# Pregnancy After 35 and 40: Real Risks and Extra Care

> What actually changes with age, the extra screening and monitoring offered, and what helps.

Stage: pregnancy - Topic: Your pregnancy - Page: https://www.askcladle.com/guides/pregnancy/pregnancy-after-35

Grounded in: ACOG patient guidance "Having a Baby After Age 35", ACOG Obstetric Care Consensus "Pregnancy at Age 35 Years or Older", ACOG guidance on prenatal genetic screening, antenatal fetal surveillance and low-dose aspirin. Summarized in Cradle's own words; none of these sources endorse Cradle. General information, not medical advice.

Reviewed: 2026-11

## TLDR

- Age 35 isn't a cliff: risks rise gradually, more after 40, and most pregnancies are healthy.
- Genetic screening is offered to everyone; aspirin may be advised if you're 35+ with another preeclampsia risk factor.
- Start a folic acid vitamin before conception if you can, and call the same day for bleeding or the baby moving less.

## 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.