UPDATED 6/2024
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
...for those of you who don't have time to read the article:
Pregnant patients over age 40 should receive preconception (before pregnancy) evaluations by their obstetrician–gynecologist (ObGyn) and other appropriate specialty care providers as they pertain to any preexisting medical conditions. In the preconception period, attention should be given to managing and optimizing preexisting medical conditions and associated medications. Referral to specialists in assisted reproductive technologies (ie fertility specialist) or maternal-fetal medicine (ie high-risk pregnancy specialist) should be considered for appropriate evaluation and counseling. During pregnancy, accurate dating and counseling on aneuploidy (chromosome abnormalities or differences) 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 (ie with BPPs or NSTs) can be considered. Given that no contraindications exist, these patients should be encouraged to pursue a vaginal delivery with consideration for induction of labor 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 complications associated with advancing age.
Recommended Preconception Counseling Points
*Evaluate desire for childbearing in all patients 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, patients aged ≥40 y should receive standard prenatal care, in addition to specific points highlighted below:
First trimester
*For patients without preconception evaluation, perform workup and counseling as indicated by their history
*Consider early gestational diabetes screen in all patients 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 weeks' 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 surveillance/monitoring
Delivery
*Consider induction of labor at 39 weeks' gestation, or sooner if medically indicated
*Recommend vaginal delivery, given there are no maternal or fetal contraindications
Other Resources
Go to my Instagram Page and click on my "After 35" playlist for more info!
ACOG Obstetric Care Consensus: Pregnancy at Age 35 Years or Older
SMFM Consult Series #60: Management of pregnancies resulting from in vitro fertilization