From the Guidelines
Women are generally considered to be of advanced maternal age and at increased risk for pregnancy-related complications at 35 years or older, with fertility declining significantly after this age. For women, fertility declines gradually but significantly after age 32 years, and faster after 37 years, which compromises fertility when delaying childbearing 1. The risks of complications like gestational diabetes, preeclampsia, and chromosomal abnormalities in the baby also increase with age, with nearly one third of all pregnancy-related deaths in the United States occurring in women aged 35 years or older 1. By 45, natural conception is extremely rare, and the decision to become pregnant at an advanced age should be made with caution and after consulting with a healthcare provider to discuss personal risks and options, including fertility treatments or using donor eggs/sperm if needed. Key factors to consider when evaluating the upper limit of reproductive age include:
- Fertility decline: Women's fertility declines significantly after 35 years, with a faster decline after 37 years 1
- Pregnancy-related complications: Women 35 years or older are at increased risk for pregnancy-related complications, including gestational diabetes, preeclampsia, and chromosomal abnormalities in the baby 1
- Mortality risks: Nearly one third of all pregnancy-related deaths in the United States occur in women aged 35 years or older 1 It is essential to weigh these factors and consider individual health, circumstances, and willingness to accept potential risks when deciding to become pregnant at an advanced age. With advances in reproductive technology, some people have children later in life, but it is crucial to prioritize the health and well-being of both the mother and the baby, and to make informed decisions based on the latest evidence and medical guidance.
From the Research
Upper Limit of Reproductive Age
The upper limit of reproductive age is not strictly defined, but various studies suggest that pregnancy risks increase significantly after the age of 40, and even more so after 45.
- Women aged 45 and above are considered to be at a higher risk for pregnancy complications, such as gestational diabetes, preeclampsia, and cesarean delivery 2, 3, 4, 5.
- The risk of obstetric complications, including preterm delivery, gestational hypertension, and fetal death in utero, also increases with maternal age 3, 4, 6.
Pregnancy Risks by Maternal Age
The following pregnancy risks have been associated with advanced maternal age:
- Hypertensive disorders: increase gradually until age 35, then accelerate 6
- Multiple gestations: increase slowly until age 30, then accelerate 6
- Major congenital anomalies: increase slowly until age 30, then accelerate 6
- Maternal mortality or severe morbidity: increase slowly until age 30, then accelerate 6
- Cesarean delivery: increase linearly with age 6
- Gestational diabetes: increase linearly with age 6
Maternal Age and Pregnancy Outcomes
Studies have shown that maternal age is an independent risk factor for pregnancy complications, including:
- Preeclampsia: significantly higher in women aged 40 and above 3
- Gestational diabetes: significantly higher in women aged 40 and above 3
- Cesarean delivery: significantly higher in women aged 40 and above 3, 4
- Preterm delivery: significantly higher in women aged 40 and above 3, 4
- Fetal death in utero: significantly higher in women aged 40 and above 3