Geriatric Pregnancy: Pregnancy After 35

Medically Reviewed by Jabeen Begum, MD on December 15, 2023
8 min read

Geriatric pregnancy is a rarely used term for having a baby when you’re 35 or older. Health care professionals now are more likely to call it "advanced maternal age."  Technically, the benchmark for geriatric pregnancy age is if you will be 35 or older on your due date.

Most healthy people who get pregnant after age 35 and even into their 40s have healthy babies. That doesn't mean you shouldn't think about smart ways to make sure you and your baby stay as healthy as possible during your pregnancy.

Problems can arise no matter how old you are when you get pregnant. But some become more likely with a geriatric pregnancy, including:

  • High blood pressure, which can lead to preeclampsia (dangerously high blood pressure and organ damage)
  • Gestational diabetes
  • Miscarriage or stillbirth
  • Labor problems that require you to have a cesarean section
  • Premature birth
  • Low birthweight
  • Chromosome disorders in the baby, like Down syndrome

When you're born, you have a certain number of eggs. You release eggs with each menstrual cycle. As you age, the number of eggs you have declines, and the eggs you do have are more likely to have chromosome disorders. That's why the risk of birth defects goes up. 

You also have a higher chance of many chronic conditions as you get older. Pregnant or not, you're more likely to have high blood pressure at 35 than 25, for instance. 

Having a baby later in life increases the chances that you'll have twins or other multiples, and that also raises the risk of complications. Hormonal changes as you age make it more likely that your body will release more than one egg per cycle. Reproductive technology that helps you get pregnant, such as in-vitro fertilization (IVF), also plays a role in multiples. 



On the other hand, there’s proof you might be doing yourself and your baby a favor by putting off childbearing until you’re older. Studies have shown:

  • People who are older when they give birth tend to be better-educated and have higher incomes, so they may have more resources than those who are younger.
  • You're likely to live longer if you're older when you give birth.
  • Your child may end up healthier, more well-adjusted, and better-educated.

Preconception checkups and counseling. When you decide you’re ready to have a baby, take these steps before you get pregnant.

See your doctor. Get a checkup to make sure you’re ready for pregnancy physically and emotionally.

Get early and regular prenatal care. The first 8 weeks of your pregnancy are important to your baby's development. Early and regular prenatal care can boost your chances of having a safe pregnancy and a healthy baby. Prenatal care includes screenings, regular exams, pregnancy and childbirth education, and counseling and support.

Getting prenatal care also provides extra protection for women over 35. It lets your doctor stay on top of health conditions that are more common among women who are older when they get pregnant. For instance, your age may increase your risk of gestational diabetes and preeclampsia, a condition that causes high blood pressure along with protein in the urine. During prenatal visits, the doctor will check your blood pressure, test your urine for protein and sugar, and test your blood glucose levels. That lets them catch and treat problems early.

Take prenatal vitamins. All women of childbearing age should take a daily prenatal vitamin with at least 400 micrograms of folic acid. Getting enough folic acid every day before and during the first 3 months of pregnancy can help prevent defects in your baby's brain and spinal cord. Taking folic acid adds extra protection for older women, who are more likely to have babies with birth defects. Some prenatal vitamins have 800-1,000 micrograms of folic acid. This is still safe in pregnancy. As a matter of fact, some women need more than 400 micrograms to protect against birth defects. Don’t take more than 1,000 micrograms (1 milligram) of folic acid without asking your doctor. Women with a history of a child with neural tube defects need 4,000 micrograms.

Genetic testing for pregnancy after 35 

Talk to your doctor about what genetic screenings – if any – you'd like to have during your pregnancy. Cell-free fetal DNA (cffDNA) testing checks for certain conditions in your baby, including Down syndrome. For the test, health care professionals take DNA from your blood and your baby's blood. This screening can also spot conditions like trisomy 13 and trisomy 18. 

Other tests to consider are amniocentesis and chorionic villus sampling. These also can be used to spot certain genetic disorders.  

Amniocentesis takes a sample of amniotic fluid and cells from your uterus. Chorionic villus sampling (CVS) takes a sample of cells from the placenta. Both tests slightly increase your chance of miscarriage, so talk to your doctor and weigh the best choice for you. 

