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Having a Healthy Baby after 35

Increasingly, women are waiting until they are older to have children. Their reasons for waiting are varied. Education, career achievement, home purchases, financial security and the search for "Mr. Right" can all serve to delay a woman's childbearing until her mid-30s or even 40s.

The statistics are striking: Back in 1970 only 9% of women had not had children by the time they had reached age 35.1

Childbearing by women in their thirties and forties continued to increase. The birth rate for women aged 30-34 rose slightly between 2004 and 2005, to 95.9 births per 1,000, the highest rate since 1964. The rate for women aged 35-39 years rose to 46.3 births per 1,000, 2 percent over the rate in 2004 and the highest rate since 1965. 2

In contrast, birth rates for teens aged 15-17 years fell 3 percent, to 21.4 births per 1,000, another record low for the nation. 3

While health complications gradually increase for both mother and baby as a woman ages, more and more couples are finding the rewards outweigh the risks. Half of all married (childless) women ages 30 to 35 say they still expect to have at least one child.4

This section offers information about the risk factors associated with pregnancy after age 35, but does not attempt to offer medical advice. You should seek the guidance of your personal physician to obtain advice that is specific to your situation.

Is pregnancy after 35 too risky?

It is true that there are a number of issues that may come into play with pregnancy after age 35, but 35 is a bit of an arbitrary number. It's important to understand that these potential complications don't just "jump into effect" the day a woman turns 35. Age 35 is used because it generally represents the beginning of an age range during which some increased risk may progressively become more evident.

As women (and men) become older they experience more and more health problems. It is logical to assume that medical problems can complicate a pregnancy. For example, there would be as much concern about a woman's pregnancy risks at age 20 if she has diabetes as for a normally healthy pregnant woman of 35 or 40.

A woman needs to remember to view this "potential for risk" through a lens that looks at the entire population. So what may be true for a certain percentage of women her age may not necessarily be true for her. This is not to say that there aren't any risks - there are - but those risks need to be kept in perspective.

Having said that, here are some of the more common complications that affect some women and their babies during pregnancy after age 35 or so.

What are the most common complications?
Some of the most common complications that affect some women and their babies are: chromosomal abnormalities (one of which results in children with Down syndrome); a higher rate of miscarriage; death of the mother; increased numbers of Caesarean sections; and premature births. Older couples may also find it more difficult to become pregnant.

Chromosomal abnormalities - Down syndrome (DS)
The risk that seems the most worrisome for people is chromosomal abnormalities (one of which results in children with Down syndrome). And, generally, the odds of having a baby with Down syndrome increase with a woman's age.

Although no one knows for sure why DS occurs and there's no way to prevent the chromosomal error that causes it, scientists do know that women age 35 and older have a significantly higher risk of having a child with the condition. 5. The risk of having a baby with Down syndrome increases with advancing maternal age (e.g. 1 in 910 at age 30, and 1 in 28 at age 45) but where a previous pregnancy has been affected it increases further to about 1 in 200 at age 30 and 1 in 25 at age 45. 6

Neural tube defects
Anencephaly and spina bifida are both neural tube defects. Spina bifida and anencephaly are the most common preventable birth defects. It is believed that occurrences of both anencephaly and spina bifida can be reduced if women begin taking folic acid several months before and after becoming pregnant.

It should be noted here that while the risk for these defects is higher in babies of older mothers, remember that the risk of neural tube defects is relatively stable across any age group, and can occur in any pregnancy, regardless of the mother’s age.

Babies with anencephaly are missing both the skull and cerebral portions of the brain. The approximate risk is 3 to 4 anencephaly babies for every 10,000 births.Anencephaly is fatal.

“Spina bifida is one of the most common birth defects, with an average worldwide incidence of 1-2 cases per 1000 births, but certain populations have a significantly greater risk. In the United States, the incidence is 0.7 per 1000 live births. The incidence is higher on the East Coast than on the West Coast, and higher in whites (1 case per 1000 live births) than in blacks (0.1-0.4 per 1000 live births).” 8

The effects of spina bifida may be able to be repaired by surgery very early in a baby's life. Some effects are being repaired in the womb through prenatal microsurgery. Properly treated, persons with spina bifida can live well into adulthood. 9

Parents of children with spina bifida have an increased risk of having a second child with a neural tube defect.10

The Dr. D. McLone & Colleagues study on a series of almost 1,000 unselected cases of spina bifida which they had aggressively treated showed that:

  • 75% had normal intelligence
  • 80% were walking by school age
  • 90% had bowel and bladder control by school age
  • 99% of parents were satisfied with the treatment.11

Higher Miscarriage Rates
As mentioned above, chromosomal abnormalities increase with a woman's age. These abnormalities are the main cause for miscarriages. This fact contributes to a somewhat higher risk for miscarriage among women who are 40 and older.

For example, a woman in her 20s and 30s may be told that, once a heartbeat is heard, her risk of miscarriage is way less than 5%. However, this cannot be said for a woman over 40 years of age. Her risk of miscarrying may still be at 10% or greater even after a heartbeat is heard.

