Pregnancy over 40

Pregnant woman over 40 looks at nurse in hospital

More women are embarking on motherhood later in life, with pregnancies over the age of 40 on the rise, according to the Office for National Statistics

There's some level of risk in all pregnancies; and certain risks are increased when you're older. It's not all bad news by any means – there are plenty of mums who have brilliant things to say about being a parent later in life. But if you are entering your fourth decade and pregnant, or trying to conceive, here are a few things to think about.

Getting pregnant naturally over 40

The Royal College of Obstetricians and Gynaecologists suggests the 'optimal age' for childbearing is 20 to 35; as the ONS figures show, however, this doesn’t necessarily square with the reality of life these days, when getting ‘settled in life’ is somewhat more challenging than it was a few decades ago.

Nevertheless, women aged 35 and over are deemed to be 'older' mothers; this is the point at which fertility begins to decline, and women may therefore find it harder to conceive by this age. NHS statistics say that at age 35, a third of women will experience problems getting pregnant, and this rises to two thirds by the age of 40. Male fertility also declines as they approach their 40s, albeit at a slower rate.

I found out I was pregnant with my fourth child on my 40th birthday. It was my healthiest pregnancy.

How successful is fertility treatment over 40?

Some couples who are having difficulties conceiving due to their age have success with fertility treatments, although the success rates of options such as IVF drop with age just as natural conception does, and the likelihood of having a miscarriage with an IVF pregnancy increases, too, as you get older.

At the age of 40-42, one in five to one in 10 IVF cycles develops into a successful pregnancy – but by the age of 43-44 that drops to between one and five in 100, a pretty sharp decline. Above the age of 44, your chances of becoming pregnant using IVF are considered to be minimal.

However, plenty of older parents do get pregnant. In 2015, 29,000 women over 40 had a baby and 2,000 of those women were over 45. In fact, there are now more babies born to women over 40 than to women under 20.

Pregnant woman looking at scan photos

Interestingly, the older you are, the greater your chance of having twins, due to the presence of the hormone FSH, which is produced as fertility declines. It’s nature’s way of giving you the chance to double your odds. If you’re pregnant with multiples you’ll have additional appointments, as well as the careful monitoring older mothers receive as a matter of course.

Will my pregnancy be monitored more closely if I’m older?

If you are an older mother, you may be seen by a doctor or obstetrician rather than a midwife at antenatal appointments, particularly if this is your first pregnancy. Medics might refer to you as an 'elderly primagravida' – sounds like a blooming cheek, but actually simply means that you're a first-time mother over 35.

You’ll have all the regular tests and scans at your antenatal appointments, but you may also be offered additional tests (see below). These are optional, so you can of course decline – but they are able to pick up on some irregularities better than standard checks.

Testing in pregnancy for older mums

Blood tests

All pregnant women are given a number of blood tests at around 12 weeks for things like anaemia, HIV, rhesus status, and inherited blood diseases.

Further screening can be carried out to look for specific irregularities or concerns relating to the foetus if abnormal anenatal test results are turned up. As an older mother, you may be considered to be higher risk, in which case these tests may be recommended to you – though as always, it is your choice to accept them or not.

Nuchal scan

A nuchal translucency scan can show if you have a higher risk of genetic abnormalities, particularly Down's syndrome, and is offered to most women regardless of their age. The nuchal scan needs to be done between 11 weeks and 13 weeks plus six days – it may be offered as part of your 12-week scan.

Another blood test is done alongside this (combined screening). The blood test looks at the levels of some hormones which can indicate a higher risk of chromosomal abnormalities.
The nuchal test and the combined screening only give an indication of risk and this will be expressed as ‘risk factor’, for example, one in 2,000 or one in 80. It’s worth remembering that it will be higher the older you are, simply because statistically age increases your risk factor.

If you are assessed as having an increased risk, you might be offered a more definitive test to get a more accurate indication of any genetic abnormalities. These are invasive tests, and you’ll need to weigh up whether or not the increased risks of miscarriage associated with them are worth it for the peace of mind they will bring.

Chorionic villus sampling

CVS takes a sample of cells from the placenta, to look at the foetus's DNA. It’s offered between week 10 and week 13 and can detect:

  • Genetic abnormalities such as Down's syndrome
  • Cystic fibrosis
  • Muscular dystrophy
  • Inherited blood disorders such as sickle cell anaemia and thalassaemia
  • Metabolic disorders such as antitrypsin deficiency
  • Mental health conditions such as fragile X syndrome
  • CVS doesn't test for physical problems such as spina bifida.

Amniocentesis

Amniocentesis involves taking a sample of the amniotic fluid from inside the womb. Normally done between week 16 and week 22, it can be used to test for:

  • Down's syndrome
  • Edwards' sydrome
  • Patau's syndrome
  • Sickle cell disease and Thalassaemia
  • Cystic fibrosis
  • Muscular dystrophy
  • Tay-Sachs disease
  • Neural tube defects such as spina bifida
  • Rhesus disease
  • Infections

NIPT test

A new test, known as Non Invasive Pre-natal Testing or NIPT is now available. It's still a screening test, but is much more accurate in spotting abnormalities (Down’s, Edwards’ and Patau syndromes) with a detection rate of over 99%. If your result is high risk, it will then need to be confirmed with a diagnostic test. It’s already available privately and is being piloted for NHS use. This is a simple blood test so carries none of the risks of CVS or amniocentesis.

