HEALTH & LIFESTYLE
WHAT AGE IS CONSIDERED HIGH RISK PREGNANCY
Aug 20, 2022
WHAT AGE IS HIGH RISK PREGNANCY?
Quick Answer
A pregnancy is generally considered high risk starting at age 35, the threshold the American College of Obstetricians and Gynecologists (ACOG) uses for advanced maternal age, and again under about age 17. ACOG itself calls 35 an arbitrary cutoff. Your overall health, including conditions like high blood pressure, diabetes, and obesity, often matters more than age by itself. Age is one factor your OB/GYN will weigh, not the only one.
Key Takeaways
- ACOG sets 35 as the standard advanced maternal age threshold, but calls it an arbitrary line, not a hard boundary.
- Risks like preeclampsia, gestational diabetes, and chromosomal differences rise gradually with age, and several don’t increase meaningfully until 40 or later.
- A healthy pregnancy at 35 or older with no other risk factors can carry less overall risk than a younger pregnancy complicated by chronic health conditions.
- Pregnancy under about age 17 also carries some increased risk, mainly preterm birth and preeclampsia, more tied to limited prenatal care access than age alone.
- A father’s age contributes too, through sperm quality and genetic factors, though this research is less settled than for maternal age.
- If you’re 35 or older, genetic screening like NIPT is now offered to everyone, not just older patients, so it isn’t a flag unique to your age group.
Technically, a woman can get pregnant in early adolescence when she has her first period through menopause when she stops having periods, but is there a perfect time for pregnancy?
Pregnancy is a major commitment, and deciding to get pregnant is a life-changing decision that most people do not take lightly. Most women prefer to be mentally, physically, and financially prepared for all stages of pregnancy and childbirth. Ideally, the best time to get pregnant should be when it works best for you. However, adolescence and menopause pose different challenges for pregnancy, thus limiting the years when a woman can successfully get pregnant. Fertility, especially for women, diminishes with advancement in age, making it harder to plan for pregnancy much later in life.
What Actually Makes a Pregnancy High-Risk?
A high-risk pregnancy means you or your baby have a higher chance of a health complication before, during, or after delivery. The American College of Obstetricians and Gynecologists (ACOG) uses age 35 as the standard threshold for “advanced maternal age,” though ACOG’s own clinical guidance calls that an arbitrary cutoff and says counseling should depend on your specific age and health history, not age alone.
Age is one risk factor among several, and it doesn’t act alone. ACOG’s guidance names chronic hypertension (high blood pressure that exists before pregnancy), diabetes you already had before pregnancy, autoimmune disease, obesity, carrying multiples, and a prior pregnancy complication like pregnancy loss as risk factors that add to, and sometimes outweigh, the risk that comes from age by itself. At the same time, research shows that even people 35 and older with no other health conditions can still see some increase in pregnancy complications purely from age. The honest answer is that age and overall health both matter, and neither one tells the whole story on its own.
For the fuller list of every category of pregnancy risk factor, medical, genetic, and pregnancy-related, see our complete guide to navigating a high-risk pregnancy. This article stays focused on what age specifically changes.
What are the Peak Reproductive Years?
How does Age Affect Fertility?
As the number and quality of eggs decline, a woman’s ability to get pregnant also starts to decrease. According to the Society of Reproductive Medicine, females experience a reduction in fertility in their early 30s. Women are half as fertile in their 30s compared to their 20s. By age 35, things speed up, and by the time a woman turns 45, her ability to conceive naturally is significantly reduced. A 25-year-old woman has a 25-30% chance of conceiving in every monthly cycle; a 30-year-old has about a 20% chance; and a 40-year-old-woman has just a 5% chance of getting pregnant in that same period.
How does Infertility Affect Pregnancy?
Infertility problems also affect maternal age at pregnancy. According to the National Institute of Health (NIH), about 12-15% of couples in the U.S. are unable to get pregnant after a year of unprotected sex. The NIH estimates that problems with fertility are:
- one-third from the man
- one-third from the woman
- one-third from both man and woman or from unknown reasons
Most women trying to get pregnant at an advanced age are often faced with fertility challenges and naturally seek help from fertility clinics. Fertility clinics provide reassurance of successful pregnancies at an advanced age, subsequently leading to more women postponing pregnancy until much later in life. Unfortunately, advancing age has a negative impact on insemination and fertility treatments. Women in their 20s and 30s are more likely to have successful outcomes than those over 35 years old and beyond.
