Pregnancy After 35: Understanding High-Risk Factors and How to Prepare
By Lindsay Morris
As more women choose to have children later in life, they face unique risks and challenges. But with personalized care, early planning, and the right support, pregnancies after 35 can still be safe, healthy, and deeply rewarding.
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Every pregnancy carries some risks for mom and baby, especially after age 35. But with personalized care, careful planning, and the right support, even mature mothers can have a healthy, low-stress pregnancy. To understand what doctors mean by a “high-risk” pregnancy (and how to navigate it), we spoke with Steve Rad, MD, a board-certified obstetrician-gynecologist and maternal-fetal medicine specialist.
As founder and director of the Los Angeles Fetal Maternal Care Center and the Ari Rubin-Rad Pregnancy After Loss Center at the Los Angeles Center for Maternal Fetal Health and High-Risk Pregnancies, Rad focuses on high-risk and “at-risk” pregnancies, particularly for women of advanced maternal age. He shares what every woman should know about risk factors, the latest advances in prenatal care, and how to prepare for a successful pregnancy.
What Doctors Mean by a “High-Risk” Pregnancy
“Every pregnancy is at risk of having pregnancy complications,” explains Rad. “So a lot of us—especially high-risk doctors—have changed the name to ‘at-risk pregnancies’.”
A variety of factors can put a pregnant person at risk, including preexisting and pregnancy-related conditions.
Some preexisting conditions that may affect pregnancy include:
- Autoimmune diseases like lupus or multiple sclerosis
- Blood clotting problems
- Diabetes or high blood pressure
- Fibroids and kidney disease
- HIV/AIDS
- Mental health conditions such as depression
- Obesity
- Polycystic ovary syndrome (PCOS) and thyroid disorders
Some pregnancy-specific conditions that can increase risk include:
- Abnormal levels of amniotic fluid
- Carrying multiples, like twins or triplets
- Gestational diabetes
- High blood pressure-related conditions, including gestational hypertension, preeclampsia, and eclampsia
- History of preterm birth or other complications in previous pregnancies
- Cervix abnormalities
- Fetal growth restriction and Low birth weight
- Placental abnormalities, such as placenta previa or placental abruption
- Congenital abnormalities and birth defects
And then there are lifestyle factors, such as alcohol use, smoking, substance use, and toxin exposure.
Research shows that alcohol use during pregnancy is unsafe. Alcohol crosses the placenta and accumulates in the fetus. Exposure can lead to Fetal Alcohol Spectrum Disorder (FASD), a range of physical, cognitive, developmental, and behavioral challenges.
Smoking during pregnancy has been linked to abnormal bleeding, stillbirth, slowed fetal growth, low birth weight, preterm delivery, birth defects such as cleft lip or palate, lasting damage to a baby’s brain and lungs, and an increased risk of sudden infant death syndrome (SIDS).
Opioid use among pregnant women has spiked in recent years—rising 131% from 2010 to 2017—and increases the risk of preterm birth, stillbirth, maternal death, and neonatal abstinence syndrome.
Finally, there’s that age factor. While pregnancy rates have decreased since 1990, they have risen among individuals over 30, including a 193% increase in pregnancies over age 40.
While Rad notes many women of advanced maternal age can have successful pregnancies, it automatically places them in a higher risk category due to the increased likelihood of complications affecting both mother and baby.
Pregnancy After 35: The Risks to Consider
Approximately 20% of U.S. women have their first child after 35, a period historically called “geriatric pregnancy” and now referred to as advanced maternal age or simply “pregnancy at age 35 and older.”
Thirty-five has traditionally marked the cutoff point after which fertility begins to decline, and the risk of genetic abnormalities increases. Research shows that pregnancies after 35 carry a higher likelihood of chromosomal abnormalities and congenital malformations, and complications from chronic conditions such as diabetes, high blood pressure, and obesity also rise with age. These risks often increase sharply in five-year increments, which is why the medical community frequently reports statistics by these age ranges. Rates of miscarriage, for example, illustrate the dramatic differences that can occur between age groups.