Death of the mother
The risk to mothers of not surviving childbearing increases fourfold at ages 35 to 39 compared to ages 20 to 25. However, these deaths are extremely rare and are usually associated with pre-existing medical problems rather than the pregnancy itself. 12

Caesarean Section (C-Section Births)
Women over 35 also face an increased risk for having their child born via Caesarean section. Concern for the child's safety through a vaginal birth is often the cause for the increase in C-Section births.

Ectopic pregnancies - (Tubal pregnancies)
The ectopic pregnancy rate is actually higher for younger women who have experienced tubal damage from sexually transmitted diseases. Generally speaking, ectopic (or tubal) pregnancies are less common for older women.

Premature births
There is a fourfold increase in the risk for premature births for women age 35 and over (compared to women 20 to 25). These premature births are most likely associated with medical complications.13

Fertility issues - difficulty getting pregnant
Early 20s to late 30s - Most women (not all, but most) who aren't pregnant will get pregnant eventually. It is recommended that a woman in her 20s (or even early 30s) who has not become pregnant after trying for a year is still likely to become pregnant during the following 12 to 18 months. This assumes that the woman is having regular menstrual cycles and is otherwise healthy.

As women reach their thirties, they experience a decline in fertility. Furthermore, complications during pregnancy are more common when women reach age 35. Age-related decline in fertility may be due, in part, to the following:

  • A decrease in the number and health of the eggs to be ovulated.
  • Changes in the hormones resulting in altered ovulation.
  • Fewer number of eggs.
  • A decrease in sperm counts.
  • A decrease in the frequency of intercourse.
  • The presence of other medical and gynecologic conditions, such as endometriosis, which may interfere with conception. 14

Late 30s to early 40s - If an older woman (late 30s or early 40s) has these difficulties, she should not wait as long to seek help. After six months of trying without success she deserves some closer investigation. Again, this assumes that the woman is having regular menstrual cycles and is otherwise healthy.

How important is folic acid for older women who want to get pregnant?
For younger or older women, it is wise to take the recommended amounts of folic acid several months before becoming pregnant and several months into the pregnancy as well.

It is known that (across the general population) when folic acid is included in the diet, the number of neural tube defects is reduced. Common neural tube defects are spina bifida and anencephaly. In the U.S. in recent years, folic acid has been added to a number of breakfast cereals and enriched breads.

How much folic acid should I be taking?
Women who anticipate becoming pregnant should be taking (daily) at least 400 micrograms of the B-vitamin folic acid several months before and after becoming pregnant. Folic acid pills are small and easy to swallow. Folic acid pills can be bought in the vitamin section of grocery stores, pharmacies and discount stores. If you prefer, you can get 100% of your daily folic acid intake from a daily bowl of certain cereals. Some of these cereals are Total, Product 19, Cheerios Plus and Smart Start.

What if my baby is diagnosed with a severe defect - is abortion the only answer?
Sadly, there are instances in which babies do not develop properly. But even when serious complications occur, all is not lost. In recent years, modern medical techniques have corrected some amazingly complicated problems - even while the child is still in the womb. For example, unborn babies diagnosed with spina bifida have had pre-birth surgery to correct some of the most serious side effects.

While some diagnosed abnormalities may seem severe, aborting the child is not the correct response - for several reasons.

First, the diagnosis may be wrong.

Second, the abnormality may not be as severe as the diagnosis suggests.

Third, even children with a disability such as Down syndrome are special. They have wonderful potential for productive lives and to give and receive love.

And fourth, even if the child is afflicted with a condition that limits his or her life potential to a mere few hours or days, that brief life can leave positive, encouraging memories - instead of regret.

Keep in mind that aborting a child (even a child with severe health problems) may cause life-long psychological trauma for the mother.


Reference Notes:
1. National Center for Health Statistics, “Preliminary Births for 2004,” 
http://cdc.gov/nchs/products/pubs/pubd/hestats/prelim_births04.html 

2,3. National Center for Health Statistics, Births: Preliminary Data for 2005,

http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prlimbirths05.htm

4. Williams Obstetrics 20th Edition, Appleton and Lange, 1997

 5. Estimate from MedLine Plus Medical Encyclopedia, a service of the National Library of Medicine, 7/17/01.

 6. Mothers, 35 Plus, http://www.mothers35plus.co.uk/down.htm

 7. See note 5.

 8,9.Llemire, R. J. (1988). “Neural tube defects.” JAMA 259 (4): 558-62. PMIC 3275817; Cotton, P (1993). “Finding neural tube ‘zippers’ may let geneticists tailor prevention of defects.” JAMA 270 (14): 1663-4. PMID 8411482 
http://en.wikipedia.org/wiki/Spina_bifida#Incidence 
10,11. D. McLone et al., Concepts in the Management of Spina Bifida, Concepts in Pediatric Neuro-surgery S 33 (1986): 359-370 as cited in Why Can't We Love Them Both - Questions and Answers About Abortion, Dr. & Mrs. J.C. Willke, p184, 1997, Hayes Publishing, Cincinnati, OH
12,13. Williams, See note 4. 

14. WebMDHealth, Pregnancy after 35, FAQs,2/26/2009.