Pregnancy after age 35

If you're 35 or older and trying to get pregnant, you may have heard that it can be more difficult. While fertility declines with age, many people in their 30s and beyond have healthy pregnancies and babies. By working with your health care provider and making health choices, you can improve your chances of a healthy pregnancy and delivery. 

What pregnancy complications are more likely after 35?

As you get older, you’re more likely to have certain health conditions that can affect pregnancy, such as:

• Trouble getting pregnant (also called fertility problems). Each woman is born with a set number of eggs. As you get older, you have fewer and fewer eggs, and the eggs you have aren’t easily fertilized by sperm. If you’re older than 35 and have been trying for 6 months to get pregnant, talk to your health care provider.
• Diabetes (preexisting or gestational). Preexisting diabetes is when you have diabetes before you get pregnant, and gestational diabetes is when you develop it during pregnancy. Both types need treatment and management to avoid complications..  
• High blood pressure (also called hypertension). Having high blood pressure before or during pregnancy increases the risk of complications such as preeclampsia.  
• Preeclampsia. This condition can happen after the 20th week of pregnancy or right after pregnancy. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches. If you’re older than 40, your risk is higher for preeclampsia than for younger pregnant people.  

These health conditions can cause problems during pregnancy, including: 

• Preterm birth. Babies born before 37 weeks of pregnancy may have health problems at birth and later in life. 
• Low birthweight. This is when your baby is born weighing less than 5 pounds, 8 ounces.
• Being pregnant with multiples (twins, triplets or more). People over 35 are more likely to get pregnant with multiples. This can happen on its own because of changes in your hormones with age, and some fertility treatments make getting pregnant with multiples more likely. Being pregnant with multiples can cause problems during pregnancy, like preterm birth, preeclampsia, and gestational diabetes. 
• Birth defects, including Down syndrome. The chances of having a baby with a birth defect increases with age.
• Cesearean birth (also called c-section). Like any surgery, a c-section comes with risks, like infection and reaction to anesthesia. The older you are, the more likely you are to have pregnancy complications that make a c-section necessary. 
• Pregnancy loss. The risk of miscarriage (pregnancy loss before 20 weeks) and stillbirth (loss after 20 weeks) increases with age.

If you’re older than 35, do you need any special prenatal tests?

Because older women are more likely than younger women to have a baby with a birth defect, if you’re older than 35 your provider may want to recommend some prenatal tests including:

• Screening tests, like cell-free fetal DNA screening or maternal blood screening. These tests don’t tell you for sure if your baby has a birth defect, but they can tell you if your baby may be at risk for a birth defect.
• Diagnostic tests, like chorionic villus sampling or amniocentesis. These tests can tell you for sure if your baby has or doesn’t have a birth defect. 

Talk to your provider about these tests to decide if they’re right for you. 

If you’re older than 35, what can you do to help you have a healthy baby?

No matter your age, doing these things before and during pregnancy can help you have a healthy pregnancy and a healthy baby:

Before pregnancy

• Get a preconception checkup. This is a medical checkup to help make sure you’re healthy before you get pregnant. At your checkup, talk to your provider about your overall health, lifestyle and concerns about being able to get pregnant. Also talk to your provider about your family health history, vaccinations you need and medicines you take.
• Get treatment for any health conditions you have. These include diabetes, high blood pressure and depression. Talk to your provider about any medicine you take to make sure they are safe to take during pregnancy.  
• Take a multivitamin with 400 micrograms (mcg) of folic acid each day. Taking folic acid before and during early pregnancy can help prevent birth defects in your baby’s brain and spine (neural tube defects).
• Get to a healthy weight range. You’re more likely to have health problems during pregnancy if you’re overweight (weigh too much) or underweight (weigh too little). Eating well and staying active can help you reach a weight that supports pregnancy.
• Avoid smoking, alcohol, and drug use. These substances can increase the risk of pregnancy complications. Tell your provider if you need help to quit.
• Protect yourself from unsafe chemicals at home or work. Some chemicals in household products and workplaces may increase your chances of having a baby with a birth defect. 
• Manage your stress. Chronic stress can affect pregnancy. Find ways to relax and seek support when needed.

During pregnancy

• Go to all of your prenatal care checkups, even if you’re feeling fine. Getting regular prenatal care lets your provider check on you and your growing baby. 
• Keep up with treatment for any health conditions you have. Keep all of your providers up to date about any medications you take or any symptoms you may notice.
• Gain the recommended amount of weight. The amount of weight to gain during pregnancy depends on how much you weigh before pregnancy. Talk to your provider about how much weight you should gain. 
• Eat whole and fresh foods as much as possible, take your prenatal vitamin and do something active each day.  A healthy diet can help you get the nutrients you and your baby need like calcium, folic acid, iron and vitamin D.
• Avoid smoking, alcohol, and drugs. Talk to your provider if you need help to quit.
• Protect yourself from chemicals at home or work that may be harmful to your baby and reduce your stress.
• Stay active. Regular physical activity like walking can help lessen discomfort and keep your strength up for childbirth. Talk to your provider about what’s a safe amount of exercise for you.

Last reviewed: February 2025