Pregnancy Over 40: Managing the Risks of Advanced Maternal Age

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An increasing number of women in the United States are giving birth at age 40 and beyond.

According to the Centers for Disease Control and Prevention (CDC), more than 147,000 women aged 40 and older gave birth in 2023 — marking a new record. The number of women giving birth after turning 40 has increased by 193% since 1990.

Giving birth after age 35 bears the medical definition of advanced maternal age. Pregnancy after 40 presents several challenges, from fertility difficulties to a higher risk of adverse pregnancy outcomes. But with the right care, you can have a healthy pregnancy.

Here’s what to know about pregnancy after 40 and how to prepare for a pregnancy in your 40s.

How Fertility Changes After Age 40

It’s more difficult to become pregnant after age 40 than it is just a few years earlier. Women have only a certain number of eggs in their ovaries, which declines as they age — affecting fertility. Remaining eggs can also degrade over time.

A woman’s peak fertility is between her late teens and late 20s, according to the American College of Obstetricians and Gynecologists (ACOG). Fertility begins to decline at age 30, and the pace increases after age 35.

According to ACOG, about 10% of women aged 40 and above will get pregnant during a single menstrual cycle. That number is about 25% in healthy couples in their 20s and early 30s, ACOG says. After age 45, getting pregnant is unlikely without assisted reproductive technology.

ACOG recommends that women age 40 and over undergo infertility evaluation before trying to become pregnant.

If you’re trying to become pregnant and are struggling to conceive, you may consider visiting a specialist in fertility and/or reproductive endocrinology. You may wish to discuss fertility treatments, such as in vitro fertilization (IVF).

What Are the Risks of Pregnancy After 40?

Women who give birth after age 35 are at greater risk for adverse maternal and neonatal outcomes than younger women. Those risks only increase as you get older.

According to ACOG, women who give birth after age 35 are at greater risk for miscarriage and stillbirth. They’re also more likely to have a multiple pregnancy, meaning two or more babies.

Other common risks of pregnancy over age 40 include:

• Birth defects — There is a higher risk of babies with certain genetic conditions. The most common is Down syndrome, which affects 1 in 86 births after age 40, according to ACOG.
• Cesarean delivery (C-section) — This procedure involves an obstetric surgeon making cuts in your belly and uterus to deliver your baby instead of a vaginal delivery.
• Gestational diabetes — A type of diabetes that develops during pregnancy.
• Labor dystocia — Slow, difficult, or obstructed labor.
• Low birth weight — Babies born to mothers of advanced maternal age are more likely to have a lower birth weight than is typical.
• Neonatal intensive care unit (NICU) admission — Babies born to mothers of advanced maternal age are more likely to need to stay in the NICU after birth.
• Preeclampsia — A serious type of hypertension (high blood pressure) that typically occurs later in pregnancy. Preeclampsia can damage your liver and kidneys.
• Postpartum hemorrhage — Severe bleeding after childbirth.
• Preterm birth — Babies have a higher likelihood of birth before the expected term of 40 weeks.

Although there are common associations between these risks and all pregnancies after age 35, they increase as the mother’s age increases.

A 2025 study in Acta Paediatrica examined births among women ages 35 and older in Sweden. It broke the births down into mothers ages 35 to 39, 40 to 44, and 45 and up. The study reported that the risk of stillbirth, low birth weight, and preterm birth increased in the older groups.

A 2022 study in The International Journal of Gynecology and Obstetrics had similar findings. It reported that the risk of stillbirth, cesarean delivery, and maternal mortality, among other adverse outcomes, increased with older pregnancies.

Tips for a Healthy Pregnancy After 40

Later-in-life pregnancies are higher risk than pregnancies at younger ages. However, women over 40 can still have healthy pregnancies, labors, and deliveries. Getting the right care can help ensure your and your baby’s health.

Schedule a prepregnancy discussion with your doctor

If you’re over 35, ACOG recommends talking with your ob-gyn about your plans to become pregnant before you begin trying to conceive. They can provide advice on diet, vaccines, and other health steps to take before becoming pregnant.

Follow your prenatal care schedule

Prenatal care is vital for a healthy pregnancy. The first prenatal appointment typically takes place at eight weeks into your pregnancy. If you’re over 40, your doctor may suggest scheduling the first visit sooner than that. You also may want to consider an earlier appointment if you have high blood pressure, diabetes, or another preexisting health condition.

Your ob-gyn can recommend the best prenatal vitamins for women over 40. You also may have increased prenatal visits and more imaging tests to ensure your baby’s health, especially late in your pregnancy.

Consult a maternal-fetal medicine specialist

Your ob-gyn may recommend that you see a maternal-fetal medicine (MFM) specialist.

MFM doctors specialize in caring for high-risk pregnancies. They can help manage your care to ensure you have a healthy pregnancy and childbirth experience.

Consider genetic testing

Because pregnancies with advanced maternal age come with increased risks of genetic disorders or other congenital abnormalities, your doctor may suggest you undergo genetic testing. Genetic testing during pregnancy is optional.

There are two types of prenatal genetic testing:

• Screening tests — Prenatal screening tests tell you the odds that your baby has a genetic disorder. If results are abnormal, your doctor may recommend a diagnostic test.
• Diagnostic tests — Prenatal diagnostic tests can determine if your baby has a certain condition.

For example, because advanced maternal age carries a risk of Down syndrome, your doctor may recommend noninvasive prenatal testing (NIPT). This screening test analyzes fetal DNA in the mother’s blood for signs of Down syndrome or other genetic conditions. They can perform it as early as 10 weeks into a pregnancy.

Genetic testing is also possible before pregnancy to determine the likelihood that you and/or your partner will pass conditions on to your child.

Early delivery

Your ob-gyn may recommend that you deliver your baby at 39 weeks instead of the typical 40 weeks.

Although the risk of C-section is higher in women over age 40, it’s still possible to have a vaginal delivery. Your care team will discuss your options with you to ensure the safest possible childbirth experience.

Is It Safe to Have a Baby After 40?

Yes! Although there are challenges that come with pregnancy at age 40 and beyond, it’s still very possible to have a safe and healthy pregnancy. By seeking out the right care and following your prenatal visit schedule, you can help manage your and your baby’s health.

UPMC Magee-Womens is a national leader in pregnancy care. For more information about the services we provide before, during, and after pregnancy, visit our website.