Another type of test is the quad screen, or quad marker screen. Your doctor will offer you the test during the second trimester, between weeks 15 and 20. You'll give a sample of blood (taken from your arm), and a lab will check the levels of four substances in your blood. They are:

  • AFP (alfa-fetoprotein)
  • HCG (human chorionic gonadotropin)
  • Estriol (a type of estrogen)
  • Inhibin-A 

If you have too much or too little of some of these substances, that means your baby is at risk for Down syndrome, trisomy 18, and neural tube defects. The quad screen is a simple blood test and very safe for you and your baby.

Obstetricians – the doctors who take care of you during your pregnancy and deliver babies – have guidelines for advanced maternal age. The guidelines are best practices based on research. Among the recommendations: 

  • A daily low dose of aspirin to prevent preeclampsia if you have one other risk factor in addition to your age
  • Discussing your options for prenatal genetic screening with your doctor 

In the same paper, doctors noted that a C-section is not necessary simply because you're older. Vaginal delivery can be safe. It depends on your health, the health of your baby, and your preferences.

You deserve the same TLC as your baby. Taking care of yourself will help you manage any health problems and protect you from pregnancy-related diabetes and high blood pressure. And the healthier you are, the better it will be for your little one.

Keep up with other doctor appointments. If you have a chronic health problem such as diabetes or high blood pressure, don’t skip your regular doctor visits. Managing your condition before you get pregnant will keep both you and your baby healthy. See your dentist for regular exams and cleanings, too. Having healthy teeth and gums lowers your odds of preterm birth and of having a baby with a low birth weight.

Eat a healthy, well-balanced diet. Eating a variety of foods will help you get all the nutrients you need. Choose plenty of fruits and veggies, whole grains, beans, lean meats, and low-fat dairy products. You should eat and drink at least four servings of dairy and other calcium-rich foods every day. That will keep your teeth and bones healthy while your baby grows. Include good food sources of folic acid, like leafy green vegetables, dried beans, liver, and some citrus fruits.

Gain the amount of weight your doctor suggests. Women with a normal body mass index (BMI) should gain 25-35 pounds during pregnancy. If you were overweight before getting pregnant, the doctor may suggest you gain 15-25 pounds. Obese women should gain about 11-20 pounds. Gaining the right amount of weight makes it less likely that your baby will grow slowly. It also lowers the risk of preterm birth. And it makes it less likely that you’ll have pregnancy problems like gestational diabetes and high blood pressure.

Exercise regularly. It’ll help you stay at a healthy pregnancy weight, keep your strength up, and ease stress. Just be sure you review your exercise program with your doctor. You'll most likely be able to continue your normal exercise routine throughout your pregnancy. But the doctor can help you figure out if you'll need to scale back or modify your routine.

Stop smoking and drinking alcohol. Regardless of age, smoking and alcohol during pregnancy aren't recommended. Alcohol raises your baby's risk of a wide range of mental and physical defects. Smoking increases the chance that you’ll have a low-birth weight baby, which is more common in older women. Not smoking can also help prevent preeclampsia.

Ask your doctor about medications. They can tell you what meds are safe to take during pregnancy and while breastfeeding. This includes prescription and over-the-counter medicines, supplements, and natural remedies.

The 12 weeks after you give birth are sometimes called the fourth trimester, and it's an important time for your health. That's especially true if you're 35 or older. 

Maternal mortality – the death rate for those who are pregnant or whose pregnancies ended within the last 6 weeks – is rising in the United States. You're at particular risk if you're older. You should check in with your doctor in the first 3 weeks after childbirth to make sure you're recovering well. If you had pregnancy or delivery complications, you may need a checkup in the first week or two.

Certain problems require prompt medical care. If you have any of these symptoms, get help right away: 

  • Fever and chills
  • Shortness of breath 
  • Dizziness
  • Bright bleeding that is brisk, not seeping 

Having a baby when you're older may make it more difficult for you to lose the weight you gained in pregnancy.  

Is it harder to get pregnant if you're over 35?

You hit your peak of fertility between your late teens and late 20s. By the time you're 30, fertility begins to decline, and that process speeds up during your 30s. That doesn't mean you won't get pregnant, but it may take longer. Among healthy couples in their 20s and early 30s, about 1 in 4 will become pregnant during any menstrual cycle. By age 40, that has fallen to 1 in 10.

Why are there more complications if you're over 35 and pregnant?

The risk of health problems goes up as you age, regardless of pregnancy. But we know from research that even people who had no health problems beforehand can have pregnancy complications. 

What are my chances of miscarriage if I am of advanced maternal age?

If you're between the ages of 35 and 40, your chance of miscarriage is 20% to 30%. Once you hit 40, the risk increases.