Pregnancy After 35: Evidence on Age-Related Risks, Testing and Outcomes

“Advanced maternal age” is the medical term for a pregnancy where the due date falls at age 35 or older. It is not a diagnosis and it doesn’t mean something is wrong. It’s a label doctors use because research shows certain pregnancy risks become somewhat more common starting around this age. Most people who become pregnant after 35 go on to have healthy pregnancies and healthy babies, especially with regular prenatal care.

Newer guidance from the American College of Obstetricians and Gynecologists (ACOG) also looks at risk in narrower age bands, such as 35 to 39 and 40 and older, rather than treating everyone 35 and up as one group. Risk tends to rise gradually with age rather than jumping the moment someone turns 35.

Urgent Warning Signs to Know About Regardless of Age

Some pregnancy symptoms need same-day or emergency care no matter how old you are. Call your doctor right away, or go to an emergency room, if you notice any of the following:

A severe headache that won’t go away, vision changes, or sudden swelling in your face or hands
Sharp or one-sided abdominal pain, dizziness, or fainting
Heavy vaginal bleeding, or bleeding that soaks through protection every hour
A noticeable decrease in your baby’s movement
Sudden shortness of breath or chest pain

These signs can point to conditions like preeclampsia or ectopic pregnancy that need prompt evaluation. Don’t wait for a scheduled appointment if you notice them.

Which Risks Increase After 35, and by How Much

Age is one factor among many that affects pregnancy risk, and having a birthday doesn’t change your risk overnight. Still, research does show some patterns. According to ACOG’s clinical guidance, pregnant people aged 35 and older are two to four times more likely to have chronic high blood pressure, and nearly twice as likely to have type 2 diabetes, compared with people ages 25 to 29. People over 40 have two to three times the risk of developing gestational diabetes compared with younger pregnant people.

Other risks that research links to pregnancy after 35 include:

Preeclampsia, a blood pressure condition of pregnancy
Gestational diabetes
Higher chance of needing a cesarean delivery
Preterm birth
Miscarriage and stillbirth
Chromosome conditions in the baby, such as Down syndrome
Twins or other multiple pregnancies, which become more common with age, partly due to fertility treatment

These are population-level patterns, not predictions about any one person. Someone who is healthy going into pregnancy at 38 may have a very different risk picture than someone with existing health conditions at the same age.

Why Age Affects These Risks

Older adults in general are more likely to have health conditions like high blood pressure, and those conditions can affect pregnancy. But research also shows that people with no other health problems can still have a higher-risk pregnancy simply due to age. Egg quality also changes over time, which is part of why the chance of chromosome conditions rises with age. None of this means complications are guaranteed. It means your care team may recommend closer monitoring.

Testing That May Be Offered

ACOG recommends that screening and diagnostic testing for chromosome conditions be offered to everyone during pregnancy, regardless of age. Your counseling about which tests make sense for you will be based on your age, family history, and personal preferences. Broadly, these fall into two categories:

Screening tests estimate the chance of a chromosome condition. These include first-trimester combined screening and cell-free DNA screening (sometimes called NIPT), both done through a blood draw or ultrasound and considered low-risk to the pregnancy.
Diagnostic tests give a more definite answer and include chorionic villus sampling (CVS) and amniocentesis. These involve a small procedure and carry a small risk of complications, which your provider can walk you through.

If you’re 35 or older, your provider may also recommend closer monitoring for blood pressure and blood sugar, and discuss whether low-dose aspirin is right for you if you have risk factors for preeclampsia. Don’t start taking aspirin or any medication during pregnancy on your own — this is a decision to make with your provider based on your specific risk factors.

What to check before acting on Pregnancy After 35

Ask what “advanced maternal age” means for your specific health history, not just your age.
Ask which screening and diagnostic tests are available to you and what each one can and can’t tell you.
Ask whether you have risk factors for preeclampsia and whether aspirin might be recommended for you.
Ask how your prenatal visit schedule might differ because of your age.
Ask what warning signs should prompt you to call between visits.
If you’re still trying to conceive and it’s been six months without success and you’re 35 or older, ask about a fertility evaluation.

How to act on what you know about Pregnancy After 35

If you are 35 or older and pregnant, schedule prenatal care as early as you can. Early, regular care is one of the most consistent ways to catch and manage problems.
At your first visits, ask your provider to review your personal risk factors, not just your age, so you understand your specific situation.
Discuss which screening or diagnostic tests, if any, make sense for you and your family.
Ask about a monitoring plan for blood pressure and blood sugar through the rest of your pregnancy.
If you are 35 or older and trying to conceive without success after six months, ask for a referral for a fertility evaluation rather than waiting longer.

Questions studies have not settled about Pregnancy After 35

Risk generally increases further after age 40, more so than the jump from the early 30s to 35. People with existing conditions like high blood pressure, obesity, or diabetes going into pregnancy, and people carrying twins or other multiples, may face compounded risks that are worth discussing specifically with a provider.

Most of the research behind these numbers comes from population-level studies, which show associations between age and certain outcomes but can’t predict what will happen for any one individual. This page doesn’t cover every personal risk factor, medication decision, or testing choice, since those depend on your full health history. It’s a general educational overview, not a personalized risk assessment or care plan.

Reader questions on Pregnancy After 35

What exactly counts as “advanced maternal age”?

It refers to a pregnancy where the due date falls at age 35 or older. It’s a planning category clinicians use to guide conversations about testing and monitoring, not a judgment about your health or a guarantee of complications.

Does being over 35 mean I automatically have a high-risk pregnancy?

Not automatically. Age is one risk factor among several, including your overall health, prior pregnancies, and whether you’re carrying more than one baby. Many people 35 and older have pregnancies with no complications at all.

Will I be required to get extra testing because of my age?

No test is required. Screening and diagnostic testing for chromosome conditions is offered to everyone, and you and your provider will decide together what makes sense based on your age, history, and preferences.

Can I lower my risk of complications on my own?

Getting early and regular prenatal care is one of the most consistent ways to support a healthy pregnancy. Beyond that, any specific steps — including whether to take aspirin or adjust medications — should be discussed with your provider, since the right approach depends on your individual health history.

Educational Disclaimer

This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It does not diagnose any condition, recommend any specific test or medication for any individual, or predict outcomes for any pregnancy. Always talk with a licensed healthcare provider about your own health history and pregnancy care. If you are having a medical emergency, call 911 or go to the nearest emergency room. See our full Medical Disclaimer.