Pregnancy

Pregnancy After 35: Real Risks, Extra Tests and How to Have a Healthy Pregnancy

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Pregnancy after 35 is common, and most go well. Being 35 or older at delivery does raise the chance of some problems, including chromosome conditions such as Down syndrome, miscarriage, gestational diabetes, preeclampsia, placenta problems and C-section, and these risks climb further after 40. Good prenatal care, the right screening and attention to your overall health lower many of them.

In New York City especially, having a first baby in your late 30s is ordinary. Yet many people still walk out of their first visit having heard "geriatric" or "high risk" and feeling like something's wrong with them. Let's separate what's real from what's just a label.

Myth vs. fact

Myth: At 35, your risk suddenly jumps. Fact: 35 isn't a cliff. Risks rise gradually through your 30s and more steeply after 40. Your overall health matters as much as the number.

Myth: "Geriatric pregnancy" means you're high risk. Fact: It's an outdated phrase for being 35 or older at your due date. Most providers now say "advanced maternal age." Many healthy people over 35 get routine prenatal care with a few extras.

Myth: Over 35, you have to get an amniocentesis. Fact: ACOG recommends offering everyone, at any age, both screening and diagnostic testing. You decide what, if anything, you want.

Myth: You'll need a C-section because of your age. Fact: C-section rates are higher in older patients, but age alone isn't a reason for a planned C-section. Most people over 35 can plan a vaginal birth.

The real risks, in one table

Many of these risks are tied to conditions that become more common with age, like high blood pressure, diabetes and fibroids. Managing those makes a real difference. And the absolute risk of most complications is still low. Ask your provider to give you your personal risk in plain numbers ("1 in 200," not "elevated").

Genetic screening and testing

You'll be offered the same options as everyone else:

• Cell-free DNA screening (NIPT) from about 10 weeks: a blood draw with high accuracy for Down syndrome. Because chromosome conditions are more common after 35, a high-risk NIPT result is more likely to be a true positive than it is for younger patients. Results often take about a week. See our NIPT guide.
• First-trimester screening (nuchal translucency ultrasound plus blood tests) at about 11 to 14 weeks.
• Diagnostic tests: CVS at about 10 to 13 weeks or amniocentesis from about 15 weeks give a definite answer but carry a small risk of miscarriage.
• Carrier screening for inherited conditions like cystic fibrosis and spinal muscular atrophy.

Some people go straight to diagnostic testing; others start with screening. A genetic counselor can walk you through the trade-offs, and it's worth asking for one if you feel rushed.

What may change in your prenatal care

Depending on your health and your provider:

• Early glucose screening if you have other diabetes risk factors. See the pregnancy glucose test.
• Low-dose aspirin to lower preeclampsia risk if you're 35 or older and have at least one other moderate risk factor, such as a first pregnancy, obesity or a family history of preeclampsia. Take it only if your provider recommends it.
• A detailed anatomy ultrasound, sometimes with a maternal-fetal medicine (MFM) specialist.
• Extra growth ultrasounds in the third trimester if there are concerns.
• Fetal monitoring near the end of pregnancy, such as non-stress tests, which many providers recommend particularly for people 40 and older. Expect to sit with two belts on your belly for 20 to 40 minutes while the baby's heart rate is tracked.
• A conversation about delivery timing, since stillbirth risk rises later in pregnancy with age.

With chronic conditions, you may be referred to a maternal-fetal medicine specialist. Our guide to high-risk pregnancy explains how co-management works.

A practical note: extra visits add up. If you commute, ask whether monitoring appointments can be scheduled early or late in the day, or at an office near work.

How to have a healthy pregnancy after 35

You can't change your age, but you can move many of the risks:

• Get a preconception checkup if you're planning, to review medicines, vaccines and chronic conditions.
• Take folic acid (at least 400 micrograms a day, as the CDC recommends), ideally starting before pregnancy.
• Get blood pressure, blood sugar and thyroid under control before and during pregnancy. A home blood pressure cuff is a smart buy.
• Reach a healthy weight before pregnancy if you can, and aim for recommended gain during it.
• Stay active: most people can safely get about 150 minutes of moderate exercise a week.
• Avoid smoking, alcohol and recreational drugs.
• Go to every prenatal visit so problems like rising blood pressure are caught early.
• Look after your mental health. Anxiety is common when you've heard a lot about "risk." Say so.

Pregnancy after 40

Risks are higher after 40 than in your late 30s, especially for chromosome conditions, miscarriage, preeclampsia, gestational diabetes and stillbirth. Many providers recommend extra monitoring in the third trimester and talk with patients about delivering around their due date rather than going past it. Pregnancies at 40 and beyond, including those conceived with donor eggs, are often co-managed with MFM.

Does the partner's age matter?

It can, to a smaller degree. ACOG notes that older age of the sperm-providing parent, usually over about 40, is linked to a slightly higher chance of some genetic conditions and pregnancy complications. Mention your partner's age at your first visit so it's factored into screening discussions.

Prenatal care for people over 35 in New York

If you're planning, a preconception visit with an OB/GYN is a good first step, and with chronic conditions, ask for an MFM consult early. New York has a network of state-designated Regional Perinatal Centers for the most complex pregnancies, and your OB will refer you if that level of care is needed. If you're uninsured, NY Medicaid covers pregnant people with incomes up to 223% of the federal poverty level, and pregnancy lets you enroll in a NY State of Health plan outside open enrollment. Browse MFM specialists in Manhattan, or search the directory for an OB/GYN near you.

When to call your provider

Call your provider if you have:

• Vaginal bleeding or leaking fluid
• Cramping or contractions before 37 weeks
• A headache that won't go away, vision changes, upper belly pain or sudden swelling (possible preeclampsia)
• Extreme thirst or urination
• Fewer baby movements than usual in the third trimester
• Depression or anxiety that's getting in the way of daily life

Call 911 for heavy bleeding, chest pain, trouble breathing, fainting or a seizure.

Frequently asked questions

Sources

• ACOG — Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy FAQ
• ACOG and SMFM — Pregnancy at Age 35 Years or Older (Obstetric Care Consensus)
• ACOG — Screening for Fetal Chromosomal Abnormalities (Practice Bulletin 226)
• USPSTF — Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.