Updated Recommendations for Pregnancy After Age 40

Pregnancy After Age 40!

Due to the increasing number of patients I see who are pregnant over age 40, I got together with two of my ObGyn residents to publish the article, "Pregnancy After 40: Recommendations for Counseling, Evaluation, and Management From Preconception to Delivery." This article aims to educate obstetrical care providers on how to care for this group of patients prior to pregnancy, and during pregnancy and delivery, but it is also a great source of information for anyone who is considering pregnancy or who is currently pregnant after age 40.

Click HERE to read the FREE article on my google drive!

Quick Summary

Here is a summary for those of you who don't have time to read the article:

Pregnant patients over age 40 should receive preconception evaluations by their obstetrician–gynecologist and other appropriate specialty care providers as they pertain to preexisting medical comorbidities. In the preconception period, attention should be given to managing and optimizing preexisting medical conditions and associated pharmacotherapeutics. Referral to specialists in assisted reproductive technologies or maternal-fetal medicine should be considered if indicated for appropriate evaluation and counseling. During pregnancy, accurate dating and counseling on aneuploidy screening, with consideration for early diabetes screening, should be performed in the first trimester. A detailed anatomy scan and fetal echocardiogram should be completed by 22 weeks' gestation, along with routine and high-risk (if indicated) prenatal care. Close attention should be given to the development of pregnancy-related complications associated with advancing age. Third-trimester fetal surveillance can be considered. Given that no contraindications exist, these patients should be encouraged to pursue a vaginal delivery with consideration for induction at 39 to 40 weeks' gestation.

Pregnancy rates are increasing in persons over age 40. As a result, preconception evaluation and counseling tailored to that demographic are essential. In addition to standard prenatal care, they should have early screening and diligent monitoring for pregnancy-related comorbidities associated with advancing age.

Recommended Preconception Counseling Points

*Evaluate desire for childbearing in all women of reproductive age

*Discuss implications of delayed childbearing on fertility and pregnancy risks

*Address weight, diet, and exercise

*Consider referral to providers in maternal fetal medicine and reproductive endocrinology and infertility

*Discuss contraindications to pregnancy

*Assess mental health and provide support systems if necessary

*Offer screening for genetic conditions

Examples of Risks in the Pregnant Population Older Than 40 Years

*Higher rates of chronic disease (eg, hypertension, obesity, diabetes mellitus)

*Less likely to achieve spontaneous conception

*Higher rate of early pregnancy loss

*Higher stillbirth rates

*Higher rates of placental previa

*Higher rates of gestational diabetes mellitus, gestational hypertension, and preeclampsia

*Higher rates myocardial infarction

Antenatal Management by Trimester

Throughout pregnancy, women aged ≥40 y should receive standard prenatal care, in addition to specific points highlighted below:

First trimester

*For women without preconception evaluation, perform workup and counseling as indicated by their history

*Consider early gestational diabetes screen in all women aged ≥40 y45

*Ensure accurate dating and counsel on benefits and risks of aneuploidy screening

*Offer genetic counseling

Second trimester

*Perform detailed anatomy scan and fetal echocardiogram, preferably by 22-wk gestation

*Offer genetic counseling

*Monitor for development of pregnancy-related complications

Third trimester

*Monitor for development of pregnancy-related complications

*Discuss risks and benefits of antenatal fetal monitoring

Delivery

*Consider induction of labor at 39 wk, or sooner if medically indicated

*Recommend vaginal delivery, given there are no maternal or fetal contraindications

Other Resources

ACOG Obstetric Care Consensus: Pregnancy at Age 35 Years or Older

SMFM Consult Series #60: Management of pregnancies resulting from in vitro fertilization

Frequently Asked Questions

What are your qualifications?

I am a double board certified ObGyn and Maternal-Fetal Medicine Specialist. I have worked at a large academic center in academic medicine as a clinician, educator and researcher since 2004.  I am currently a tenured Professor and actively manage patients with high-risk pregnancies.

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Please send me an email.
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I do not do private consults or review medical records submitted by patients.

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Yes! Please email me for more info.