What to Expect in Pregnancy Over Age 45
An expert explains the health screenings, fertility options, and lifestyle changes women should consider for a healthy pregnancy after 45.
More and more women are choosing to start families later in life. In 2022, the birth rate among women ages 45-49 rose by 12 percent, according to the Centers for Disease Control and Prevention. Approximately 10,500 births every year across the United States are born to women over 45.
“We’ve had enormous advances in reproductive endocrinology and infertility treatments, and that has given many women more options,” says Dr. Mary D’Alton, obstetrician and gynecologist-in-chief at NewYork-Presbyterian and Columbia.
While pregnancy at this age brings specific challenges, Dr. D’Alton says that working with the right doctor, being proactive with health assessments, and making healthy lifestyle choices all help support a healthy pregnancy. She shared with Health Matters what people should know about pregnancy over age 45.
The first step is to talk to your doctor.
According to Dr. D’Alton, before getting pregnant, it’s important to see an OB-GYN or a maternal-fetal medicine physician to get a full exam and medical history. “This is to assess your overall health — your diet, exercise, and management of any chronic conditions, such as high blood pressure,” she says.
Fertility testing is often the next step. Women over 45 typically have a difficult time conceiving naturally due to the decrease in egg quantity and egg quality. However, fertility treatment options — like in vitro fertilization (IVF) and egg donation — have become successful options for women over 45, leading to healthy pregnancies. “The treatment needs to be individualized,” says Dr. D’Alton. “A consult with a reproductive endocrinologist is crucial to determine the optimal approach for patients.”
Know your risks.
Generally speaking, pregnancy after age 45 carries higher risks because of increased age. “Usually the risks that doctors closely monitor for in patients who are over 35 include high blood pressure, preeclampsia, and gestational diabetes,” says Dr. D’Alton. “We also monitor for placental abnormalities and prepare for the chance of a C-section.”
Babies born to mothers over 45 have a higher chance of being born prematurely or having a low birth weight, which can lead to health issues in early infancy. The risk of chromosomal abnormalities, such as Down syndrome, also increases with maternal age.
“Although your risks are higher than they would be if you were 25, if you’re healthy and have normal screenings, the risk is quite low,” assures Dr. D’Alton.
Expect more tests and screenings.
If you’re pregnant over 45, providers will be keeping a close eye on you and the baby. These include tests to check for heart disease, kidney and liver function, blood pressure, thyroid function, and diabetes status, says Dr. D’Alton. Also, a genetic carrier screening is recommended to check for a variety of genetic conditions. These can help identify potential issues early and guide you toward a healthy pregnancy.
Once you’re pregnant, Dr. D’Alton recommends more frequent visits to “closely monitor the mother’s health, do regular blood pressure checks, and regular ultrasounds to monitor the growth of the baby and the function of the placenta. In fact, we recommend that all patients over 35 take a baby Aspirin once a day to reduce the risk of hypertensive complications.”
High blood pressure postpartum is also more common in pregnant women over 45, so close monitoring of blood pressure should be done after delivery as well.
Medical advances have made pregnancies over 45 safer.
“We know that medical conditions increase with age, like diabetes, hypertension, and heart disease, but as obstetrics and infertility have advanced so have medical and surgical treatments for those conditions,” says Dr. D’Alton.
Dr. D’Alton and her team at the Mothers Center, which specializes in caring for pregnant women with complex medical and surgical conditions, help optimize the care for pregnant mothers and have access to world-renowned specialists at NewYork-Presbyterian and Columbia if specialty care is needed. “To me, that’s one of the privileges of working at NewYork-Presbyterian/Columbia,” says Dr. D’Alton. “That gives me and the women I see who become pregnant enormous confidence.”
Lifestyle changes for a healthy pregnancy
To have the best chance of a healthy pregnancy at 45 or older, Dr. D’Alton recommends the following lifestyle habits to make sure you are as healthy as possible:
- Maintain a healthy weight. Being at a healthy weight reduces the risk of complications like gestational diabetes. “I generally advise people not to worry about weight gain in the first trimester, as many women have low energy and nausea,” says Dr. D’Alton. “After that, about 1 pound a week is ideal. So, 24 to 28 pounds weight gain is a very reasonable recommendation for women who were normal weight.”
- Eat a balanced diet. Nutrition is vital during pregnancy, especially for women over 45. Focus on a diet rich in fruits, vegetables, lean proteins, and whole grains. “Include prenatal vitamins with folic acid to support fetal development.”
- Exercise regularly. Staying active can help manage weight, reduce stress and anxiety, and keep your heart healthy. Low-impact activities like walking, swimming, and prenatal yoga are great options.
- Manage chronic conditions. Keep any conditions — like diabetes, hypertension, and thyroid issues — well-controlled through medication, lifestyle changes, and regular monitoring with your doctor.
- Avoid harmful substances. Smoking, alcohol, and consuming unpasteurized products, high-mercury fish, and raw or undercooked meats can harm your pregnancy. Stay away from these substances to protect your health and your baby’s development.
While pregnancy over 45 comes with challenges, it’s possible to have a healthy pregnancy with the right care and preparation. Always consult with your doctor to ensure you’re making the best choices for you and your baby.