Pregnancy After 35 and 40: Real Risks and Extra Care

The big picture

• More people now have babies in their late 30s and 40s, and most have healthy pregnancies.
• "Advanced maternal age" and "geriatric pregnancy" are old labels. Age 35 is not a cliff; risks rise gradually, and more noticeably after 40.
• Older parents often bring more stability, resources and readiness. Your overall health matters as much as your birthday.

What changes with age

• Getting pregnant takes longer on average, and twins are more likely.
• Chromosome differences, such as Down syndrome, become more common: roughly 1 in 350 births at 35 and about 1 in 100 at 40.
• Miscarriage and ectopic pregnancy are more likely.
• Gestational diabetes, preeclampsia, placenta problems, preterm birth and cesarean birth are more common.
• Stillbirth risk is slightly higher, especially from 40 and late in pregnancy, which is why extra monitoring is offered.
• Existing conditions like high blood pressure, diabetes and thyroid disease are more common, and are worth getting under control before or early in pregnancy.
• A partner's or sperm donor's older age also adds a small amount of risk for some conditions.

The care you can expect

• Genetic screening and diagnostic testing are offered to everyone regardless of age. Cell-free DNA screening from 10 weeks is a common first step. See the prenatal visits and tests guide.
• Low-dose aspirin to lower preeclampsia risk may be recommended if you're 35 or older and have another risk factor, such as a first pregnancy, higher weight or IVF.
• Early or repeat glucose testing if you have other diabetes risk factors.
• An ultrasound later in pregnancy to check growth.
• Weekly fetal testing near the end of pregnancy is often offered: around 39 weeks for ages 35-39 and from about 36 weeks at 40 and older.
• Many providers discuss induction at 39 weeks, especially after 40. Induction at 39 weeks doesn't raise the cesarean rate in healthy first pregnancies and may lower it.

What helps

• A prenatal vitamin with folic acid, started before conception if you can.
• A preconception visit to review medicines, weight, blood pressure, blood sugar and vaccines.
• Regular exercise and good sleep; see the exercise in pregnancy guide.
• No smoking, alcohol or cannabis.
• If you're trying and not pregnant after 6 months (35-39) or are 40 or older, ask about a fertility evaluation right away rather than waiting a year.

Feelings and family life

• Some people feel judged or labeled "high risk" when they feel perfectly well. Ask what the label actually changes in your care.
• Many parents in their late 30s and 40s are also caring for aging parents or have fewer peers with babies; finding other new parents in a class or online helps.
• Single parents by choice, LGBTQ+ families and second families often start at this age too.

When to check in

• Ask at your first visit which screening, aspirin and monitoring plan fits you.
• Bring up thoughts about induction timing by about 36 weeks.
• Contact your provider the same day for bleeding, a headache that won't go away, vision changes, or the baby moving less than usual.