I know a thing or two about having a so-called high-risk pregnancy. I’ll never forget when I first saw the term “elderly multigravida” on my medical record. There it was, confirming all my worst fears: Apparently, I was old, and of course dying of something very, very grave. Except that definitely wasn’t the case.
I was, in fact, simply 35 and enjoying a healthy pregnancy with my second child.
“Elderly,” in the language of obstetrics, refers to pregnant people who are 35 or over. (Multigravida means I had been pregnant more than once. If it were my first pregnancy, my code would have read “elderly primagravida.” Elderly multigravida, elderly primagravida—just as bad!) These are just a couple of the foreboding terms people who are pregnant over 35 must contend with. There’s also “advanced maternal age,” “geriatric pregnancy,” and, of course, the fact that I was considered “high-risk.”
Am I being overly sensitive? As a health editor, I should be used to this, right? Or is age 35 really when your chances of having a healthy pregnancy start to drop?
Pregnancy over 35 is actually quite common.
I had my first child at 33, my second at 36, and recently delivered my third at age 39. When I got pregnant at 32, I was one of the first of my friends to have kids. The rest joined the club after age 35, echoing a national trend of waiting longer to start having children.
“People might want to get their career going and wait a little while, or wait until they meet the right person,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. Whatever the reason may be, times are changing when it comes to how long people are holding off before having children. (And advances in assisted reproductive technology, like in vitro fertilization, have made it easier for some people 35 and older to get pregnant than they could have in the past.)
The average age at first childbirth rose to 26.9 years old in 2018, according to the Centers for Disease Control and Prevention (CDC), a marked increase from 24.9 years old in 2000. For context’s sake, in 1970, people first gave birth when they were 21.4 years old on average, so there’s a clear upward trend happening here.
Experts are seeing national shifts when it comes to having children at age 35 and over, too. From 2000 to 2014, the number of women 35 and over giving birth for the first time climbed from 7.4 percent to 9.1 percent, the CDC notes. Since then, it has generally continued to rise. In 2010, 45.9 out of every 1,000 women aged 35 to 39 gave birth, and in 2018, that number was up to 52.6 out of every 1,000 women aged 35 to 39, according to the CDC.
Clearly, more U.S. people than ever are delaying bringing little people into the world. But what does that mean about the odds of having a high-risk pregnancy?
Is any pregnancy after age 35 automatically a high-risk pregnancy?
Many doctors are quick to discount the belief that age 35 always and instantly draws a line between a healthy pregnancy and a high-risk one.
“We’ve learned that there’s nothing magic about age 35,” Sarah J. Kilpatrick, M.D., Ph.D., chair of the department of obstetrics and gynecology at Cedars-Sinai, tells SELF. “I would never tell someone that just because she’s 35 she has to see a high-risk doctor—only if there’s something in her history or something that happened during her pregnancy that warrants it.”
According to Dr. Kilpatrick, the idea that being pregnant at 35 qualifies as a “geriatric pregnancy” seems to stem from outdated statistics about how getting pregnant at 35 or older raised the risk of various pregnancy complications. The truth about how the odds of these complications change with age (which we’ll get into further down) is much more nuanced than that.
Some doctors even downplay this type of phrase to their patients. “I hate using the term ‘advanced maternal age,’” Dr. Minkin says, explaining that this kind of language can make people feel like they’re too old to be pregnant or they need to worry a ton about how age is affecting their pregnancy even if they’re completely healthy.
With all of that (hopefully reassuring information) said, the chances of developing certain conditions or complications that can affect either you or the fetus or both do start rising after age 35, according to the American College of Obstetricians and Gynecologists (ACOG). But it’s not at all a guarantee that getting pregnant at 35 or older means something will go wrong.
It does get harder to become and stay pregnant as you age.
“That’s something to consider: [Pregnancy] rates tend to go down with age,” Dr. Minkin says. The chances of getting pregnant don’t decline as sharply once you hit 35 as you might have heard, but there is scientific reason to believe that’s when fertility starts to go down more quickly than before. The issue here basically comes down to your eggs, Dr. Minkin says, noting, “We’re born with all the eggs we’re going to have.” As you age, your number of viable eggs goes down, and this generally starts happening more rapidly once you turn 35. (You can read more about that here.)
