Pregnancy After 40

May 08, 2023

middle aged pregnant woman holding belly

If you are in your late 30s or early 40s and hoping to get pregnant, you probably already know some of the risks. But also keep in mind the reasons to be optimistic. Terri-Ann Bennett, MD, chief of Maternal-Fetal Medicine at Memorial Healthcare System, should know.

She had her first baby just before her 38th birthday. As a maternal-fetal medicine (MFM or perinatologist) physician, Dr. Bennett is an OB/GYN who cares for women during high-risk pregnancies. This can include women in their late 30s and early 40s, especially those with pre-existing health problems.

“I want women to be prepared but not fearful as they consider the challenges of pregnancy later in life,” Dr. Bennett says. “It’s important they know what to expect and work with a care provider to reduce health risks to themselves and their baby.”

Fertility After 40

More women than ever are delaying pregnancy as they focus on career advancement, financial stability and other life goals. Meanwhile, their “biological clock” continues to tick. By age 30, fertility begins to decline. By age 40, healthy women have only a 5% chance of getting pregnant each menstrual cycle. And by the time a woman is 45, pregnancy is unlikely.

Dr. Bennett cites several reasons for this decline in fertility. “Women are born with a set number of eggs in their ovaries — between one and two million eggs, in fact,” she explains. “That number declines as we age. The fewer eggs in the ovaries, the lower the odds for conception. Also, older women are more likely to have gynecological issues that make it harder to get pregnant. These can include endometriosis, where uterine-like tissue grows outside the uterus. Another example is uterine fibroids or non-cancerous growths in the uterus.”

Freezing your eggs in your 20s can buy you some time. Otherwise, a fertility specialist may be able to help if your initial attempts to get pregnant in your late 30s and early 40s aren’t successful.

Egg quality is another issue for women in their late 30s and early 40s. Older eggs are more likely to have abnormal chromosomes. These increase the risk of miscarriage and genetic conditions such as Down syndrome.

Make a Healthy Start

Dr. Bennett says it’s critical for women in this age group to be as healthy as possible before getting pregnant. “Chronic conditions such as obesity, high blood pressure and diabetes can cause concern. They can increase the risk of miscarriage, stillbirth, premature birth and low birth weight,” she explains. “The earlier and smaller a premature baby is, the more medical issues the baby will face.”

To reduce your risk for these problems, try to follow these guidelines before you get pregnant.

  • Eat a balanced diet rich in vitamins and nutrients.
  • Exercise regularly.
  • Shed extra pounds.
  • Manage existing health problems with your doctor’s help.
  • Make sure any medication you take is safe for pregnancy.
  • Don’t use illicit drugs, drink alcohol or smoke/vape.

Also, begin taking a prenatal vitamin and folic acid supplement three months before you hope to conceive. Folic acid reduces the risk of a spinal condition called spina bifida.

Get Good Prenatal Care

All pregnant women need good prenatal care, which includes regular check-ups and tests (such as a fetal ultrasound). If you are in your late 30s or early 40s, your OB/GYN may talk to you about taking low-dose aspirin. Another recommendation is to induce labor at 39 weeks gestation rather than waiting until 40 weeks or more to give birth.

“Both of these measures can reduce a mom’s risk for pre-eclampsia, a kind of high blood pressure that can be life-threatening for mom and baby,” Dr. Bennett says. “Women with diabetes, high blood pressure or kidney disease before pregnancy are at higher risk. Research shows that a low dose of aspirin during pregnancy and having your baby at 39 weeks can help.”

Dr. Bennett adds that Black women of all ages are at higher risk for pregnancy and childbirth complications than white women. Lack of access to care, poor quality care and lack of attention from providers play a role. And, as Black women reach their late 30s and early 40s, health issues such as high blood pressure and obesity compound the problem.

Memorial Healthcare is working to improve maternal health for Black women in South Florida. For example, we will host several events during National Black Maternal Health Week (April 10-17). On April 17, Dr. Bennett will present a free webinar and panel discussion. The topic is how our community can make a meaningful impact on Black maternal healthcare outcomes. All are welcome to attend.

Make a Plan

Perhaps the most important thing you can do to prepare for a healthy pregnancy after 40, Dr. Bennett says, is to plan ahead.

  • Be as healthy as possible going into your pregnancy.
  • Talk to your OB/GYN about any existing health problems and how to manage them as you prepare for pregnancy.
  • A maternal-fetal medicine specialist can offer a “preconception consult” if you have other concerns. (You’ll need a referral from your OB/GYN.)

“With age comes wisdom and experience, which means older moms have a lot to look forward to,” Dr. Bennett says. “My colleagues and I in maternal-fetal medicine love helping them prepare for the journey ahead.”

Learn about high-risk pregnancy care at Memorial Healthcare.