Risks and Rewards of Having a Baby in Your 40s

Thomas Jefferson once wrote, “With great risk comes great reward.” While having a baby after age 35 is considered a high-risk pregnancy, more and more moms are happily and safely choosing this path. Million Dollar Baby and Freedom Writers actress Hilary Swank, 48, joins the ranks of celebrity moms and everyday moms who are having their babies in their 40s. Swank, who has not one, but two Academy Awards for Best Actress is having not one, but two babies as a first-time mom.

While we may be used to hearing about the risks of pregnancy in advanced-age moms, especially ones involving multiple births, there’s another side to motherhood after 35 that we hear about less often: the benefits.

“Women who have children at a later age tend to begin pregnancy with several important advantages,” says Rachel Humphrey, MD, medical director of the AdventHealth for Women Maternal-Fetal Medicine Program.

First, they often have a more stable home and career. Swank has been married to entrepreneur Philip Schneider since 2018 and has a successful, established acting career. She was also her father’s sole caregiver for more than seven years after a lung transplant. He passed away in 2021 and twins’ due date is on her father’s birthday, April 16. More than ready to have her babies, Swank stated, “It’s just this tribute of life — (the twins) being born on his birthday. He would be elated. He would be so happy for me. He just wanted me to have everything that I wanted in my life.”

Secondly, these moms-to-be are also more motivated to take advantage of every health resource and screening possible to keep themselves and their babies healthy and safe.

“In general, I find that women over the age of 35 are incredibly focused on doing everything they can to stay healthy,” said Dr. Humphrey, whose practice specializes in treating women with high-risk pregnancies. “These women take our recommendations to heart.”

A pregnancy after 35 is sometimes called “high risk,” but it’s important to put the facts in context. “The most likely outcome of a pregnancy for a woman in her 40s, once you get past the first several weeks, is normal,” Dr. Humphrey says.

Forty-something pregnancies are no longer considered extremely unusual. In 2016, for the first time, women giving birth in their 30s outnumbered women who gave birth in their 20s. And birth rates have gone up the fastest for women over 40, rising 19 percent since 2007.

Dr. Humphrey said these trends are reflected in her practice, which tends to include at least one patient in her 50s at any given time. While it’s understandable for women who wait to have kids to feel nervous about pregnancy, the odds are on their side.

Dr. Humphrey said mothers should be made aware of the increased risk of complications that come with pregnancy at advanced maternal age, which starts at age 35 and above.

Otherwise, these women tend to have less stress than younger moms because they're often in a better spot in their life to handle pregnancy, she said. Women who give birth after 35 are in good company. Hilary Swank explains her reasoning for waiting: "I was having a career and just not having the right relationship until five years ago now … and just you know all the elements needed to come together and be right," she said.

Other such celebrity moms like Swank include Alanis Morissette, who had her third child at 44; Janet Jackson, who became pregnant with her first child at 49; and Gwen Stefani, who also gave birth to her third child at age 44.

Getting pregnant later in life makes getting off to a healthy start even more important.

Getting a Healthy Start

“Health advice for women of advanced maternal age who are planning on having a baby is not different from advice for other women,” Dr. Humphrey says. It includes:

• Maintaining a healthy diet and body weight, perhaps with the help of a nutritionist
• Staying active with an exercise routine
• Avoiding radiation exposure and certain infections, like Coronavirus and Zika virus
• Assembling a health care and wellness team, perhaps including a nurse midwife and/or a doula
• Understanding your health insurance benefits, if applicable

A mother’s health choices during pregnancy can not only lead to a healthier baby, but they can also affect her baby's health as an adult.

“Moms who are vitamin D deficient during pregnancy are more likely to have babies with asthma,” Dr. Humphrey says. There are even studies to show that a mother who exercises and has a healthy diet may help her baby stay healthier as an adult.

Mothers over 35 are generally advised to start on low-dose aspirin to help prevent pre-eclampsia, a potentially dangerous condition involving high blood pressure.

Some moms may find all this advice overwhelming, but with solid support from their care team, their partner, family members and friends, they can find comfort knowing others have their backs.

Finding the Due Date

Dr. Humphrey says some of her patients at any age don't know they're pregnant for some time after conception. But moms who are a little more experienced seem to be more in tune with their bodies, she says.

In either case, the earlier the ultrasound (12 to 14 weeks is ideal) the more accurate the due date will be. An ultrasound made at 20 weeks is still reasonably accurate, but as the pregnancy progresses the due date is harder to estimate.

To explain why earlier ultrasounds are more accurate, Dr. Humphrey draws an analogy between guessing the age of a newborn and a five-year-old child. It’s a lot easier to guess for a newborn, of course, because not all kids grow at the same rate, and a five-year-old could be large or small for their age. It’s the same for babies in the womb, as they tend to develop at the same predictable speed at first, but can grow faster or slower than normal later on in a pregnancy.

There are a handful of other tests that are advised for some or all women of advanced maternal age, including:

• Noninvasive Prenatal Testing, or NIPT, a blood test to screen for potential genetic disorders that is accurate as early as 10 weeks
• Gestational Diabetes Test, which screens for a health condition that can affect mother and child and is usually given about 25 weeks into a pregnancy
• Fetal Non-Stress Test, or NST, a test to monitor the baby's heart health that's called non-stress because it places no stress on the baby. It’s typically conducted later in a pregnancy, often after the 28th week.

These tests can be anxiety-provoking, but Dr. Humphrey said most women's results are normal and they end up being reassuring tests.

As with all pregnancies, Dr. Humphrey advises women over 35 to attempt a vaginal birth rather than a C-section. Their risk of needing a C-section is only slightly higher than it is for younger moms.

When it comes time to decide where to give birth, Dr. Humphrey says a hospital with a Level 3 neonatal intensive care unit, or NICU, like AdventHealth for Children, is the best choice for many women of advanced maternal age. Depending on the mother’s individual case, it may be helpful to establish a relationship with specialists, like a pediatric cardiologist.

Talking About Risk

There are two ways to think about the increased risk that comes from giving birth at a later age. The first is to compare the risks at an older age with those at a younger age.

Though many of these risks, like developing genetic disorders, are several times higher at an older age, that doesn’t mean they’re inevitable. It’s important to consider these risks and to look at their likelihood of occurring, rather than comparing them to other pregnancies to understand the bigger picture.

For example, a woman at age 30 has a 1 in 1,000 chance of delivering a baby with Down Syndrome. At age 40, a woman has a 1 in 85 chance, but that still means that 84 out of 85 births are normal.

Dr. Humphrey sometimes compares pregnancy with a trip down Florida’s Interstate 4, sometimes named among the most dangerous highways in the country.

“But most people on I-4 make it from point A to point B and are fine,” Dr. Humphrey notes. “Potential issues can sound scary, but the majority of women go through a normal pregnancy, and I try to emphasize that with patients.”

AdventHealth for Women has specialists, physicians and nurses who create a nurturing and patient-centered environment you, regardless of your age.

When combined with 24-7 availability of a delivery team and AdventHealth for Children's Level III NICU to provide the highest level of care for our tiniest patients, there’s no more comfortable choice for a mother-to-be.

We believe in the whole health and well-being of you and your baby from conception to birth and beyond and are committed to providing you with the best care available. Click here to visit AdventHealth for Women to make an appointment or to speak with one of our specialists about your next steps on the path to motherhood.