Current Trends in Pregnancy
In the United States, there has been an overall increase in the number of women who are getting pregnant in their 30s and 40s, and this number is expected to keep rising.
Women are postponing pregnancy for many personal reasons including career priorities, education, financial concerns, and remarriages. Women, especially those who intentionally decide to have babies later in life, may worry about dealing with infertility when they are ready to have babies at this stage in life. And those who are dealing with infertility might be uncertain about how long they should safely try to have a baby without increasing the risk of pregnancy complications.
According to the CDC’s most recent national birth data, birth rates remain highest in women aged 30-34, at 93.7 births per 1,000 women in 2024, compared with 89.5 for ages 25-29 and 54.3 for ages 35-39. The birth rate for women in their early 20s has continued its decades-long decline, while the average age of a first-time mother in the U.S. keeps climbing.
Risks of Pregnancy in Advanced Age
Pregnancy later in life can increase the risk of complications to the health of the mother and baby. As a woman ages, the risk of pregnancy complications like miscarriage, chromosomal abnormalities, still birth, gestational diabetes, and c-section increases. Women aged 35 and older are more likely to have complications with pregnancy compared to younger women. Some pregnancy complications that are more common in advanced age include:
PREECLAMPSIA
The older the woman is, the more likely that she would have a pre-existing medical condition like high blood pressure, a disease that is common in older people. High blood pressure prior to pregnancy can worsen during pregnancy, increasing the risk of preeclampsia – a condition that usually occurs around 20 weeks of pregnancy and is characterized by high blood pressure and organ damage. Preeclampsia can be potentially fatal to both mother and baby. Although preeclampsia is more common in older mothers, it can also occur in young pregnant women with no history of high blood pressure. If you’re 35 or older with even one other risk factor for preeclampsia, such as obesity or a first pregnancy, ACOG recommends a daily low-dose aspirin starting between 12 and 16 weeks. Ask your OB/GYN whether this applies to you.
DOWN SYNDROME
Most older women worry about having a baby with Down Syndrome, a chromosomal abnormality where a developing fetus has an extra chromosome. Down Syndrome is more common in babies born to older women.
Babies are typically born with 46 chromosomes; however, a baby with Down Syndrome has an extra copy of chromosome 21. This condition is known as Trisomy 21 and causes mental and physical challenges to the baby. A baby with Down Syndrome typically has a flattened face, almond slanted eyes, poor muscle tone, small hands and feet, and other medical challenges. According to the CDC, Down Syndrome occurs in about 1 in every 640 babies and is more prevalent in babies born to older women.
ACOG’s own current patient guidance estimates that the chance of a pregnancy affected by Down syndrome is about 1 in 1,250 at age 20, 1 in 1,000 at age 25, 1 in 714 at age 30, 1 in 294 at age 35, and 1 in 86 at age 40. Prenatal screening and diagnostic tests can detect these differences, and knowing that your unborn child might have permanent health challenges is psychologically challenging for any pregnant woman.
MULTIPLE PREGNANCIES
Another pregnancy risk common in older women is multiple pregnancy. As the ovaries age, women release more than one egg per month and this could lead to multiple pregnancy. Also, older women are more likely to be on fertility treatment, which sometimes leads to multiple babies. Although most multiple pregnancies lead to healthy babies, some common complications of multiple pregnancy include gestational diabetes, anemia, miscarriage, preterm labor, cesarean delivery, and a higher risk of congenital abnormalities.
Is Teen Pregnancy Considered High-Risk Too?
Yes, though the reasons are different from the ones tied to age 35 and older. ACOG and public health researchers generally treat pregnancy under about age 17 as higher-risk, mainly for preeclampsia and preterm birth.
A large review of more than 291,000 adolescent pregnancies found preeclampsia in about 5.9 percent of cases, modestly higher than the roughly 5 percent baseline rate in the general pregnant population. A separate cohort study following teen mothers ages 14 to 17 found a real, though moderate, increase in preterm birth (birth before 37 weeks) compared with mothers in their 20s.
