pregnant women holding her bare belly

Pregnancy over 35: What to expect, risks, and self-care

Dr. Muthoni Mwangi
In many countries, the average age of having a first child for women has been increasing. This trend is driven by many factors such as many women choosing to pursue careers, education and financial stability before starting a family.

Advanced maternal age is commonly defined as being over 35, though there is no standardized definition.

Risks of advanced maternal age

Women over 35 face higher risks of pregnancy-related complications, such as gestational diabetes and hypertension. There is also a greater likelihood of requiring operative deliveries, such as cesarean sections. For the baby, there are increased risks of chromosomal abnormalities (e.g., Down syndrome), early pregnancy loss, preterm birth, neonatal intensive care unit (NICU) admission, and stillbirth.

Antenatal care for advanced maternal age

First Trimester: An early scan is recommended between 11 and 13 weeks to check for chromosomal markers via ultrasound. This can be combined with a blood test (double test) to assess the risk of chromosomal abnormalities. If the risk is high, a diagnostic test such as amniocentesis (sampling the amniotic fluid) may be performed to determine the baby’s health. If abnormalities are found, the obstetrician will discuss options with the parents.

12 Weeks: The obstetrician will assess the risk of hypertension and may prescribe aspirin to help prevent it.

20-22 Weeks: A follow-up ultrasound is performed to check the baby’s development and detect any abnormalities.

24-28 Weeks: Screening for gestational diabetes is conducted for all pregnant women.

36 Weeks: Another ultrasound is done to monitor the baby’s growth. Women aged 40 and above are typically advised to deliver at 40 weeks due to higher risks of complications if the pregnancy continues beyond this point. If labor has not begun by 40 weeks, induction may be recommended.

Advances in reproductive medicine

Medical advancements have made it possible for women to freeze their eggs for future use. This offers women more flexibility in deciding when to have children without being as constrained by the biological clock.

Recommendations if considering getting pregnant

For women considering pregnancy at an advanced age, it is important to seek preconception advice. Visiting an obstetrician before conceiving helps optimize health and start folic acid supplementation early. Beginning antenatal care early, ideally by 12 weeks, is crucial for monitoring and managing potential risks effectively.

While pregnancy over 35 comes with increased risks, careful planning and regular medical care can help ensure a healthy pregnancy and baby. The ability to freeze eggs and advancements in medical care have empowered women to make more informed and flexible reproductive choices.

For those embarking on this journey, proactive health management and early antenatal care are key to a positive outcome.

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