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Pregnancies during advanced maternal age were once called “geriatric pregnancies,” which is an outdated term.
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The likelihood of pregnancy complications increases with age, and a diagnosis of “advanced maternal age” can help patients get the care and support needed for a successful pregnancy.
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Maternal fetal medicine (MFM) specialists work one-on-one with women of advanced maternal age and their obstetrician gynecologists to monitor and manage high-risk pregnancies.
Pregnancy is a transformative experience at any age, and many women look to age 35 as a milestone for family planning decisions. That’s because 35 is considered “advanced maternal age” (AMA), an age at which pregnancy complications may become more likely.
As pregnancy later in life becomes more common, is a classification like AMA still necessary? We spoke with Kelsey Olerich, MD, Ph.D., a physician at Swedish Maternal and Fetal Specialty Center, to find out the latest about pregnancies after the age of 35 and how a diagnosis of advanced maternal age supports the health of women and babies.
What does advanced maternal age mean?
It used to be common to refer to pregnancy after age 35 as “geriatric pregnancy,” but that is an outdated term that never accurately or fully describes the diverse life circumstances or health profiles of pregnant women in this age group. This is more true now than ever, as in recent decades, it has become more common for people to start families throughout their 30s and 40s. The Centers for Disease Control and Prevention (CDC) found that the birth rate for women between the ages of 40–44 began increasing in the 1980s and more than doubled between 1990 and 2012.
“Geriatric pregnancy is an antiquated term, and 35 is a relatively arbitrary age that was identified in the 1980s as an inflection point for an increased risk of having offspring with chromosomal abnormalities,” says Dr. Olerich. “Today, 35 is still the age that determines a diagnosis of advanced maternal age, but it is important to understand AMA as a continuum of risks that are progressive with age.”
At Swedish, Dr. Olerich is a member of a team that includes maternal fetal medicine physicians, nurse practitioners and midwives, as well as genetic counselors and perinatal social workers who work together to help women navigate high-risk pregnancies. Her team offers full prenatal care as well as consults for women referred by their primary obstetricians because of high-risk maternal conditions, pregnancy complications or fetal complications.
Advanced maternal age increases pregnancy risks
“Age contributes to health for everyone, so age goes into the overall assessment of what a woman’s risks are going into a pregnancy,” says Dr Olerich. “All the things that can impact health during pregnancy can happen regardless of age, but they can happen more frequently in someone older.”
“The most notable difference is that at age 35, we start to recommend — not just offer — genetic screening, including screening for aneuploidy, a genetic disorder where a person has either an extra or missing chromosome,” she says.
There are two main types of aneuploidy: trisomy, in which there is an extra copy of a chromosome, and monosomy, in which there is a missing copy. Trisomy may result in miscarriage or Down syndrome. Monosomy may result in Turner syndrome. Most providers recommend screening tests for fetal aneuploidy at 10 weeks of pregnancy or later, and the first step is usually an ultrasound. If the ultrasound shows that the baby is at risk of aneuploidy, providers may recommend additional screenings. Some prospective parents also choose genetic carrier screening, which can be done before or during pregnancy.
In addition to chromosomal abnormalities, some of the risks of advanced maternal age include:
- Pre-term birth.
- Low birth weight.
- Miscarriage.
- Stillbirth.
- Fetal growth disorders.
- Labor complications, including early labor.
- Cesarean delivery.
- High blood pressure (preeclampsia).
- Gestational diabetes.
- Multiple pregnancies, such as twins or triplets.
Maternal fetal medicine specialists can work with your primary OB-GYN
“Many times, the patients we work with already have an established relationship with their primary OB-GYN, and we provide additional support and recommendations,” says Dr. Olerich. “In general, for healthy patients of advanced maternal age, those recommendations will include surveillance to support the pregnancy while the patient continues to see their primary OB-GYN throughout pregnancy.”
At Swedish, prenatal surveillance may include screenings or procedures to help ensure the baby is healthy and growing as expected. A variety of ultrasounds help maternal fetal medicine providers monitor babies throughout pregnancy. These include:
- 1st trimester anatomy/nuchal translucency ultrasound.
- Detailed fetal anatomic ultrasound.
- Fetal echocardiogram.
- Follow-up (growth) ultrasound.
- Targeted or limited ultrasound.
- Transvaginal ultrasound.
- Doppler flow ultrasound.
- Amniotic fluid index (AFI) ultrasound.
- Biophysical profile (BPP).
Genetic counseling helps with difficult decisions
The maternal fetal medicine specialists at Swedish often recommend genetic screening for patients of advanced maternal age, and patients today have many genetic testing options during pregnancy.
“We work closely with our genetic counselors to make sure patients understand the screenings we recommend and why we recommend them,” says Dr. Olerich. “Sometimes the statistics and information can be complex and confusing, and it can change with advancing age. Our goal is to help patients make sense of our recommendations and feel confident about their choices.”
Genetic counseling helps patients weigh their options and make a decision about whether or not to go ahead with genetic testing. Genetic counseling at Swedish includes:
- A discussion of the pros and cons of testing options during and before pregnancy.
- Personal guidance on test decision-making through test results.
- Patient-friendly explanations of complex medical information.
- Guidance to make informed, independent decisions about your health care and reproductive options.
- Resources and educational materials.
Pregnancy is a unique experience at every age
“There is a huge spectrum of life experiences, activity levels and overall health at different ages for different people,” says Dr. Olerich. “So, health and wellbeing during pregnancy is as personal and specific to each person as before pregnancy, but we know that older women have lived longer and therefore have had more time to develop and identify conditions that pregnancy could exacerbate.”
Dr. Olerich emphasizes that for everyone, regardless of age, the best way to prepare for pregnancy is to work on being the healthiest version of yourself. Patients who have been diagnosed with chronic medical conditions can work with their providers to have them well-controlled before pregnancy, and this is often a good predictor of health throughout pregnancy.
“A patient of advanced maternal age who has kept up with all of their preventive care is doing the best thing they can do to experience a healthy pregnancy.”
She also emphasized the importance of seeing a provider early.
“While we know that there are risks associated with AMA, it is the acknowledgment and management of these risks that is important,” she says. “Getting plugged into care ensures that we identify anything that may arise so we can do everything we can to have a successful pregnancy.”
35 is not too old for pregnancy or parenthood
“Some people think that at 35, they are too far behind to have a successful pregnancy,” says Dr. Olerich. “But medical risks should not be seen as a one-sided argument against getting pregnant. There are positives of having lived a bit more life that benefit pregnancy and parenthood later in life.”
Learn more and find a provider
If you have a health issue or concern, it’s important to see a provider for the right care when you need it. Whether you require an in-person visit or want to consult a doctor virtually, Swedish is here for you.
For urgent, walk-in or after-hours care, visit one of our Swedish Urgent Care facilities. Swedish Express Care Virtual connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our Swedish provider directory.
Join our Patient and Family Advisory Council.
Related resources
At Swedish, midwives’ expansive role in care is helping build community
Newsweek ranks Swedish among best U.S. maternity hospitals
U.S. News & World Report names Swedish Issaquah among best U.S. maternity hospitals
This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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