Much of this added risk traces back to limited access to early prenatal care and social factors like nutrition and financial stability, rather than a teenager’s body being inherently less capable of a healthy pregnancy. The single most protective step at this age is the same one that matters at every age, starting prenatal care as early as possible and keeping every appointment.
Does the Father's Age Matter?
It can, though the research here is newer and less settled than the research on maternal age. Studies link advancing paternal age, usually defined as 40 to 45 and older, to lower sperm quality and a higher chance of specific genetic changes in sperm. Reviews of the medical literature have also found associations between older paternal age and a modestly higher chance of certain conditions in the child, including some neurodevelopmental and psychiatric conditions.
None of this means an older father guarantees a problem. It means paternal age is one more factor worth mentioning to your OB/GYN or a genetic counselor, especially if you’re already weighing other risk factors on your own side.
When is the best time to have a baby?
Determining the best age for pregnancy is not an exact science. The American Society for Reproductive Medicine estimates that by age 40, a woman’s chances of getting pregnant drops to less than 5 percent per cycle.
A review of the data from research on:
- The cessation of ovarian follicular function
- Natural childbearing population and the age of most women during their final childbirth
- successful pregnancy among artificially inseminated women
points in the same direction as ACOG’s own patient guidance, which says fertility declines gradually starting around age 30, speeds up in your mid-30s, and by 45 has declined enough that getting pregnant naturally is unlikely for most women.
What Extra Prenatal Care Should I Expect After 35?
If you’re 35 or older, expect a few real differences in your care, not a completely different pregnancy.
- Genetic screening for everyone, not just you. Cell-free DNA screening (cfDNA, sometimes called NIPT) used to be offered mainly to older patients. ACOG now recommends offering it to all pregnant patients early in pregnancy regardless of age, so this isn’t a test that singles out your age group anymore.
- Low-dose aspirin, if you have one added risk factor. If you’re 35 or older and have at least one other moderate risk factor for preeclampsia, such as obesity, a family history of preeclampsia, or a first pregnancy, ACOG recommends a daily low-dose aspirin starting between 12 and 16 weeks.
- Extra monitoring mainly after 40, not at 35. Additional fetal surveillance and a conversation about delivery around 39 weeks generally start at age 40, not 35. If you’re in your late 30s with no other risk factors, this level of extra monitoring usually isn’t needed yet.
Pair this with the fundamentals of prenatal care that matter at any age. Read our full guide to prenatal care for what a typical visit schedule looks like.
Frequently Asked Questions
Can a healthy 38-year-old have a lower-risk pregnancy than a 25-year-old with health conditions?
Yes, that’s realistic. Age is one input your OB/GYN weighs, not the deciding one. A 38-year-old with no chronic health conditions and a straightforward pregnancy history often faces less overall risk than a 25-year-old managing high blood pressure, obesity, or diabetes. ACOG’s own guidance treats these health conditions as risk factors in their own right, separate from age.
Does the father's age affect pregnancy risk?
It can. Advancing paternal age, generally 40 to 45 and older, has been linked to lower sperm quality and a modestly higher chance of certain genetic and developmental conditions in the child. It’s a newer, less settled area of research than maternal age, but worth mentioning to your OB/GYN if it applies to your situation.
What extra prenatal testing is offered after 35?
The main addition is genetic screening. ACOG now offers cell-free DNA screening (NIPT) to every pregnant patient regardless of age, not just those 35 and older. If you have one added risk factor for preeclampsia, your OB/GYN may also recommend daily low-dose aspirin. Extra fetal monitoring typically doesn’t start until 40, not 35.
Is a pregnancy under age 17 automatically considered high-risk?
It’s generally treated as higher-risk, mainly for preeclampsia and preterm birth, though the increase is moderate rather than dramatic. Much of the added risk connects to limited access to early prenatal care rather than a teenager’s body being incapable of a healthy pregnancy. Starting prenatal care as early as possible makes a real difference.
Is 40 too old to have a healthy pregnancy?
No, though it does call for a bit more monitoring. By 40, natural fertility has declined significantly and some risks like gestational diabetes and stillbirth increase further, which is why ACOG recommends additional fetal surveillance and often suggests delivery around 39 weeks. Many women 40 and older have healthy pregnancies with this added layer of care.
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