Advanced maternal age: Your essential guide to pregnancy after 35

Are you trying for a baby in your thirties? Then you’re part of the growing group of Australian mothers having children later in life than they used to. Figures from the Australian Bureau of Statistics show the average age for first time mums has lifted from 27.9 years in 2009 to 29.4 years in 2019. For those who’ve previously given birth, it has increased from 31.0 years in 2009 to 31.9 years in 2019. 

And while the highest proportion of mums (36%) were aged between 30 and 34, many are having babies at 35 years or older.

What is advanced maternal age?

“From a biological point of view, age is important for a woman – no matter how young you look or feel!”

Advanced maternal age (AMA) is the term doctors and midwives use to describe a woman who’ll be 35 years of age or older when she gives birth to her baby.

The term ‘advanced’ might sound a little excessive and 35 is not ‘old’ by life standards. However, from a biological point of view, age is important for a woman – no matter how young you look or feel!

What are the risks of an advanced maternal age pregnancy?

“Most women over the age of 35 years will still have a healthy pregnancy and baby.”

While most women over the age of 35 years will still have a healthy pregnancy and baby, virtually all pregnancy risks and complications increase as the age of the woman increases.

These include:

• difficulties conceiving and increased need for fertility advice/treatment
• miscarriage in early pregnancy
• chromosome or other abnormalities with the baby
• diabetes – either before pregnancy or developed during pregnancy (gestational diabetes)
• high blood pressure – either before pregnancy or developed during pregnancy (also known as pre-eclampsia)
• a small or ‘growth restricted’ baby, who may require more intensive monitoring during pregnancy and/or premature delivery
• abnormal position of the placenta – which may affect the growth of your baby, cause bleeding problems in pregnancy, and require a caesarean birth
• premature birth
• stillbirth
• your baby not being head down at the end of pregnancy, which may lead to a more complicated vaginal birth or require a caesarean birth
• induction of labour
• caesarean birth.

What if I don’t have a partner that I’d like to have a family with?

“If you haven’t found that special person you’d like to start a family with, consider seeing a fertility specialist.”

Each year you get older, your ability to conceive and/or have an uncomplicated pregnancy declines. 

If you haven’t found that special person you’d like to start a family with, consider seeing a fertility specialist. They will discuss options available to you, such as egg freezing or using donor sperm.

What can I do to prepare for pregnancy?

“If you’re planning a pregnancy, it’s a good idea to see your GP for a pre-pregnancy check and to discuss what you need to do to boost your chances of having a healthy pregnancy and baby.”

If you’re planning a pregnancy, it’s a good idea to see your GP (or obstetrician/gynaecologist if you already have one) for a pre-pregnancy check and to discuss what you need to do to boost your chances of having a healthy pregnancy and baby.

Issues that will be discussed include:

• important lifestyle factors – you and your partner should aim to achieve a weight that’s within the normal range (i.e., not underweight or overweight), not smoke, not drink alcohol, and not take any party or illicit drugs. You also need to eat a healthy, balanced diet and undertake regular exercise that you can continue throughout your pregnancy.
• blood tests – to check your immunity. 
• vaccinations – if needed, your doctor might administer vaccinations (such as rubella, chicken pox, influenza, and now COVID vaccine) to reduce your chance of developing an infection during pregnancy that could cause complications for you or your baby.
• cervical screening test (CST) – to ensure it is up to date. This is the new test which has replaced the Pap Smear.
• underlying health conditions – if you have any long-term health conditions (such as diabetes, high blood pressure, thyroid disease, or fibroids), these may need optimising before pregnancy.
• medications or over-the-counter preparations – your doctor will review everything you take and discuss whether your medications/preparations should be ceased, continued, or altered whilst trying to conceive and for pregnancy. Never stop taking any medications yourself without checking with your GP or specialist first.
• family medical histories – both yours and your partner’s. We particularly look for any genetic disorders that may impact you or your baby.
• reproductive carrier screening – these relatively new tests will be offered to you and your partner to see whether you carry any similar genetic abnormalities which could affect your baby. These tests are not currently covered by Medicare, so will cost a few hundred dollars if you decide to have them.
• prenatal supplements – these are recommended to reduce the risk of complications for your baby. Standard recommendations are folic acid 500mcg/day and iodine 250mcg/day while you’re trying to conceive and throughout the first half of your pregnancy.

“It’s important to know when you’re most fertile during your menstrual cycle, so you know when the best time is to have sex.”

While you’re preparing for pregnancy, keep a record of your menstrual cycle, either in a diary or an app. Monitor your cycle length – 21-35 days is normal. If cycles are shorter or longer than that, let your GP know so they can look into it.

Keep a record of the first day each menstrual period begins.

It’s important to know when you’re most fertile during your menstrual cycle, so you know when the best time is to have sex. You can use ovulation detection kits to help with this. These require you to test your urine or saliva and can be purchased over the counter at a pharmacy.

Do I need private health insurance?

If you’d like the option of private care for your birth, make sure you have private insurance that covers pregnancy and birth (‘Gold’ cover). There is usually a 12-month waiting period before you can use this insurance for pregnancy care, so it needs to be in place at least 3 months before you become pregnant. Ideally, have it in place 6-12 months before conceiving. This will ensure you’re covered for any complications that may require hospital admission during your pregnancy.  

How long should I try to conceive naturally before seeking help?

Once you’re over the age of 35 years, it’s recommended that you try to conceive naturally for six cycles before seeing your GP for an opinion or referral to a fertility specialist.

What should I do once I’m pregnant?

“Your GP will order some standard blood and urine tests once it’s confirmed that you’re pregnant.”

Once you have a positive urine pregnancy test, see your GP for confirmation within 1-2 weeks.

Your GP will order some specific pregnancy-related blood and urine tests once your pregnancy is confirmed.

As miscarriage is more common in women who are aged 35 years or older, it’s a good idea for your GP to organise a high-quality ultrasound at around seven to eight weeks of pregnancy to check how things are going. This is often performed through the vagina and is perfectly safe.

Your GP will also discuss pregnancy care options through the public or private health systems. They will need to provide a referral if you’d like to see a private obstetrician. Some public hospitals will also require a referral from your GP.

Your GP may also discuss the optional tests you can have in the first trimester of pregnancy to look for any chromosome or other abnormalities in your baby.

 

Dr Wendy Hawke
Obstetrician and Gynaecologist

Dr Wendy Hawke is passionate about supporting women through a confident and natural birthing experience with minimal fuss. Her extensive experience and down-to-earth nature provide a calm, educated presence throughout your pregnancy. In a world full of complexities and concerns that can impact pregnant mothers, her practical approach focuses on you and your baby. 

She offers a similar caring and pragmatic approach to women under her care who are experiencing gynaecological issues.

Prince of Wales Private Hospital
Suite 2, Level 7
Barker Street
Randwick NSW 2031
P: 02 9650 4050
hawkecoogan.com.au

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¹ Australian Institute of Health and Welfare. Australia's mothers and babies. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/demographics-of-mothers-and-babies/maternal-age. Accessed 5.8.2021