Why 'Geriatric Pregnancy' Is a Thing of the Past

If you are pregnant or hoping to have a baby after 35, you may be familiar with the old term geriatric pregnancy. Thankfully, that's been phased out; the term is now advanced maternal age (AMA). But there are still many misconceptions that float around about getting pregnant later on. For example, the likelihood you will be able to conceive plummets, and your risk factors for complications skyrocket, right? Not so fast, experts say.

"It's not as if a switch is flipped," says Siobhan Dolan, MD, OB-GYN, medical advisor to the March of Dimes, and author of Healthy Mom, Healthy Baby: The Ultimate Pregnancy Guide. "The guidelines have changed. We're moving toward personalized risk assessment. There's no one-size-fits-all answer."

That's right: age is, well, just a number when it comes to understanding a person's risk factors during pregnancy. You can be designated AMA and still have a healthy pregnancy.

Increasingly, health care providers are looking at the individual, and how their genetics, health history, and current health status play a role in conception and pregnancy. Learn more about modern views on pregnancy after 35 and why the term geriatric pregnancy is being phased out.

What Is a Geriatric Pregnancy?

Traditionally, the term geriatric pregnancy has referred to a pregnancy carried by someone who is 35 years of age or older. But experts are moving away from this outdated classification in favor of individualized care and descriptors like advanced maternal age (AMA).

Is It Harder To Get Pregnant After 35?

The ability to conceive after age 35 varies significantly from person to person.

"The number one factor is really health," says Kecia Gaither, MD, MPH, FACOG, double board-certified OB-GYN and maternal-fetal medicine specialist and director of perinatal services at NYC Health + Hospitals/Lincoln. "If nothing else is going on with her health, a woman's ability to conceive is the same after 35."

But Dr. Gaither still wants people capable of getting pregnant to understand a simple biological fact: "As you get older, the number of eggs you have decreases."

Margarita Mercado-Medina, MD, a board-certified OB-GYN in Long Island, New York, also points out, "Fecundability, or the probability of achieving a pregnancy in one menstrual cycle, begins to decline significantly in the early 30s, with a more rapid decline a few years later at about 37 years."

Yes, there is truth to the notion of the biological clock, especially around age 40. A healthy person in their 20s or early 30s has a 25-30% chance of getting pregnant in a single menstrual cycle. By 40, that percent decreases to less than 10%.

"As we get closer to 40, the ticking becomes louder and by 45, it can be deafening," says Sheryl Ross, MD, OB-GYN, a women's health expert at Providence Saint John's Health Center in Santa Monica, California. "Fertility decreases by as much as 95% in women between 40 and 45 years of age."

But pregnancy in these age groups is certainly still possible, although there are risks and other factors to consider.

Risk Factors for Pregnancy After 35

Dr. Mercado-Medina notes risk factors that increase with age include: 

• Miscarriage
• Premature birth
• Low birthweight
• Ectopic pregnancy
• Preeclampsia
• Gestational diabetes
• Stillbirth
• Chromosomal abnormalities

Age can also complicate nursing, says Kathy Leeper, MD, I.B.C.L.C., medical director of Milkworks, a lactation support center in Lincoln, Nebraska. In her experience, some people over 35 have milk supply issues, and this is particularly likely in people who needed medical assistance to become or stay pregnant.

The good news is that health assessment, genetic screening, and diagnostic and counseling options are more sophisticated than ever, allowing people to understand as much as possible about their health and pregnancies.

Geriatric Pregnancy Benefits

Statistics show about 20% of people in the U.S. are having their first kid after 35. That decision comes with benefits, including more financial stability and education. "When it's your choice to get pregnant you are much more in control of the process and more prepared to become a parent," says Dr. Ross.

In some respects, age is an asset, not a liability. "You're so much more emotionally ready to be a parent," says Tracy Gaudet, MD, executive director of Duke Integrative Medicine in Durham, North Carolina, and co-author of Body, Soul, and Baby. "I see in my older patients that they have more life experience; they're more likely to honor pregnancy as the sacred experience it is."

Research also shows having a kid after 33 doubles a person's chance of living longer. Another study found people who gave birth after 40 were four times more likely to live to 100 than those who had kids younger.

Children may also benefit too: Research shows kids with older parents do better academically, financially, and behaviorally.

Pregnancy Care Over 35

"All people should be offered prenatal diagnosis, regardless of maternal age," says Dr. Dolan in keeping up with American College of Obstetricians and Gynecologists (ACOG) recommendations. But genetic screenings are especially important when a person is 35 and older. These tests check to see if the fetus is high risk for certain congenital conditions.

If an issue is found, invasive genetic testing can be done. Dr. Ross explains that usually, "Chorionic villus sampling (CVS) is done between 11 and 14 weeks, and amniocentesis is done between 16 and 18 weeks. Both these tests determine the chromosomes to know if the baby is genetically healthy."

Keep in mind, using the guidance of ultrasound, the risk of miscarriage during an amniocentesis is now somewhere around 1 in 500, another reason why that "magic age" obsolete.

Preparing for Pregnancy Over 35

Better medical care, including increasingly successful infertility treatment, has improved older people's chances of conceiving and having a healthy baby over 35. Knowing this, older people capable of getting pregnant are more willing to take a chance on pregnancy. "We're seeing over-40 pregnancies more often, and more that are successful," confirms Barbara O'Brien, MD, a maternal-fetal medicine specialist and director of perinatal genetics at Women and Infants' Hospital of Rhode Island.

But it's important to be aware of risks and take proper precautions to increase the chance of a healthy pregnancy and baby. Those include:

• Eating healthy
• Exercising
• Taking a prenatal vitamin with folic acid
• Managing any medical conditions
• Not smoking or drinking alcohol 
• Keeping vaccinations and preventative care up to date
• Maintaining a healthy weight

Ultimately, when you decide to start a family is a personal choice, but having a healthy pregnancy at 35 and older is certainly possible. Once you’re ready to conceive, make sure to see your health care provider and discuss any concerns you have. And make sure to find a medical team you are comfortable and happy with.