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Pregnancy in Your 40s: The Path May Be Longer, but You Are Not Alone

Last updated December 17, 2021

Although the overall fertility rates and those for many other age groups have been declining in the US, more women are having children after 40. Depending on your peer group, you may feel like you are the only one trying in your 40s, the data show otherwise: You are not alone.

CDC reports that in 2018, over 3% of all births were to women over 40. That translates to 117,381 babies born to women between 40 and 44, 8,616 babies born to those 45-49 and 959 babies born to those 50-54. For women 40-44, that’s an increase of 30% since 2000. Compared to 2010, fertility rates for women 40-44 has seen a 16% increase, while those for women 45-49 has increased by 80%.

The TTC journey in your 40s is going to be different from the paths women in their 20s and 30s may take – it’s likely to be longer, and at the population level, the risks of complications are higher. But remember - you have good reasons to be trying now, and most women will have healthy pregnancies.

 

A pregnancy may take longer.

Female fertility peaks in our early 20s and starts to decline rapidly after about age 35. American Society for Reproductive Medicine estimates that a 40-year-old woman has about a 5% chance of getting pregnant each month on average, while a woman in their 30 has a 22% chance. This is partially due to the decline in ovarian reserve – a measure of how many eggs remain in a woman’s ovaries. Scientists think that non-ovarian factors also impact fertility in women over 40, such as changes in hormonal regulation, endometrial functions and genetics.

If you don’t get pregnant within 6 months after having regular sex, it’s recommended that you go see your doctor. Don’t wait for a year – if you do have a fertility problem, the sooner you see a doctor and identify the roadblock, the easier it is to address it.

 

Risk for complications may be higher.

Complications during pregnancy, like preeclampsia, gestational diabetes, low birth weight among others, become more common as women age. For example, a 2013 study published in the British Medical Journal showed that mild preeclampsia affects 2.3% of women at age 40, while at age 30, it affects only 1.3% of women.

For gestational diabetes, which affects 2-10% of pregnancies in the US, an analysis of over 120 million patient records found that the risk of developing the condition was 4.2 times higher for women over 40, compared to those in their early 20s.

Caesarean sections are also more likely for women in their 40s than their younger peers. CDC data for 2019 shows 47% of women over 40 (up to age 54) delivering via a C-section, while the rate was 40% for women 35-39 and just under 32% overall.

 

Genetic abnormalities become more common.

Genetic abnormalities in embryos are surprisingly common at any age. For example, a 2014 study of over 15,000 genetic analyses estimated that 25% of embryos are genetically abnormal, even among women under 30. For women over 40, 60 to 90% of embryos have genetic problems. 

These problems have three main consequences: Embryos with some genetic or chromosomal abnormalities don’t result in a pregnancy. Some of these embryos do implant in the uterus, but end in a miscarriage. In other cases, the baby survives the pregnancy and are born with genetic disorders, such as Down’s syndrome. 

Because the rates of many chromosomal and genetic problems rise with the mother’s age, both miscarriages and genetic disorders in the baby are more common in women in their 40s, compared to younger women. 

A Norwegian analysis of 421,000 pregnancies found a U-shaped curve of miscarriage risks, with women in their late 20s having the lowest risk just under 10%. The risk was about 27% at age 40, climbing to over 55% for women above 45.

 

Healthy pregnancy to-do in your 40s

While it’s a good idea to start the TTC journey in your 40s with full awareness of the possible difficulties risks that may be involved, not all is lost. As we saw, plenty of women get pregnant and deliver babies in their 40s – almost 127,000 babies in 2018, in fact. Furthermore, there are things you can do to increase the chance of a healthy pregnancy, and medical professionals to guide you on the journey.

  • Talk to your healthcare providers. It's absolutely crucial to talk to your medical team. They can help you understand your chances and risks unique to you - and be your guide in managing them. Your medical team may include your OBGYN, a reproductive endocrinologist if you need fertility treatment to get pregnant, a genetic counselor who can advise you on what screenings to consider and help you interpret the results, a maternal fetal medicine doctor who can help you manage your pregnancy better if you are at higher risk of complications, among others.
  • Follow healthy pregnancy tips for mothers-to-be of all ages: Start a prenatal vitamin at least 3 months before you plan to get pregnant and stay on it, so your body is ready, and the baby receives the all the critical nutrients like brain-building choline and folate in all stages of the pregnancy. Stop smoking if you do. Track ovulation if you don’t, so you can time your sex with your fertile window. Try to lose some weight if you are overweight before you get pregnant, which studies have shown to reduce the likelihood of complications like gestational diabetes. Stay active and eat a balanced, varied diet with plenty of antioxidants. Watch your blood sugar levels – normal blood sugar levels have been associated with regular ovulation and reduced risk of pregnancy complications. Reduce exposure to endocrine disruptors like BPA. Chances are, you already know what to do.
  • Check out “It Starts with the Egg”: A best-selling guide to egg quality and fertility, Rebecca Fett’s “It Starts with the Egg” is full of research-driven, actionable advice on reproductive health for women in their 40s. Take a look at our summary here, but we highly recommend reading the whole book for nuanced, situation-specific recommendations. (And if you’ve already read that, her “Brain Health from Birth” covers more ground, focused on facilitating the baby’s cognitive development.)

 

Remember the good reasons you are trying now.

Whether it’s your first child or a sibling for your existing children, there are good reasons you are on the TTC journey in your 40s. You may be with the right partner now whom you deliberately spent time looking for. Your socioeconomic base may be much more secure now. You may be in a better place emotionally and take better care of yourself than in your 20s and 30s.

Whatever your particular reason(s), there are a lot of positives for moms-to-be in their 40s. Also remember: While struggles are a tough reality for some of us, many in our 40s are pleasantly surprised by the ease of the journey, like Leslie, 42, featured in this ACOG article. Rather than blame yourself or focus on the risks of complications, concentrate on working on what you can control each day – and once pregnant – nurturing and relishing your connection with the baby.

Please reach out if we can answer any questions or be an attentive ear. We believe in your body's potential, and we are with you.

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