What Does Advanced Maternal Age Mean for Your Pregnancy Journey?

Being pregnant at 35 or older comes with new terms like “AMA" (advanced maternal age), which can bring on a wave of emotions whether it's your first pregnancy or fourth. This gentle guide will help expecting moms navigate the risks, tests, and common concerns that come along with advanced maternal age pregnancy and eliminate fear. Wisdom often comes with age, and you can approach a later-in-life pregnancy with calm confidence, resting assured that your medical team will help you navigate your unique journey with compassion and care! 

What Is Advanced Maternal Age? A Brief Introduction

"Advanced maternal age" refers to any pregnancy at age 35 or older, also known as geriatric pregnancy. Even though this terminology can sound scary, the fact is that most women over 35 have healthy babies.

However, pregnancy risks increase after age 35. These include risks like birth defects and pregnancy complications, both of which increase with maternal age. The average age of first birth has increased in recent years, with more women delaying childbearing until their 30s and 40s. This can be due to a number of factors, like wanting to spend more time advancing in your career, waiting until later in life to get married, facing infertility issues, and having concerns about the financial impact of having a child.

Understanding the risks and challenges associated with advanced maternal age is crucial for a healthy pregnancy. Being pregnant at a later age does put you at higher risk of pregnancy-related complications, but discussing these concerns with your doctor can help you make the best choices for your geriatric pregnancy journey.

Risks and Challenges of a Geriatric Pregnancy

Pregnancy complications, such as gestational diabetes and high blood pressure, are more common in older women. Furthermore, the risk of low birth weight and preterm birth also increases with maternal age.

Advanced maternal age is an independent risk factor for severe maternal morbidity and adverse pregnancy outcomes. This is why women over 35 should be aware of the potential risks and take steps to prevent them.

Types of Risks: Genetic Conditions

The risk of genetic conditions, such as Down syndrome and neural tube defects, increases with maternal age. Because of this, most doctors encourage older women to do genetic testing during their pregnancy.

Neural tube defects are a category of serious birth defects that happen when the neural tube (what forms before the brain and spinal cord) doesn't properly close in early pregnancy. The most common neural tube defects are spina bifida and anencephaly. These conditions can lead to serious physical problems and health conditions.

Spina bifida occurs when the spinal cord doesn't develop properly, leading to nerve damage and maybe even paralysis. Anencephaly occurs when a major part of the brain and skull fail to develop, resulting in adverse outcomes like stillbirth or death following delivery. Encephalocele occurs when brain tissue goes through an opening in the skull.

Genetic testing, such as non-invasive prenatal testing, can help identify potential genetic disorders. Non-invasive prenatal testing (NIPT) is a special type of genetic testing that analyzes fetal DNA using a pregnant woman's blood. It looks for chromosomal abnormalities to identify risks early on. This non-invasive test doesn't require any fluid or tissue directly from the fetus, unlike other types of prenatal testing.

The NIPT can be done as early as 10 weeks gestational age and uses the mother's bloodstream to pick up some of the fetus' DNA (known as cell-free fetal DNA) to look for potential chromosomal abnormalities. It checks for the number of chromosomes, such as trisomies, or extra copies of chromosomes. Common trisomies include Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13). The NIPT has a high accuracy rate for finding common chromosomal issues. It is important to note that the NIPT does not provide a diagnosis, and other diagnostic tests might be required.

Women over 35 should discuss their individual risk factors with their healthcare provider. Prenatal genetic screening can help identify potential birth defects and allow for parents to make informed decision-making.

Types of Risks: Fertility and Pregnancy

A woman's fertility declines with age, especially after 35, due to decreased egg quality and quantity. This makes having a baby later in life more challenging for many couples of later childbearing age. If you struggle with getting pregnant, it might be a good idea to go get an infertility evaluation so that you can get on the path toward having a healthy baby.

In vitro fertilization (IVF) and other fertility treatments may be necessary for women over 35. However, the risk of multiple pregnancy, which can increase the risk of pregnancy complications, is higher with fertility treatments.

If you are planning to wait until later in life to have a baby, it might also be a good time to talk to your doctor about what measures can be taken for preserving fertility. Thinking about your future fertility is a good idea, as it can be harder to achieve a healthy pregnancy as maternal age increases.

Women should be aware of their fertility options and discuss them with their healthcare provider during their infertility evaluation.

Struggling to Conceive: Using Assisted Reproductive Technology

Assisted reproductive technology, such as IVF (in vitro fertilization), can help women over 35 conceive. However, it is important for families to understand that these technologies also carry risks, such as multiple pregnancy and adverse pregnancy outcomes.

Women should carefully consider their options and discuss the potential risks and benefits with their healthcare provider before starting fertility treatments and forming a reproductive life plan.

