What Is a 'Geriatric' Pregnancy?

The term geriatric pregnancy refers to a pregnancy carried by someone who is 35 years of age or older. But is this classification a thing of the past?

It's 12:01 a.m. on the eve of your 35th birthday. Poof! If you're pregnant or hoping to have a baby, you're considered AMA (of advanced maternal age). The likelihood you will be able to conceive plummets, and your risk factors for "geriatric pregnancy" complications skyrocket, right? Not so fast, say experts like the American College of Obstetricians and Gynecologists (ACOG).

"It's not as if a switch is flipped," says Siobhan Dolan, M.D., OB-GNY, 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."

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 But experts are moving away from this outdated classification in favor of individualized care and descriptors like "advanced maternal age" (AMA).

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, doctors 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.

Conceiving 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, M.D., 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 this simple biological fact: "As you get older, the number of eggs you have decreases."

"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," explains Margarita Mercado-Medina, M.D., a board-certified ob-gyn in South Nassau, N.Y.

She notes a large, well-designed study that looked at the probability of clinical pregnancy following intercourse on the most fertile cycle day in cisgender women of average fertility. In those women aged 27 to 34 years, the probability was approximately 40%. In cisgender women 35 to 39 years, it was 30%.

Yes, there is truth to the notion of the biological clock, especially around age 40.

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

Related:PSA: Science Says It's Totally Fine to Have Babies After 35

Potential Geriatric Pregnancy Complications

As people capable of pregnancy age, the likelihood of having a multitude of medical conditions like hypertension and diabetes goes up, and that is a big reason why the risk of potential pregnancy complications increases.

Dr. Mercado-Medina notes the risk for miscarriage, ectopic pregnancy, preeclampsia, gestational diabetes, stillbirth, and chromosomal abnormalities like Down syndrome all increase with age as well. "At 35 years of age the risk of having a baby with chromosomal abnormalities is 1 in 204, at 37 years 1 in 130, at 39 1 in 81, and going as high as 1 in 39 at 42 years of maternal age," she says.

Related:How to Have a Healthy Pregnancy After 35

Age can also complicate chest/breastfeeding, says Kathy Leeper, M.D., I.B.C.L.C., medical director of Milkworks, a breastfeeding support center in Lincoln, Nebraska. In her experience, some older mothers 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 Testing

It used to be that the risk of a person at age 35 having a baby with Down syndrome equaled the risk of their risk of a miscarriage during amniocentesis. In fact, that is where the age of 35 or older being considered high risk originated from, according to Dr. Dolan. But now, using the guidance of ultrasound, the risk of miscarriage during an amnio is somewhere around 1 in 500, making that "magic age" obsolete.

"All [people] should be offered prenatal diagnosis, regardless of maternal age," says Dr. Dolan in keeping with recent ACOG recommendations.

Explains Dr. Ross, "Chorionic villa 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."

The Latest on Geriatric Pregnancy

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

In some respects, age is an asset, not a liability. "You're so much more emotionally ready to be a parent," says Tracy Gaudet, M.D., 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."

So is there a bottom line? "The age of 35 being a cutoff point is an artifact," states Dr. Dolan.

But not all doctors agree. Dr. Ross says, "The truth is advanced maternal age is over 35 years. If there are any reclassifications to be made it should be for those over 40 years. I would call this group VAMA which would stand for very advanced maternal age."

Regardless of age, there is one thing that is not open for debate. A person who maintains a healthy weight, takes a prenatal vitamin with folic acid, manages medical conditions, doesn't smoke, and keeps vaccinations up to date, has a better chance of conceiving a healthy baby and having a healthy pregnancy.

And for parents over 35, there are a few benefits to, ahem, your AMA, namely financial security, and as Dr. Ross says, "When it's your choice to get pregnant you are much more in control of the process and more prepared to become a parent."