More women are having babies later in life, and doctors say “advanced maternal age” can bring higher risks—though most pregnancies still end with healthy outcomes. A federal report cited in an Associated Press story found that 21% of births in the U.S. in 2023 were to women 35 and older, compared with 9% in 1990.
For clinicians, the key message is that older pregnancy is not automatically dangerous, but it does tend to change the risk profile. In the AP report, Dr. Jacquelyn Means, a Texas OB-GYN who had her first child at 37 and her second at 39, said being pregnant in her late 30s was harder on her body and that there are “certain complications to watch out for,” while also adding that “It’s usually going to be fine.”
Doctors point to a range of conditions and pregnancy complications that become more common with age. The AP report says older pregnant women are more likely to have issues such as high blood pressure and obesity and are more prone to developing pregnancy complications. It also says older mothers are more likely to undergo cesarean sections and to give birth to twins or babies with some genetic abnormalities.
Because the risks are generally low but higher than average, the report emphasizes preparation—starting before conception. Dr. Ashley Zink, a maternal-fetal specialist at the University of Texas Southwestern, compared the process of optimizing health to “building your baby’s first home.” She said prospective parents should keep the habits established over the years, including eating a well-balanced diet, staying active and avoiding risky behaviors such as smoking.
The AP story also points to the value of a preconception checkup. It says doctors recommend meeting before trying to conceive to discuss health concerns, treat conditions that might affect pregnancy and ensure vaccinations are up to date. During pregnancy itself, clinicians said, expect follow-up planning around prenatal tests and ultrasound monitoring.
On the testing front, doctors in the report recommend a first-trimester ultrasound to measure fetal size, help confirm the due date and check for multiple fetuses. The report also notes that women over 35 may be more likely to have twins or triplets because they can produce more of the hormone that stimulates the ovaries to produce eggs and because some use in vitro fertilization, which the AP report says can increase the likelihood of multiple births.
The story adds that noninvasive prenatal testing using blood work can screen for certain chromosomal abnormalities. It cites Stanford Medicine Children’s Health’s risk estimates for Down syndrome as about 1 in 1,250 for a woman who conceives at age 25, rising to about 1 in 100 for a woman who conceives at 40. If screening suggests a fetus may be at risk, doctors may recommend more invasive diagnostic options, including amniocentesis—where a small amount of amniotic fluid is taken from the uterus—or chorionic villus sampling, where cells are taken from the placenta.
As pregnancy progresses, doctors also suggested asking about additional ultrasound monitoring later in the third trimester. In the AP report, Zink said older women can ask about a “growth ultrasound” around 32 or 34 weeks, describing it as a way to check whether the placenta is doing a good job and whether fluid and growth look normal.
Ultrasounds later in pregnancy, the report says, may also help spot problems with the fetus. It notes that older pregnant women face increased risk of birth defects, particularly cardiac defects, and that there is also a higher risk of stillbirth, though the AP report characterizes the risk as still very small.
When it comes to delivery, the report says risks can shift again, including the likelihood of a C-section. It quotes the March of Dimes as saying the percentage of babies delivered by C-section rises with maternal age, averaging 48% of live births for women 40 and older, based on 2022 to 2024 data. The story also says C-sections are associated with higher risks of maternal complications such as infection and bleeding compared with vaginal delivery.
The AP report describes medical reasons that can lead to cesareans, including chronic health conditions that can make vaginal birth riskier, such as diabetes or high blood pressure, and complications that arise during labor. It also links some pregnancy issues more common in older mothers—such as placenta problems—to bleeding before or during labor, adding that placental abruption occurs in about 1 in 100 pregnancies overall.
In the reporting, Means provided a personal account of her pregnancies that included placenta-related problems and gestational diabetes with both children. The AP story says that after giving birth to her first child in 2023, some placenta was retained and had to be removed, and she needed treatment for postpartum hemorrhage. It adds that a week after giving birth to her son the year before, she suffered severe bleeding and received hospital treatment.
Despite those experiences, Means said her children were ultimately healthy. She joked that “So both of my babies tried to kill me a little bit,” and said that once she got past the bleeding issues she “have been fine,” adding that both of her kids are super healthy.