Preserving fertility through egg or embryo freezing may be an option for women who are not yet ready to conceive. With increasing age, it can become harder to get pregnant naturally, so taking measures to preserve fertility might be a good idea.

Prenatal Care and Monitoring

Although prenatal care is important for every woman, regular prenatal care is crucial for women over 35 to monitor fetal growth and detect potential complications. Women should attend all of their prenatal appointments as scheduled and report any concerns or symptoms to their healthcare provider.

Part of prenatal care includes prenatal testing. Prenatal testing, such as ultrasounds and non-stress tests, can help identify potential issues. Women with chronic medical conditions, such as high blood pressure or diabetes, should receive specialized care.

Pregnancy Complications

Pregnancy complications, such as preeclampsia and placental abruption, are more common in older women. Women over 35 should be aware of the signs and symptoms of these complications and seek medical attention if they begin to experience anything concerning.

Regular prenatal care and monitoring can help detect potential complications early. Care can include checkups, screening tests, advice on nutrition and lifestyle, and monitoring the baby's growth. Women of older maternal age with a history of pregnancy complications should definitely receive specialized care.

Fetal Testing and Monitoring

Fetal testing, such as non-stress tests and biophysical profiles, can help monitor fetal well-being. Women over 35 might need more frequent fetal testing due to increased risk of pregnancy complications that come with older age.

Fetal monitoring can help identify any potential issues and allow for prompt intervention if possible. Women should discuss their individual risk factors and testing options with their healthcare provider.

Geriatric Pregnancy: How It Affects Labor, Delivery, and Recovery

Elective Induction and Cesarean Delivery

Elective induction and cesarean delivery may be necessary for women over 35 due to increased risk of pregnancy complications, even if you have had a vaginal birth in the past. Women should discuss their individual risk factors and delivery options with their healthcare provider prior to delivery.

Vaginal delivery is still possible for women over 35, but may require more careful planning and monitoring. Older women are at an increased risk for labor complications. No matter how you give birth, just remember that the goal is a healthy baby. Your labor and delivery might not go according to the plan you originally had in mind, but know that your care team is there to help you give birth in the way that will be most successful in delivering a healthy child.

Women should be aware of the potential risks and benefits of each delivery option before deciding on what is right for their family.

Age and Recovery After Birth

Women over 35 may experience a longer recovery time after birth due to increased risk of pregnancy complications. Receiving regular postpartum care can help identify potential issues and allow for prompt intervention.

Women should attend their routine postpartum appointments as scheduled and report any concerns or symptoms to their healthcare provider. It is important for all women to continue to receive care after they give birth, but it is especially important for women of older age to be monitored following delivery. Postpartum care includes physical and mental evaluation to prevent any issues that may arise.

Breastfeeding and newborn care can also help promote a healthy recovery and bonding experience. Breastfeeding increases bonding between mother and baby across all age groups. If you are willing and able to breastfeed your little one, this can help speed up postpartum recovery as well.

Healthy Pregnancy Choices Make A Difference

Maintaining a healthy weight, eating a balanced diet, and exercising regularly can help promote a healthy pregnancy. Just like any pregnancy, women over 35 should avoid smoking and alcohol, which can increase the risk of pregnancy complications.

Taking prenatal vitamins and folic acid can help prevent birth defects and promote fetal growth. Taking folic acid even before you become pregnant can also help prevent issues in your future baby's brain and spine.

Women with a higher body mass index should also be aware of pregnancy weight gain, as this can increase pregnancy risks. Eating a balanced, healthy diet and exercising regularly throughout pregnancy can lead to better outcomes.

Women should discuss their individual risk factors and healthy pregnancy choices with their healthcare provider, figuring out which lifestyle choices might help them achieve a healthy pregnancy.

Healthy body, healthy mind

Whether this is your first birth or fifth, having a healthy pregnancy is possible even for women of advanced maternal age. There is a sense of wisdom and empowerment that comes with age, and while many young mothers may doubt themselves or be filled with anxiety about becoming a parent, older mothers have an innate sense of wisdom and peace that can help them achieve a healthy, wonderful pregnancy experience.

A geriatric pregnancy comes with relative risk, but can still be a wonderful, successful experience for mothers.

Advanced maternal age can increase the risk of pregnancy complications, but with proper care and monitoring, and healthy choices during pregnancy, women over 35 can have a healthy, successful pregnancy. Women should be aware of their individual risk factors and discuss them with their healthcare provider prior to getting pregnant.

Regular prenatal care during a geriatric pregnancy, fetal testing, and monitoring can help identify potential issues and allow for prompt intervention. By making healthy pregnancy choices and seeking specialized care, women over 35 can experience a happy, healthy pregnancy and welcome a healthy baby into the world.