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The biggest obstacle for women age 35 or older may be getting pregnant in the first place. Fertility rates begin to decline gradually at age 30, more so at 35, and markedly at age 40. Even with fertility treatments such as in vitro fertilization, women have more difficulty getting pregnant as they age.
Women 45 and older rarely get pregnant, even with fertility treatment. Fertility specialists routinely recommend oocyte donation (IVF with eggs donated by a young egg donor) for these women because pregnancies with their own eggs are so rare.
Women also have more trouble staying pregnant as they get older: The rates of miscarriage and ectopic pregnancy go up substantially with age.
On the other hand, more women are having babies later in life in the United States than ever before. In 1970, the average age for a first-time mom was about 21. In 2008, the average age rose to 25.
In 2008, when the number and rate of births fell in all other age groups, the pregnancy rate for women in their 40s rose about 3 percent (to the highest rate since 1967), and the rate for women age 45 and over rose 4 percent.
Infertility evaluation is generally recommended for women who have been trying for 12 months or longer. But if you're 35 or older, don't wait a whole year. Get an evaluation after six months, or sooner if you suspect that something may not be right – such as if your periods aren't regular, or if you've had previous abdominal surgery.
Once you conceive, and you get past the first trimester miscarriages, you face a higher risk of conceiving a baby with a chromosomal problem. This risk goes up every year. If you get pregnant at age 25, your risk of having a baby with Down syndrome, for example, is about 1 in 1,250, according to the National Institutes of Health. At age 40, the risk is 1 in 100.
If you'll be 35 or older on your due date, you'll be offered genetic counseling. This is normally done by your obstetrician after you show up pregnant, but increasingly, couples are opting for "pre-conceptual counseling" – an opportunity to plan ahead and get information before getting pregnant.
A genetic counselor can help you understand your particular risks and decide whether to have genetic testing to screen for or diagnose chromosomal problems or other birth defects. Keep in mind that every woman has a chance of having a baby with problems, no matter what her age.
Even after you get pregnant, age continues to have an effect. The older you are when you get pregnant, the more likely you are to have a chronic disease, such as high blood pressure or diabetes, that may be undiagnosed and can affect your pregnancy.
You're also at higher risk of developing certain complications during pregnancy – such as gestational diabetes, preeclampsia, placental abruption (in which the placenta prematurely separates from the uterine wall), and placenta previa (in which the placenta lies low in the uterus, partly or completely covering the cervix).
Research also shows that your chances of having a low-birth-weight baby (less than 5 1/2 pounds) or a premature delivery increase with age. Some studies show that older women are more likely to need pitocin during labor, and most studies show a significantly higher rate of delivery by cesarean section.
All of that sounds scary, but population studies don't take into account whether or not the moms took good care of themselves or if they received appropriate prenatal care. Make sure you do both of those, and your chance of having a healthy baby should be similar to that of younger women who are also in good health.
Women who give birth at 35 or older have a higher risk of stillbirth and maternal death (although the overall number of stillbirths and women who die in childbirth each year has dropped significantly in the United States in the last few decades). The increased risk is largely due to underlying medical problems more common in older women. Proper diagnosis and treatment will help reduce the risks for you and your baby.
If you're considering getting pregnant, see your doctor or midwife for a thorough examination. Your provider will take a detailed medical and family history of both prospective parents to identify conditions that might affect your pregnancy or your chances of getting pregnant. You can manage many of the risks of pregnancy at age 35 and up by seeing your doctor or midwife regularly for good prenatal care.