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Risks to childbearing later in life include potential miscarriage, chromosome abnormalities, and gestational diabetes. Learn more about pregnancy after age 35

Nowadays, having a baby after 35 is becoming more and more common. While conceiving and delivering a healthy baby despite advanced maternal age is possible, there are risks to childbearing later in life—including potential miscarrage, chromosome abnormalities, and gestational diabetes.

9 potential risks of planning a baby after age 35

1. Decline in fertility: Each woman is born with a fixed number of eggs, and each month, one egg is released from your ovaries. Theoretically, as you reach your mid to late 30s, your egg count plunges and so does the quality of your eggs. It may take you longer to conceive since your eggs are not as easily fertilized as when you were younger.
2. Miscarriage: Poor egg quality means that the egg that is released may be genetically damaged or have chromosomal abnormalities, which can result in miscarriages or stillbirth. 
3. Chromosome abnormalities: Babies born to older mothers have a statistically higher risk of chromosome problems such as Down syndrome. The risk is about 1 in 1,250 for a woman who conceives at the age of 25 years and 1 in 100 for a woman who conceives at age 40 years. There is also a higher risk of having a baby with autistic spectrum disorder (ASD) or dyslexia (a learning disability).
4. Gestational diabetes: Assisted reproductive techniques and age puts older mothers at a higher risk of diabetes during pregnancy. If left untreated, gestational diabetes can affect the lung maturity and spinal cord of the developing fetus and increase the risk of birth injuries during delivery, infection of birth membranes (chorioamnionitis), premature delivery, and sepsis. There is also an increased risk of developing type II diabetes mellitus after pregnancy.
5. Pregnancy-related hypertension: Studies suggest that high blood pressure or pregnancy-related hypertension is more common in older women. This may adversely affect maternal health and cause the baby to develop intrauterine growth restriction (IUGR).
6. Multiple pregnancy: The use of assisted reproductive techniques and hormonal changes in your mid-30s may cause the release of multiple eggs at the same time. This can result in multiple (twin, triplet, or more) pregnancy, which is considered a high-risk pregnancy.
7. Placental problems: Women in their late 30s often have a placenta that is low lying, covering the cervical opening (placenta previa). Placenta previa can cause severe bleeding during pregnancy, resulting in pregnancy loss and even maternal death. Histopathological studies have confirmed that the placenta of a woman older than 30 often has poor blood circulation and areas of microscopic cell death. Babies are thus at a higher risk of IUGR and stillbirth.
8. Cesarean delivery: Poor pelvic floor muscle tone, high risk of comorbid conditions, increased likelihood of obstructed and prolonged labor, etc. may increase the chances of cesarean delivery. Cesarean delivery is associated with increased maternal health risks.
9. Postpartum comorbidities: Childbearing and parenting are demanding and stressful. For many women in their 40s, nursing, feeding, and sleepless nights can be overwhelming and increase the risk of other disorders.

What is the oldest age a woman can get pregnant naturally?

You can get pregnant as long as you get your periods. However, a healthy pregnancy is statistically most likely in your 20s. After age 30, fertility starts to decline.

This decline becomes more rapid once you reach your mid-30s. By your late 40s, getting pregnant naturally is unlikely, though not impossible. Your best bet if you want to get pregnant later in life in your 40s is either freezing your eggs in your 20s or arranging for donor eggs.

How can I improve my egg quality?

Egg quality deteriorates with age. Other factors that hasten the deterioration of egg quality include:

• Oxidative stress: Poor eating habits, poor sleep, obesity, and addictions
• Environmental causes: Exposure to toxins such as bisphenol A, parabens, phthalates, herbicides, and pesticides
• Metabolic causes: Imbalanced insulin levels due to sugar intake, thyroid imbalance, diabetes, or polycystic ovary syndrome (PCOS)
• Coexisting uterine conditions: Endometriosis, uterine tuberculosis, and uterine polyps

DNA damage in your eggs is permanent. In order to improve egg quality, it is important to make healthy choices from a young age with proper hydration, healthy diet, regular exercise, and stress management.

Recent studies have explored antioxidant remedies while on fertility treatment. Although most of these studies are small-scale and in the early stages, many fertility experts believe that certain supplements taken over a course of 3-4 months may help boost egg quality to some extent. It is important to choose antioxidant supplements that do not interfere with drugs used to stimulate and regulate hormones, such as:

• Melatonin supplementation may improve egg maturation during in vitro fertilization (IVF) treatments.
• Coenzyme Q10 (CoQ10) has been shown to increase egg quality, ovulation, and fertilization rates in IVF trials.
• D-chiro-inositol has been shown to support pregnancy-promoting levels of luteinizing hormone and luteinizing hormone follicle-stimulating hormone required to maintain pregnancy. It is especially useful in those with polycystic ovarian disease, thyroid imbalances, and diabetes.
• Myo-inositol and N-acetyl cysteine may increase the rate of ovulation.

Is it possible to get pregnant with poor egg quality?

Poor egg quality means that the egg has abnormal DNA. Without healthy DNA, an egg will not fertilize or will resist implantation. These eggs often result in miscarriage or early pregnancy loss. 

In rare cases, if the egg is fertilized, poor egg quality can cause the baby to be born with birth defects. 

However, all women, irrespective of age, will not have 100% poor-quality eggs. So a healthy pregnancy is still possible, even if the chances are low.

How to assess egg quality

Both the egg quality and quantity must be optimal to ensure a healthy pregnancy. 

No single test of ovarian reserve can predict your ability to get pregnant with 100% certainty. These tests are often done in clusters and used to develop a treatment plan for assisted reproduction and donor egg planning.

Most ovarian reserve tests look for markers of your egg count, not your egg quality. Egg quality can only be determined after the egg is fertilized and genetically analyzed:

• Anti-Mullerian hormone levels: A low level at any time during the menstrual cycle predicts low fertility (low egg count).
• Transvaginal ultrasound: When done by an experienced radiologist in the early part of the menstrual cycle to count the number of small (2-10 mm, antral) follicles in the ovary, a transvaginal ultrasound can help initiate fertility treatment.
• Measuring hormone blood levels: Follicle-stimulating hormone (FSH) and estradiol are checked at the beginning of the menstrual cycle on day 3, but they can be drawn from days 1-5, and their levels are tracked. A high FSH level correlates with poor fertility.
• Clomiphene citrate challenge test: This test involves taking a medicine called clomiphene citrate to see how the ovaries respond or release eggs. It is given early in the menstrual cycle.