Is geriatric pregnancy high risk?

There are many reasons why women may delay pregnancy. According to the American College of Obstetricians and Gynecologists, there is an upward trend in the average age of pregnant women around the world.

About 19% of all pregnancies and 11% of all first pregnancies are currently in people over the age of 35 in the United States. In 2020, the average age at first birth was 27.1 years compared to 21.4 years in 1970.

If you are pregnant or planning a pregnancy over 35, you may have many questions or concerns regarding pregnancy and childbirth.

Definition of geriatric pregnancy

We define advanced maternal age (formerly geriatric pregnancy) as those who are 35 or older on their estimated due date. Historically, pregnancies at this age or older are considered higher risk – for the patient and the fetus – for a variety of reasons.

Increased risk factors for pregnancy at age 35 or older

Although pregnancies at age 35 and older are considered high risk, not all will face the same challenges. The potential risks are on a continuum and increase with age. Medical studies divide these age groups and their associated risks into five-year increments.

“At Nebraska Medicine, we consider age as one thing,” says Teresa Berg, MD, Maternal-Fetal Medicine Doctor at Nebraska Medicine. “We consider everything that may be going on in your life that could complicate your pregnancy, and then we make plans based on all the variables.”

Increased risk factors exist for a variety of reasons, including:

• The development of age-related diseases, such as high blood pressure, obesity, or diabetes
• As the number of eggs decreases with age, the remaining eggs are at greater risk for disorders that can affect fertility and chromosomal abnormalities
• Falling fertility rate

Potential complications include an increased risk of:

• Gestational Diabetes
• Cesarean delivery
• Premature birth
• Miscarriage and stillbirth
• Fetal growth
• Chromosomal abnormalities and birth defects
• Multiple pregnancies (twins)
• Preeclampsia, especially after age 40

Pregnancy care over 35: what to expect

What to expect for pregnancy care and testing depends on your age, medical history, and other factors. Your doctor will consider all risk factors when developing your individualized care plan.

Depending on your situation, expect to discuss:

• Ultrasounds: At a minimum, one in the first trimester, one at 20 weeks and one in the third trimester (detailed ultrasound). Women over 40 with risk factors can have ultrasounds every 4-6 weeks
• Possible prenatal DNA screening, genetic counseling or diagnostic test
• Prenatal fetal monitoring: monitoring of heart rate, fetal activity and amniotic fluid (once or twice a week)
• Preferences for labor and delivery
• If you have two or more risk factors, your doctor will most likely recommend daily low-dose aspirin to reduce your risk of preeclampsia.

“Although there is an increased risk at age 35 or older, we still see the majority of women deliver at term with developing babies,” says Dr. Berg. “There are more decisions to make, but generally these women approach with the preparation and education they need to start or expand their families.”

Prepare for pregnancy

If you are planning a pregnancy after age 35, carefully consider your current health status and the medications you are taking. If you have a chronic health condition, talk to your doctor. Ask them how you could make pregnancy safer and healthier.

“We support our patients by treating the whole person,” adds Dr. Berg. “We not only discuss all the physical aspects, but also things like their support system and their mental health. We explain what to expect at each stage of pregnancy and guide them through it.”

Tips to remember:

• Unless you have a chronic illness or medical condition, you may not need to see a maternal-fetal medicine specialist. It’s common to stay with your obstetrician and only see a high-risk specialist if and when needed.
• If you’re at risk of preterm labor, try preparing your home earlier so you feel ready.
• If or when complications arise, know that there is nothing you did (or did not do) that caused them
• Consider attending one of our childbirth education classes and support groups during pregnancy and postpartum

Nebraska Medicine Olson Center for Women’s Health has a team of maternal-fetal medicine specialists with specialized expertise in managing high-risk pregnancies. If you are new to Nebraska Medicine and need to schedule a new pregnancy appointment, please call 402.559.4500.