Something we frequently hear from our patients is that they are determined to complete their childbearing by age 35. It is commonly perceived that at age 35 we suddenly become “high risk” and that pregnancy after 35 is ill advised. In fact the great majority of pregnant patients over 35 do just fine, and while certain risks increase with age, pregnancy from 35-40 has become quite common as we are often choosing demanding careers and later marriage.
While pregnancy after 35 is generally safe, there are some issues to consider. The first problem many women over 35 may encounter is that getting pregnant may be more difficult. While there is enormous variation, the 1:3 chance of conception each month that we had when we were in our 20s may be significantly lower as we age. So conception may take time. It is more common to need help to ovulate (release eggs), and the use of ovulation induction medications increases with age, and with it the incidence of twins and higher number multiples, which carry increased risks. Once we conceive, the risk of miscarriage is also higher since aging eggs are more prone to division errors in the early embryonic stage which can lead to pregnancy loss. These same division errors can also lead to chromosomal problems such as Down’s syndrome, in which the fetus has an extra copy of chromosome 21, leading to varying degrees of mental retardation and other anatomical abnormalities.
Other chromosomal problems such as trisomy 13 and 18 (which are incompatible with life) also increase with maternal age . The good news is that the risk of chromosomal problems is only 1/200 at age 35, increasing to about 1/50 at age 40. These problems can be detected in the first trimester if a patient wishes to test for them. Other pregnancy issues including gestational diabetes and pregnancy associated high blood pressure also increase with age. If you are anticipating pregnancy after 35 it is more important than ever to be in the best of health before pregnancy, and to come in for a preconception visit to talk to us about what you can do to reduce your risks.
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