Then there’s the fact that the odds of miscarriage (losing a pregnancy before 20 weeks gestation) rise in pregnant people who are 35 and over, ACOG says. Around 80 percent of miscarriages happen in the first trimester, which is sometimes known as early pregnancy loss. Here are the rates of clinically recognized early pregnancy loss by age, per ACOG (keeping in mind that rates may be higher since early miscarriages sometimes go undetected):
- 20-30 years old: up to 17 percent
- 35 years old: 20 percent
- 40 years old: 40 percent
- 45 years old: 80 percent
The reason for these rising rates becomes clearer when you understand that around 50 percent of early pregnancy losses happen because of chromosomal abnormalities with the fetus, according to ACOG. “[Our eggs] get older as we get older,” Dr. Minkin says. “In the process of eggs ripening and separating into gametes, which are the [cells] that get together to make babies, more abnormalities can happen … proportional to age.”
Stillbirth, or losing a pregnancy after 20 weeks gestation, is unfortunately also more common after 35, ACOG says. Experts aren’t totally sure why this is and are exploring possibilities like an increased risk of issues with the placenta in pregnant people 40 and over. (The placenta is really important—it’s the organ that develops inside the womb during pregnancy to supply vital oxygen and essential nutrients to the fetus, the Mayo Clinic explains.)
Some pregnancy-related health conditions become more common as you get older.
“As we age, there is the potential for developing medical diseases; an aging woman who becomes pregnant is no exception,” Shannon Clark, M.D., a maternal-fetal medicine specialist and founder of Babies After 35, tells SELF.
Gestational diabetes is a big health condition to keep in mind here, Dr. Minkin says. It happens when high hormone levels in pregnancy make it harder for your body to produce enough insulin, a hormone from your pancreas that you need to regulate your blood sugar, ACOG explains, and it can develop even if you’ve never had diabetes before. Most importantly for the purposes of our discussion, the chances of developing gestational diabetes actually start rising in pregnant people over 25, according to the Mayo Clinic. This is more evidence that there’s really no one high-risk pregnancy age, 35 or otherwise, that definitely increases the risk of all complications.
Although gestational diabetes doesn’t typically cause symptoms, when it does, they can include things like needing to pee more often and feeling thirstier than you usually do, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains. Gestational diabetes goes away after childbirth, although it can increase your risk of developing prediabetes and type 2 diabetes afterward, and it also raises the risk of various childbirth complications like premature labor.
Then there’s preeclampsia, which happens when someone who’s pregnant has high blood pressure and damage to important organs like the liver and kidneys, ACOG explains. Pregnant people 40 and over are at greater risk of developing this condition, which usually sets in after 20 weeks gestation (and even more often in the third trimester), but it can happen earlier than that and also postpartum. (Preeclampsia is also more likely to develop in people with gestational diabetes, ACOG notes.) Symptoms of preeclampsia can include a very high blood pressure reading, abnormally high protein levels in the urine (one common sign of this is very foamy pee), along with issues like sudden face or hand swelling, a severe headache, and vision changes, the Mayo Clinic says. Preeclampsia can cause deadly complications, so it’s important to see a doctor as soon as possible if you’re concerned you may have it (or are concerned about anything else related to your health).
Beyond that, complications from these kinds of issues can raise your chances of needing a C-section, which, as a major surgery, comes with risks like infection and a higher likelihood of blood clots. Other potentially dangerous conditions that might call for C-sections include placenta previa, which happens when the placenta totally or fully blocks the cervix, and placenta accreta, when the placenta extends too far into the uterine wall. Both of these are more common in people 35 and older and can lead to issues like severe bleeding and preterm birth. Your doctor might also recommend a C-section if you’re carrying multiples, which—you guessed it—is more common in pregnancy over 35. (Interestingly enough, people 35 and older are more likely to release two or more eggs in one menstrual cycle, which can lead to multiples, ACOG explains.)
That’s a lot of intimidating information to digest, but these are possibilities, not certainties. “Does that mean somebody should not get pregnant beyond the age of 35? Hell no,” Dr. Minkin says. “I’d be a bad example, having had my first kid at 36 and my second at 38.”
If you’re over 35 and generally healthy, your pregnancy should be, too.
This is why Dr. Minkin advises anyone who’s pregnant at 35 or after (and really anyone in general) to do their best to stay healthy with steps like exercising regularly. “We can never guarantee that someone won’t get [health issues like] gestational diabetes,” she says. But trying to lower your risk if you can puts the odds more in your favor.
Ultimately, age by itself should not be major criteria for a high-risk pregnancy, says Dr. Kilpatrick. “It’s really age plus whatever else is going on with that woman.”
Additional reporting by Zahra Barnes.
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