How to prepare for pregnancy after 35

Waiting until later in life to have a baby is a growing trend in the United States. According to the Centers for Disease Control and Prevention (CDC), birth rates for women ages 35-44 have been increasing regularly since 1985. So if you’ve been waiting to have a baby, know that you aren’t the only one.

You may have heard that having a baby after age 35 is “risky.” And the terms that get used for this topic, like “advanced maternal age” and “geriatric pregnancy,” aren’t reassuring either. However, pregnancy has risks regardless of your age. And while some risks do increase with pregnancy after 35, many of those risks are small – and most people go on to have healthy pregnancies.

But we know you likely have many questions. It can be helpful to understand how age may impact your fertility, pregnancy and labor, as well as what you can do to have a healthy pregnancy after 35.

How does age affect fertility?

For women and reproductive health, many look at age 35 as a deadline for having children. Is 35 too old to get pregnant? The simple answer is no, although fertility does begin declining at 35. Everyone’s fertility decreases as they get older, but that’s a normal part of the aging process.

Women are born with a fixed number of eggs, which naturally decrease in quality and quantity with age. At the start of life, you had somewhere between 1 to 2 million eggs. By 37 years old, the number of eggs a woman has decreases to approximately 25,000. And while men don’t have to worry about the quantity of their sperm, men’s sperm also tends to see an age-related decrease in quality – though it’s usually more gradual.

Decreasing eggs is a factor that impacts fertility, but it’s not the only one. There are other factors and conditions – that come with increasing age – that may impact your fertility, including:

Chromosomal changes in eggs

As women reach their mid to late 30s, changes in fertility can mean that eggs with extra, missing or damaged chromosomes become more common. So if one of these eggs is fertilized, there’s a higher chance that it may not result in a pregnancy at all, or not be a viable pregnancy and result in a miscarriage.

This means that age can make it harder to get pregnant (even when you know your fertile window), and it increases the risk of having a baby with a chromosomal condition.

Higher risk of developing conditions that impact fertility

As women age, their risk of developing conditions like endometriosis, which can affect fertility, also increases. This is one of the reasons why it’s important to have a preconception appointment – your doctor or midwife will address these kinds of conditions as they help you prepare for pregnancy.

It’s also important to note that fertility problems can happen at any age and for a variety of reasons. If you’re noticing signs of infertility in yourself or your partner, your age isn’t necessarily causing them.

How does age affect pregnancy?

While it could be more difficult to conceive after the age of 35, it is still possible. However, keep in mind that there are age-related factors to be aware of that might affect you once you become pregnant.

Possible risks of pregnancy after 35

Older women are at a higher risk of developing certain complications during pregnancy, including:

High blood pressure, which can put stress on your organs and lead to other pregnancy complications.
Gestational diabetes, which is when you have too much sugar in your blood.
Preeclampsia, a kind of high blood pressure that can cause problems in organs like your liver and kidneys.

If left untreated, these complications can lead to others – including premature birth, low birth weight and pregnancy loss. But these are all manageable or treatable, and your care team will test for them regularly throughout your pregnancy to minimize the risk to you and your baby. For example, to decrease your chance of developing preeclampsia and help your placenta function better, your care team may recommend that you take a low-dose aspirin starting in the second trimester.

Increased risk of chromosomal conditions

As mentioned above, your chances of having a baby with a chromosomal condition increase as you get older, but it’s still rather rare. Down syndrome is the most common chromosomal condition among babies born to older mothers and affects about one in 106 babies born to 40-year-old mothers.

If you want to know about the likelihood of chromosomal conditions and other issues before or during your pregnancy, ask your care provider about genetic testing. Screenings and diagnostic tests are usually offered as a part of prenatal care and can be used to check for the presence of various conditions, or their odds of developing.

A common example is noninvasive prenatal testing (NIPT). NIPT screens a regular blood sample for pieces of DNA shed by the placenta, which is usually the same as the fetus’ DNA. Analyzing these pieces can determine the fetus’ risk for certain chromosomal conditions.

Increased chance of multiples

Pregnancy after 35 also increases your chance of multiples. Around age 35 and older, your ovaries are more likely to release more than one egg per month, which means your chance of having multiples increases.

How age changes pregnancy care

Age doesn’t automatically change your pregnancy care. However, there are some extra steps that providers may take for women over 35, including additional prenatal visits, more ultrasounds and earlier genetic testing.

The number of ultrasounds needed during pregnancy over 35

Typically, there are two ultrasounds during the average pregnancy. One between 11 and 14 weeks to confirm the due date, and the second between 19 and 22 weeks to confirm normal anatomy and sex of the baby. For people over 35, your provider may perform one to two more for monitoring the baby’s health. This will depend on your overall health or other conditions, and if your pregnancy is considered high risk.

Genetic testing for pregnancy over 35

Other common tests that are important for pregnancy after 35

Healthcare professionals will administer an Oral Glucose Tolerance Test (OGTT) to all pregnant women – regardless of their age – to diagnose gestational diabetes. The condition can put babies at a higher risk of being large (nine pounds or more), being born early, and having low blood sugar. The test measures your blood glucose after fasting for eight hours and for several hours after drinking a liquid with glucose. Women over 35 years old have an increased risk of gestational diabetes.

