Dr. Amir Aviram doesn’t like the term ‘advanced maternal age.’ That said, he thinks other references like ‘geriatric pregnancy’ are even worse when referring to pregnant patients over the age of 35. The more recommended term today is ‘pregnancy with anticipated delivery at 35 years or older.’
“Age is only one factor in a multi-faceted pregnancy,” says Dr. Aviram, a Maternal-Fetal Medicine specialist at Sunnybrook. “If you’re over 40 years of age and perfectly healthy, you’re more likely to have a successful pregnancy than a 30-year-old with health issues.”
Most of the time, he says, these pregnancies are quite successful and have outcomes very similar to those at younger ages. A pre-pregnancy consult to review your health history can be helpful to learn more about what’s ahead. And Dr. Aviram encourages expectant parents to speak up and ask questions at prenatal appointments.
Dr. Aviram answers some common questions:
Do pregnancy complications increase when a patient is over 35?
Statistically speaking, these pregnancies are at a higher risk of complications, such as diabetes, or placenta related complications. The placenta forms in your uterus at the beginning of pregnancy and provides nutrients and oxygen to your baby through the umbilical cord. If there’s a problem with your placenta, your baby may be smaller than expected, or you might develop gestational hypertension or preeclampsia. Sunnybrook is currently studying preeclampsia in our patients – you can learn more here.
If I see a patient for a pre-pregnancy consult, I also look at their sugar balance, to make sure they’re not pre-diabetic, as the risk of pre-diabetes and gestational diabetes increases with age.
What about risks to the baby?
It’s true that the risk of genetic and structural anomalies in babies increases with age. You can learn more about genetic testing options here. Patients over 40 years of age at the time of delivery can do a test called NIPT for free. NIPT is a genetic test which is more sensitive than our regular first trimester screening test for Down syndrome. In addition, chorionic villous sampling and amniocentesis are options you can discuss with your care provider. We also offer patients over 40 an anatomy scan at 11-14 weeks to detect anomalies earlier in pregnancy, in addition to the 18-20 week scan.
What can I do to increase the chance of having a healthy pregnancy and baby?
First, you can maintain a healthy and active lifestyle. Second, if you have a health issue for which you are receiving medical treatment, it is suggested to you have a pre-pregnancy consult with a Maternal-Fetal Medicine specialist in order to optimize your treatment prior to conceiving.
The use of folic acid for at least 3 months prior to conceiving is also recommended to reduce the risk of spinal cord congenital defects.
If you are treated at a fertility clinic, they can run additional genetic testing on the fertilized egg prior to returning it to the uterus in order to detect genetic anomalies.
I’m using a donor egg — does all of this still apply to me?
It is important to note that some of the risks are related to maternal age (such as the risk for placental complications) and some to the age of the egg (like genetic risks). If you’re using egg donations from a younger person, some risks apply and some do not. During pregnancy we will follow the fetal growth closer to make sure your baby is growing as expected.
Is there an increase in Canada of women delaying pregnancy?
Yes, there is a measurable trend in delayed childbearing. For example, in Ontario, the average age at first birth increased from 28.4 years in 1991 to 32.1 in 2021. Across Canada, during the same years, it increased from 27.8 years to 31.4. Statistics Canada tracks birth rates and age.