- 35–39: 20% chance
- 40–44: 40% chance
- 45–49: 80% chance
Rad explains that several age-related factors contribute to the risks of pregnancy complications:
- Vascular and organ function: As you age, your organs, blood vessels, and uterine circulation may not function as optimally.
- Placental issues: The placenta may not develop as well due to age-related factors, leading to placental insufficiency.
- Increased complications: There is a higher risk across multiple areas compared to younger populations. For example, a woman’s likelihood of having a baby with Down Syndrome at 25 increases from 1 in 1,250 to 1 in 100 by the time she’s 40. Compared to women aged 35 to 39, preeclampsia rates increase by 30% for women 40 to 44 and more than double for those over 45.
“Especially over age 45, there is a greater risk to both the mother and fetus,” explains Rad. “Many women still do well, but individual health and medical history make a big difference.”
Risks aside, understanding factors and planning can improve outcomes.
Smart Steps to Take Before You Try to Conceive
Older women may statistically experience more pregnancy complications, but Rad says, “Everyone should be vigilant and careful, and we encourage prevention and preparing properly ahead of time.”
Here’s his checklist for reducing and even eliminating pregnancy complications:
- Schedule well-woman exams, pre-conception counseling visits, and lab work.
- Investigate family health history and address chronic conditions.
- Review medications with your healthcare provider to identify the risks and benefits of each drug and the stage of pregnancy.
- Start prenatal vitamins and supplements at least three months before conception.
- Address stress and focus on reduction methods like meditation.
- Adopt a healthier diet and exercise regimen.
- Optimize your health and any chronic conditions prior to conception.
Planning this way will set the stage for a smooth journey.
The Latest Advances That Make Pregnancy Safer
While the process of delivering a baby hasn’t changed much, prenatal monitoring and care have radically changed in recent years, says Rad. It’s made it easier for him to detect abnormalities sooner and tailor pregnancy plans to patients’ personal risk factors and health conditions.
Here are just a few of the advances in prenatal care:
- Non-invasive prenatal testing (NIPT), which can be done as early as nine weeks, detects common genetic abnormalities, including Down syndrome, with about 99% accuracy for some conditions. NIPT has significantly reduced the need for invasive diagnostic procedures like chorionic villus sampling (CVS) and amniocentesis, which carry a small risk of miscarriage. However, it is still essential to understand the limitations of NIPT screening and pursue diagnostic testing when indicated.
- Improvements in ultrasound technology now enable the earlier detection of birth defects—sometimes as early as 12 to 14 weeks—whereas previously they were visible only around 20 weeks.
Having these tools helps your provider identify potential issues early, ensuring timely treatment and a safer pregnancy.
How to Choose the Right Doctor for a High-Risk Pregnancy
Technology can support a healthy pregnancy, but nothing replaces the bond between you and your healthcare provider, says Rad.
“It’s most crucial to seek a healthcare provider who will tailor your pregnancy plan to your individual needs, risk factors, personal preferences, and values to make sure you have the healthiest and happiest pregnancy,” he says.
Rad highlights three key strategies every woman can use to navigate pregnancy care with confidence.
- Shop around. Research, get referrals, and consider meeting with two or three doctors to ensure you’ve found the right provider match.
- Advocate for yourself. Even after you’ve selected your provider, remember: this is your pregnancy, your baby. Change providers if you don’t feel heard.
- Delivery is a journey, not just a destination. Focus on ensuring a safe pregnancy throughout the lead-up to the day of delivery. Early and ongoing personalized care can help prevent complications and improve outcomes, especially for women with prior losses. And understand that no matter how much you plan and have a birth plan or wishes in place, pregnancy can be quite unpredictable. So it is essential to be prepared and open to unexpected outcomes and paths that may arise in your journey.
Finally, keep in mind that while risks increase with age, pregnancy after 35 (and even over 40) can still be safe and fulfilling with the proper support. Well wishes on your journey!