Pregnancy Afer 35

What to know before getting pregnant

Many women have understood that having a baby at age 35 or older may put them in a high-risk category for pregnancy complications. But recent studies show that the association between a mother’s age and maternal or fetal complications is more like a progressive scale of risk, and it’s more accurate to separate that risk into incremental age categories.

“Many women are continuing to have pregnancies into their late 30s and early 40s. Age alone is not a high-risk factor until a woman is over 40. Even then, the risks are most pronounced for women having their first pregnancy after age 40. As is the case for pregnancy at any age, it is usually a person's health before pregnancy that is the most important predictor of their risk," said Dr. Julianna Papez, an OB-GYN at Intermountain Health in Billings.

Women over age 40 do have a significantly greater risk for complications, including miscarriage, ectopic pregnancy, diabetes in pregnancy, hypertension, and preterm birth.

All individuals have some risk of maternal or fetal complications, and the risks increase incrementally with age. After age 40, the rate of increased risk begins to rise more dramatically. Women aged 40-45 are at lower risk than those aged 46-50, and the risks are substantial for women who become pregnant after age 50.

This is especially relevant as the age when women first give birth has been increasing over the last few decades. National data shows the age of women having their first birth in 2024 was about 27.6 years of age compared to about 21 years in 1970. This trend is not unique to the U.S. There is a global trend toward initiating pregnancy later.

Similarly, nearly 19% of all pregnancies and 11% of all first pregnancies in the U.S. were in women aged 35 years and older. The CDC reports that pregnancies among women aged 40-45 have doubled since 1990 and have risen by 450% among women over 45. But age is not the only factor that increases the risk of complications for mother and baby. Those with chronic medical conditions such as diabetes, hypertension, and obesity who become pregnant are at substantially higher risk.

“The most important predictor of health in pregnancy is health before pregnancy. Routine health maintenance, including screening for diabetes, hypertension, and heart disease, is fundamental to optimizing future pregnancy outcomes. It is much better to address these issues before pregnancy than to discover them when complications arise in the setting of pregnancy,” said Dr. Julie Middleton, OB-GYN at Intermountain Health in Billings.

“The good news is that for individuals who are over 40 or who have chronic conditions and want to get pregnant, many OB-GYNs are comfortable and familiar with caring for these patients. We also have a team of maternal-fetal medicine physicians at Intermountain Health with additional training who specialize in managing high-risk pregnancies to provide consultations,” she added.

For those at highest risk due to pre-existing medical conditions or maternal and fetal complications, their care teams are also available to provide specialized prenatal care.

What moms-to-be can do before pregnancy to increase their chances of a healthy baby

1. Schedule a pre-pregnancy visit with your women’s health or primary care provider.

2. For those with high-risk medical conditions, request a consultation with maternal-fetal medicine

3. Optimize any medical conditions before attempting pregnancy (pre-existing diabetes and hypertension in particular) and ensure current medications are safe in pregnancy

4. Adopt a healthy lifestyle that includes attention to diet and regular exercise

5. Take a prenatal vitamin with 400-800 mcg of folic acid before attempting conception

6. Avoid excessive consumption of alcohol

7. Avoid tobacco and nicotine exposure (vaping or smoking)

Genetic counseling can also assist couples in identifying genetic conditions that may run in their families and discuss options for pre-pregnancy and prenatal testing. Prenatal genetic screening ranges from maternal blood tests to procedures to sample the placenta or amniotic fluid for prenatal diagnostic purposes.

Intermountain Health is expanding obstetrics and gynecology services to help meet the growing needs of women and families across the region. In October, Intermountain Health announced it will open a new OB-GYN practice in Billings. In the coming months, Intermountain Health plans to grow the practice to include 15 providers, including Dr. Papez and Dr. Middleton, seeing patients initially at the Downtown Women’s Health and Midwifery Clinic, with plans to offer appointments at other Intermountain Health clinics in Billings.

The new OB-GYN practice will help strengthen that legacy as the trusted provider for growing families.  This new practice will join the current Intermountain Health Women’s Health and Midwifery providers and Maternal Fetal Medicine and Gynecologic Oncology physicians in offering an expanded range of comprehensive OB-GYN care in Billings.

For information or to make an appointment for OB-GYN care, contact the Intermountain Health Women’s Health and Midwifery Clinic in Billings at 406-238-6010 or visit Downtown Clinic.

More from the Experts at St. Vincent Regional Hospital

About St. Vincent Regional Hospital

Founded on our mission of compassionate care 125 years ago, St. Vincent Regional Hospital, part of Intermountain Health, has grown into one of Montana’s largest comprehensive hospitals, serving the healthcare needs of over 400,000 people in our four-state area. Continuing to respond to the needs of our community, we have been recognized as an innovator in trauma, heart, neurological and cancer care. At St. Vincent and Intermountain Health, our 12 primary care clinics, and specialty clinics in and around the Billings area, our goal is to help you live the healthiest lives possible. This also includes caring for the region's youngest patients. We opened the region's first Pediatric Intensive Care Unit staffed 24/7 by Pediatric Intensivists and the only Pediatric Surgery program serving eastern Montana, northern Wyoming, and the western Dakotas.