A fetal nonstress test (NST) is a noninvasive test that measures the heart rate of a baby as it moves in the uterus. During this 20-minute test, your baby’s heart rate will be recorded. This test helps make sure that your baby is getting enough oxygen in the womb. While not required for all pregnancies, fetal nonstress tests typically occur during the third trimester between weeks 38 and 42. This test is often performed when a baby is overdue or if you have a chronic medical condition.

How does age affect labor?

Older mothers have a higher risk of abnormal labor patterns, including a lack of progress during labor. This, along with a higher risk of complications, increases the chance that your labor will need to be induced, or that you’ll need a cesarean section.

How to prepare for a healthy pregnancy after age 35

Many women are waiting until their 30s to start a family. While fertility starts decreasing at 35, it isn’t a magical number that makes getting pregnant impossible. There are several ways you can increase fertility in your 30s and prepare for a healthy pregnancy by prioritizing your physical and mental health.

Remember, most people over age 35 have healthy pregnancies. But to increase your chances of getting pregnant and minimize risks for both you and your baby once you do, here are some tips:

Make a preconception appointment

A preconception appointment helps you prepare for pregnancy. At a preconception appointment, your care provider gives you personalized care and counseling based on all the factors that could affect your pregnancy, such as your medical history and lifestyle. It’s also an opportunity to voice any questions or concerns you have. It’s recommended that you and your partner each make your own preconception appointments.

Maintain a healthy lifestyle

Many of the recommendations you’re likely to get during a preconception appointment have to do with managing your overall health leading up to and during pregnancy. This breaks down into a few parts:

Eat a balanced diet

For women hoping to increase their chances of pregnancy after 35, it’s best to limit highly processed foods and foods high in sugar, salt and unhealthy fats as they may be linked to irregular ovulation. Instead, eating a healthy diet can be especially beneficial for women and men 35 and older who want to conceive. Just as nutrition has an impact on fertility, it is equally important to continue your nutritious diet while pregnant. Focus on whole foods rich in folate (folic acid), iron, calcium, vitamin D and protein.

The Mediterranean-style diet is an example of one pregnancy diet that can increase fertility and promote a healthy pregnancy. It’s based on key nutrients like folic acid which – found in vegetables and leafy greens – helps prevent birth defects. This diet focuses on fruits and vegetables, nuts, legumes, whole grains, low-mercury fish, and small amounts of white meat and dairy. The nutrients found in these foods can help women get pregnant faster and can boost sperm quality in men. They may also be prescribed as supplements to round out your nutrition to boost fertility and maintain a healthy pregnancy.

Reducing the amount of caffeine you have each day to less than 300 mg per day may also help boost fertility.

Maintain a healthy weight

Being overweight or underweight can decrease your chances of getting pregnant. If you’re overweight (BMI greater than 25) or underweight (BMI less than 19), it can negatively impact your fertility. Your body fat affects how your body stores its sex hormones which regulate reproductive functions in both women and men. Too much or too little can interfere with ovulation and sperm production. Achieving a healthy weight is best done with a balanced diet and physical activity – extreme diets can actually hurt your chances of pregnancy.

Exercise regularly

Exercise can help manage health conditions and strengthen your body for the demands of pregnancy. If your care provider recommends losing weight before getting pregnant, exercise is a good way to help. But be sure to ask your care provider about what exercises are safe once you’re pregnant.

Manage health conditions

Getting or continuing treatment for any existing physical or mental health conditions will help minimize their effect on your pregnancy. Physical conditions like polycystic ovary syndrome (PCOS), endometriosis and uterine fibroids can affect fertility and your ability to get pregnant. These conditions can leave scarring on the uterus and reproductive organs, making it difficult to get pregnant or carry a pregnancy to term. And there are many women who don’t know they have these conditions.

If you have a history of these conditions or believe you’re experiencing PCOS symptoms, endometriosis symptoms, or uterine fibroid symptoms, talk to your primary care physician or OB-GYN. Make sure that your care provider is aware of these conditions, especially if you take medication for them, as you may need to change medicines during pregnancy.

Eliminate toxins

Introducing your body to chemicals and toxins can decrease fertility. There are many chemicals you may come in daily contact with that can negatively impact hormones, ovulation and sperm quality. To boost fertility, quit smoking and stay away from marijuana and illegal drugs, as well as chemical fertilizers and pesticides. As demonstrated by the suggested Mediterranean diet, you should also stay away from heavy metals like high-mercury fish.

Reduce your stress

Reducing stress is easier said than done. While it’s not certain how stress affects fertility, it can affect how your eggs mature. You might consider exercise, yoga and meditation to help you relax and manage stress.

Follow your prenatal appointment schedule

Once you get pregnant, your care team will give you a prenatal appointment schedule. Prenatal appointments happen regularly throughout pregnancy. They allow your care team to track your progress and monitor you and your baby’s health. Following your schedule ensures that you’re both getting all the care you need, when you need it.

Don’t let age stop you

While there are additional factors to consider when getting pregnant later in life, it’s very possible to have a healthy pregnancy (and baby). You have knowledge on your side, and your care team will do everything they can to make your pregnancy safe, every step of the way.