Pregnancy after 35: Healthy moms, healthy babies

If you're over 35 and hoping to get pregnant, you're in good company. Many women are delaying pregnancy well into their 30s and beyond — and delivering healthy babies. Take special care to give your baby the best start.

Understand the risks

The biological clock is a fact of life — but there's nothing magical about age 35. It's simply the age at which certain issues are recognized. For example:

It may take longer to get pregnant
You're born with all the eggs you'll ever have. As you reach your mid-30s, the eggs begin to decline in quality. After fertilization, an older egg is less likely to develop into a blastocyst — the ball of cells that implants into the uterus to begin a pregnancy.

Does this mean you can't get pregnant? No. Many older women successfully conceive, but it may take a bit longer. If you're over 35 and have been unable to conceive for six to nine months, you may want to consult your health care provider for advice.

You're more likely to have a multiple pregnancy
Age-related hormonal changes may cause you to release more than one egg at a time, which boosts the odds of conceiving nonidentical (fraternal) twins.

Because of their decreased fertility, older women are also more likely to use assisted reproductive technologies — such as in vitro fertilization — to conceive. Since these procedures typically involve implanting more than one fertilized egg in the uterus, they're more likely to result in twins or other multiples.

The risk of miscarriage is higher
Sadly, the risk of miscarriage increases as you get older. Here's the breakdown:

• Before age 35 — 15 percent risk
• Ages 35 to 39 — 20 to 25 percent risk
• Ages 40 to 42 — 35 percent risk
• After age 42 — 50 percent risk

You're more likely to develop gestational diabetes
This type of diabetes occurs only during pregnancy. Tight control of blood sugar through diet, exercise and other lifestyle measures is essential to prevent complications. Sometimes, medication is needed as well. Your treatment plan may include frequent prenatal checkups and regular blood sugar testing at home.

You may need a Caesarean section
Many factors may be at play here. For example:

• Older mothers have a higher risk of pregnancy-related complications, such as high blood pressure and gestational diabetes. These problems can lead to Caesarean delivery.
• There's a greater chance that your cervix will be slow to dilate, which also may lead to a C-section.
• If your baby is too big or you've gained too much weight — common issues for older mothers — vaginal delivery may be difficult.
• Babies of older mothers are more likely to be in a position that complicates vaginal delivery, such as rump-first or feet-first (breech).
• Placenta previa — a condition in which the placenta either partially or completely covers the cervix — may lead to a C-section.
• C-sections are often recommended for multiple births.

The risk of chromosome abnormalities is higher
Babies born to older mothers have a higher risk of various chromosome problems, such as Down syndrome. At age 30, the risk of Down syndrome is about one in 1,000 live births. At age 35, it's about one in 400. By age 40, the risk is about one in 100.

Make healthy choices

Taking good care of yourself is the best way to take care of your baby. Pay special attention to the basics.

Make a preconception appointment
Meet with your health care provider before you conceive to make sure your body is prepared for the task ahead. He or she will assess your overall health and discuss lifestyle changes that may improve your chances for a healthy pregnancy and baby.

The preconception appointment is a great time to address any concerns you may have about fertility or pregnancy at your age. Ask the best ways to boost the odds of conception — and the options if you have trouble conceiving.

Seek regular prenatal care
During pregnancy, regular prenatal visits can help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you, even if they seem silly or unimportant. Talking to your health care provider is likely to put your mind at ease.

Eat healthfully
During pregnancy, you'll need more folic acid, calcium, iron, protein and other essential nutrients. If you're already eating healthfully, keep it up. A daily prenatal vitamin — ideally starting before conception — can help fill any gaps.

Gain weight wisely
Gaining the right amount of weight can support your baby's health — and make it easier to shed the extra pounds after delivery. Work with your health care provider to determine what's right for you. Here are the general guidelines:

If you're carrying twins or triplets, you'll need to gain more weight — often 35 to 45 pounds.

Stay physically active
Unless your health care provider prescribes bed rest, pregnancy can be a great time to get active. Exercise can help ease or even prevent discomfort, boost your energy level and improve your overall health. Perhaps best of all, it can help you prepare for labor and childbirth by increasing your stamina and muscle strength.

Get your health care provider's OK before starting or continuing an exercise program — especially if you have a medical condition or history of preterm labor.

Avoid risky substances
Alcohol, tobacco and recreational drugs are off-limits during pregnancy.

Even moderate or minimal alcohol use can harm your developing baby. Smoking increases the risk of preterm birth, problems with the placenta and certain birth defects. Any drugs you take can pass from you to your baby, sometimes with devastating effects.

Even prescription and over-the-counter medications deserve caution. Clear any medications or supplements with your health care provider ahead of time.

Learn about prenatal testing for chromosomal abnormalities
Diagnostic tests such as chorionic villus sampling and genetic amniocentesis can provide information about your baby's chromosomes, but at a small risk of losing the pregnancy. Your health care provider can help you weigh this risk against the value you place in having the information.

Typically, prenatal tests simply confirm that a baby is healthy. But it's important to be prepared for other possibilities. Trust your health care provider to help you make decisions consistent with your own values.

Look toward the future

The choices you make now — even before conception — can have a lasting effect on your baby. Think of pregnancy as an opportunity to nurture your baby and prepare for the exciting changes ahead.