRef=454&source=see_link

  5. Low-dose aspirin use during pregnancy. Accessed March 15, 2022. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2018/07/lodose- aspirin-use-during-pregnancy