Advanced maternal age describes a pregnancy in a person over the age of 35.
Celebrities like Kourtney Kardashian, who are reporting that they’ve conceived in their mid-40s, are bringing renewed attention to a long-debated topic in women's healthcare.
Experts say that many patients are fertile into their 40s, but it's important for HCPs to educate these patients on the risk factors involved with advanced maternal age pregnancies.
With celebrities like Kourtney Kardashian reporting pregnancies in their mid-40s, is it time to change the way we talk to patients about age and motherhood?
The question is not a new one, but it's receiving renewed attention as more people, and especially celebrities, publicize their later-in-life pregnancies.
“There's a lot of misconception around age, pregnancy, and fertility,” says Laura Fletcher, CD (DONA), a certified doula and coach who works with clients on how to increase their fertility. She adds that some of these misconceptions come from societal norms of getting pregnant at or before the mid-30s, and some come from one-sided reviews of research.
Climbing above the '35' benchmark
Women who get pregnant at or after age 35 are still sometimes described as having a "geriatric pregnancy"—a term that is considered outdated among most OB/GYNs today, who typically use the term "advanced maternal age."
But with Kardashian and other celebrities like Hilary Swank, Rebel Wilson, Uzo Aduba, Paris Hilton (and so many more) receiving media attention for their later-in-life conceptions, this long-standing benchmark may also seem outdated or misleading.
Coining post-35 pregnancies as geriatric can feel “overly cautious” and limiting, Fletcher says, adding that she works with several clients who undergo healthy conceptions, pregnancies, and birth long after the age of 35.
Being called geriatric in one’s mid-30’s or 40’s can feel “unattractive and heinous,” Fletcher adds. It can also discourage people from trying to get pregnant, or make people feel like they have missed their shot at being a mom—when in reality they may still have time, she adds.
Janis D. Fee, MD, FACOG, an OB/GYN and department chair at Providence St. Joseph Hospital in Orange County, California, says she counsels patients who are between 35 to 38, or in their early- to mid-40’s on fertility issues.
"We know that a lot of patients in their later 30’s are still very fertile, but it varies a lot. Over age 42, pregnancy is still possible!"
— Janis D. Fee, MD, FACOG
Still, it’s important to note that while pregnancy is possible at these ages, it can come with additional risk factors, and isn’t guaranteed for everyone, she adds. Some risk factors for patients in their late 30’s include taking longer to get pregnant or higher rates of miscarriages with conception, she says. For patients in their 40’s, risks may also include higher chances of genetic abnormalities with the fetus, or other pregnancy complications.
Why getting pregnant gets harder with age
Love it or hate it, there are reasons behind why conception past age 35 is looked at as an advanced maternal age pregnancy. For starters, getting pregnant does get harder with age, and studies do call out fertility declines after age 35.
According to a 2020 study on age and fertility, a woman’s chances of getting pregnant decline about 20%—from 86% to 66%—from before age 30 to after age 35 due to age-related changes in the eggs and ovaries.
Among other age-related changes, a person’s number of eggs, as well as the number of eggs that have normal chromosomes, decline in the mid-30’s, according to the American College of Obstetricians and Gynecologists (ACOG). This then decreases opportunities for a sperm to latch onto viable eggs, implant into the uterus, and start a pregnancy.
Underlying health issues, whether they have also resulted from age or other factors, can also impact a person’s fertility, says Fee.
Some issues to flag for extra care and conversations with a doctor prior to conceiving include diabetes, hypertension, obesity, and immune related diseases, she says. As such, she stresses that it is important for patients to see their OBGYN, and it is important for the OBGYN to educate the patients on how their specific condition(s) may impact fertility or pregnancy risks.
Extending the age of fertility
“There is a lot of research that shows after the age of 35 that we can have a decline in fertility and we can have a decline in the quality of our eggs, there's also a ton of research that shows that we have a lot more control over the quality of our eggs than previously thought,” says Fletcher.
Studies show that optimizing aspects of healthy living like healthy eating and de-intensifying exercise may support the reproductive system and can help increase the quality of eggs. Other lifestyle changes geared at improving mitochondrial health, taking rest—in terms of sleep and not over-exercising—hydrating, and regulating the central nervous system, can also increase fertility chances, says Fletcher.
"If we are optimizing our wellness, and focusing on our lifestyle, and checking all of the boxes, we can extend our fertility far beyond 35. "
— Laura Fletcher, CD (DONA)
These aren’t things to stress out about—stress can actually increase risks of infertility—Fletcher says, because some people can have healthy babies after age 35 even if they are not in their prime health. Still, to most fruitfully increase chances of fertility, she recommends taking care of oneself, or advising patients to take care of themselves, first.
Societal pressure to conceive early
In addition to medical guidance and research, people trying to get pregnant face societal pressure from peers, parents, social norms—even celebrities—to conceive early and successfully. For people who are older than 35, these pressures may make them feel behind in life.
"Around that 35-plus mark, there is a greater sense of urgency around getting pregnant. They feel that the clock is against them."
— Laura Fletcher, CD (DONA)
Clients will often use this phrase when talking to Fletcher about their fertility concerns, she adds—and those that do are often in their mid-30’s or 40’s.
With that in mind, it’s important to help patients gauge realistic expectations for their own body, and potential baby, and steer clear of comparisons. Part of this includes a self-dive into if and why fertility matters to the patient, Fee says. She suggests talking through the question of fertility being a goal for them. The answer may be different for everyone.
"In society, we compare ourselves relentlessly. Particularly when we’re talking about people like the Kardashians, there's this kind of societal pressure to be perfect in every area."
— Laura Fletcher, CD (DONA)
"We have to look a certain way, act a certain way—that absolutely applies to fertility,” she adds.
Fighting off comparisons is never easy, and can be harder during high-emotion and high-hormone time periods like trying to get pregnant—so encourage patients not to judge themselves if they do make those comparisons, too, she adds.
On the other hand, while Kourtney’s pregnancy journey may not apply to everyone, Fletcher says it may give older women hope that if they do want to get pregnant at an age older than the medical norm, they just might be able to, too.
What this means for you
Despite being considered advanced maternal age, many people can conceive and carry out a health pregnancy after the age of 35. Still, pregnancy and fertility timelines are different for everyone, so it is smart for HCPs to help patients focus on their own journey and not compare themselves to friends—or celebrities—who are getting pregnant at older ages.