Are there more risks if you’re pregnant over 40?

Yes, statistically, there are actually higher risk factors from the age of 35 and the risks do increase the older you get. However, it’s worth remembering that the same is true if you are overweight, underweight, have a family history of complications… the list goes on. It’s worth being aware of the increased risk factors, but try not to let it dominate your thoughts: there is every chance all will be well.

Risks for the baby

Chromosomal conditions

Chromosomal abnormalities such as Down's syndrome and Patau's syndrome, occur when there are fewer or more chromosomes than usual, or when the sets of chromosomes become altered.

The chance of any chromosomal abnormality rises from one in 500 at the age of 20, to one in 60-70 at age 40, according to NICE.

Probably the most well-known chromosomal abnormality is Down’s syndrome, which is caused by the presence of an extra chromosome in the child's DNA. One of the factors that increases the chances of a baby having this syndrome is the age of his or her mother at conception.

The statistical likelihood of your baby having Down’s Syndrome based on maternal age are:
20 years – 1 in 1,500
25 years – 1 in 1,300
30 years – 1 in 900
35 years – 1 in 350
40 years – 1 in 100
45 years – 1 in 30

Other risks for the baby

Babies can be affected by some conditions that are more likely in older mums-to-be, such as diabetes and pre-eclampsia, which can cause complications for the baby. Problems with the placenta, such as placental abruption, are also more likely. Older mothers are also at higher risk of complications during labour. See below for more.

Risks for the mother

High blood pressure and pre-eclampsia

Your blood pressure will be checked at every appointment, and one of the things doctors are checking for is pre-eclampsia. Raised blood pressure can be a symptom of pre-eclampsia , and there is a higher chance of it affecting women over 35.

Pre-eclampsia reduces the blood flow to the placenta – this can then restrict your baby's growth.

Diabetes

Women with pre-existing diabetes need to be aware that it may become harder to control during pregnancy. It can also lead to complications during labour, and in some cases it may be recommended that labour is induced, or a Caesarean offered, after 38 weeks. Gestational diabetes occurs when you have too much sugar in your blood because your body can't produce enough insulin (which converts blood sugar into energy) to meet the extra demands of pregnancy – ie incubating a growing baby and hormones produced by the placenta that resist insulin.

Pregnant woman having her blood pressure checked by a doctor

If you are at high risk of gestational diabetes you will be given a glucose tolerance test, which involves two blood tests after fasting, at 28 weeks or earlier.

Sometimes, diabetes can affect foetal development. You may be offered further tests, such as cardiac screening of the foetus, as part of your antenatal appointments.

Miscarriage

On average, one in five pregnancies will end in miscarriage, and the rate does increase with age, from a risk of around one in 10 for those under 30 years of age, to one in four at the age of 35 to 39, rising to one in two at 40 plus.

Miscarriages in the first trimester generally occur because the foetus is not developing properly. This can be linked to chromosome abnormalities, though the cause is often not identified.

Premature birth

If you're pregnant over 35, the chance of a premature birth is higher. One in 10 babies born to women over 40 is born premature (ie at 37 weeks or earlier). Women pregnant with twins or more (more likely as you get older) are also nine times more likely to give birth early.

Stillbirth

Women over 40 are, sadly, twice as likely to have a stillbirth at 39-40 weeks pregnant than women under 35. Try not to let this worry you too much, though – it’s important to remember that the chance is still only two in 1000, so relatively low.

I had my son at 39 and had my daughter at 44. Nobody batted an eyelid.

Is labour more risky over 40?

Older women may find that their labour is long (12 hours or more) and there is also an increased risk of certain complications.

If you have any condition (including diabetes or high blood pressure) which may put you, or your baby, at risk during vaginal delivery, a Caesarean may be recommended. This can be decided beforehand, or if complications arise an emergency Caesarean may be arranged. Women over 35 are more likely to need an assisted delivery with about 40 per cent having a Caesarean section.

There are always additional risks to the mother associated with a Caesarean; it is major surgery, and there's an increased chance of your baby having breathing difficulties at birth. Mostly, though, the chance of any health issues is the same as it would be for a vaginal birth.
Again, try not to dwell on the statistics – the majority of women over 40 have an uncomplicated labour and birth.

Pregnancy over 40 success stories

Getting pregnant when you're older can mean you feel the strain of tiredness and lack of energy that little bit harder throughout the pregnancy. However, with age also comes experience, independence and more stability. Don’t be disheartened by the nay-sayers, or put off by some of the statistics. The vast majority of women becoming mothers in their forties have no problems at all and most wouldn’t change what they did if they had their time over.

What Mumsnetters say is great about being pregnant in your forties

“I am 43 and pregnant with my first and my husband is 50. Waiting this long was right for us financially but also emotionally…somehow we just weren’t ready before. I have been very careful to keep myself in good condition and that seems to have been particularly important to the success (so far) of the pregnancy. The prospect of actually having and bringing up the little one doesn’t really worry me. It will be loved and cherished and if I get tired… well, that’s part of the journey.”

“I don't doubt that I would have had more energy if I'd done this in my 20s. However, my head was not at all in the right place. Some people make great mums in their 20s – I'm fairly sure i would have been a disaster.”

“I was two months off my 46th birthday when I had my naughty lovely trio, two boys and a girl. Life was much easier 10 yrs ago when they were born, we are permanently exhausted and broke now, but it’s good!”