Pregnant at 40: What to Expect

Medically Reviewed by Nivin Todd, MD on February 14, 2023
6 min read

While 1 in 4 people in their 20s and 30s will get pregnant in any one menstrual cycle, only 1 out of every 10 people will become pregnant in any one menstrual cycle by age 40. At this age, you have a 44% chance of pregnancy within 1 year. This is because as you get older, the number of eggs in your ovaries decline. With age, you’re also at a higher risk for disorders that affect your fertility.

If you get pregnant after 35 years old, experts call this an “advanced maternal age” pregnancy. But it’s still possible to get pregnant and deliver a healthy baby in your 40s. Childbirth at older ages has become more common too. Since the 1990s, birth rates in people aged 40-44 have gone up. To prepare for a baby at 40, it’s important to consider the risks and benefits.

By age 40, if you're healthy, you have only a 5% chance of getting pregnant per menstrual cycle.

At the same time, the likelihood of miscarriage climbs with your age. A typical 40-year-old has about a 40% chance of losing the pregnancy. That compares to less than 15% for someone in their 20s. 

By the time you’re over 45, the American College of Obstetricians and Gynecologists says getting pregnant naturally is “unlikely for most women.”

As you age, so do your eggs. And you have fewer of them, too. You’re born with all the eggs you’ll ever have in your life, about 1 million. By the time you hit puberty, you may have about 300,000 left. At 37, you’re down to just 25,000 -- or 2.5% of your starting count. That matters because the fewer eggs in your ovaries, the lower your odds for conception.

Even if you do get pregnant, your older eggs are more likely to have abnormal chromosomes, which may raise your chance of miscarrying your baby. Also, if you're 25-40, you are more likely to have problems like endometriosis and uterine fibroids that make it harder for you to get pregnant.

The quality of your partner’s sperm also matters. As men age, their sperm tend to swim slower and begin to lose their shape. But sperm quality doesn’t drop steeply until after men enter their 60s.

In people who can get pregnant, the peak reproductive years span the time between your late teens and late 20s. Your fertility will begin to go down around age 30. This process continues more quickly starting in your mid-30s. Once you reach 45, your fertility will usually be so low that a natural pregnancy is unlikely for most people.

But some people may still have a “menopause baby.” This refers to a pregnancy and delivery that happens when you’re in perimenopause, the transition into menopause.

The sperm-producing parent may also have a decline in fertility with age. While this isn’t as predictable, it could still affect your chances of pregnancy at 40.

Other risks of pregnancy at 40 include complications that are more common at this age. Older women tend to have more health issues than younger women, such as high blood pressure.

This condition can put you at a higher risk for preeclampsia, which is when you suddenly develop high blood pressure and signs of organ damage while pregnant. If left untreated,  this can lead to serious or fatal problems for you and your baby.

But later-in-life pregnancies can also affect the health of your baby, even if you don’t have any health conditions. If you get pregnant at 40, you’ll have a higher risk of:

A higher birth weight of your baby. One study found that the risk of macrosomia (or a higher birth weight of your baby) goes up with age.

Placenta previa. This happens when your baby’s placenta either partly or completely covers your cervix, which is the exit area of your uterus. With this condition, you may bleed more while pregnant and during your delivery.

Gestational diabetes. This is when you get diabetes for the first time while you’re pregnant. It causes high blood sugar that can affect your baby’s health and your pregnancy.

Gestational hypertension. This is high blood pressure that develops during pregnancy. It’s different from preeclampsia, which is a blood pressure complication during pregnancy. Preeclampsia is also more common in older women even without hypertension.

Miscarriage or stillbirth. You’re more likely to have a miscarriage if you’re older. At age 40, 27% of pregnancies end in a miscarriage compared to 16% for those 30 or younger.

C-section. If you’re 40 or older, you’re more likely to have a C-section delivery than a vaginal delivery.

Down syndrome. The risk of having a child with Down syndrome goes up as you age. At the age of 20, 1 in 1,480 children will be born with the condition. But at age 40, this risk goes up to 1 in 85. At age 45, your child’s risk is 1 in 35.Other chromosomal abnormalities are also more common. 

Need for a blood transfusion. This can help save your life in an emergency blood loss situation during pregnancy. But it comes with the risk of complications as well.

While there are more health risks with pregnancy at 40, there are also some upsides to later births. You may:

  • Have a more established career that allows you to have more time to raise a child
  • Have a better financial status at an older age
  • Want to have a child with a partner you met later in life
  • Find that you’re more mature and ready to handle the responsibility of a child

Studies have also shown that a child later in life may lower your mental decline, lengthen your life, and lead your child to have better educational results (like higher graduation rates and test scores).

To prepare to have a child, it’s important to create a reproductive life plan. With this, you and your doctor can prepare for you to have children at your desired age.

If you want to get pregnant now, make sure you’re as healthy as possible. Stop alcohol, marijuana, and tobacco use. Talk to your doctor about prenatal vitamins with folic acid.

Visit your doctor to chat about your diet and lifestyle, sexually transmitted infection (STI) screening, a healthy prepregnancy weight, and any other concerns before you get pregnant. Everyone should make an appointment before they try to get pregnant, but this is especially crucial if you’re 40 and older.

If you don’t want to get pregnant now but may want to have a baby at an older age, talk to your doctor about:

In vitro fertilization (IVF). With this method, experts combine a sperm and egg in a laboratory to grow an embryo. Your doctor can then freeze the embryo for later use.

Oocyte cryopreservation. This is when your doctor freezes your eggs. They’ll take some of your eggs from your ovaries and freeze them so you can use them later in IVF.

You can still get pregnant naturally at 40, but these methods may heighten your chances of having a baby at a later age. However, many of the risks will still be present.