OVERVIEW

How is advanced maternal age defined?

There is currently no universal international definition for advanced maternal age.

It is generally believed that as women age, especially after 35, ovarian function and overall physical health decline, increasing the likelihood of pregnancy complications.

Therefore, in China, advanced maternal age is defined as: women who are 35 years or older at the time of delivery. This includes those who are ≥35 years old at conception or childbirth, regardless of whether it is their first pregnancy.

Is advanced maternal age common?

Advanced maternal age is quite common in modern society.

Statistics show that over the past half-century, older women in the U.S. account for an increasing proportion of first-time births: in 2014, 9% of first-time mothers were aged 35 or older, a 23% increase from 2000. Between 1970 and 2014, the average age of first-time mothers rose by nearly 5 years.

Factors such as delayed marriage, later childbearing, further education, and work pressures have led to a global trend of postponing childbirth. The same applies in China, especially after the relaxation of the two-child policy, with the number of older pregnant women increasing yearly, including those aged 40 or even 45 and above.

SYMPTOMS

What pregnancy complications can occur in advanced maternal age?

Women of advanced maternal age face the same pregnancy complications as younger mothers, but with a relatively higher risk probability.

Clinical observations show that the miscarriage rate in the first trimester exceeds 50% for older pregnant women. They also experience increased incidences of maternal and fetal complications (including hypertensive disorders of pregnancy, gestational diabetes, congenital fetal malformations, etc.) and poorer pregnancy outcomes (such as placental abruption, dystocia, stillbirth, postpartum hemorrhage, etc.).

Which complications are more likely in advanced maternal age?

The most common complications for older mothers are hypertensive disorders of pregnancy and gestational diabetes. Statistics indicate that the incidence of hypertensive disorders is five times higher in advanced maternal age compared to younger mothers, with a higher likelihood of progressing to severe preeclampsia. The risk of gestational diabetes also increases proportionally with age.

Additionally, older mothers face a higher probability of placental abnormalities (such as placenta previa and placental abruption), increased risk of dystocia during delivery, and a 6.3 times higher likelihood of postpartum hemorrhage compared to younger mothers.

While these risks are elevated, they do not guarantee complications for every older mother. If complications arise, follow medical advice—manage blood pressure, control blood sugar, and hospitalize early for placental abnormalities. Focus on what you can control, and leave the rest to your doctor.

CAUSES

Why are advanced maternal age pregnancies risky?

As women age, their organs and reproductive functions gradually decline. After age 35, the probability of egg abnormalities increases significantly, and overall physical functions begin to deteriorate.

Pregnancy and childbirth place high demands on the body. Some previously undetected health issues may emerge during pregnancy. If the body cannot adequately adapt to the changes during pregnancy, various complications may arise. These factors contribute to the increased risks for older mothers.

DIAGNOSIS

What special tests do advanced maternal age women need during prenatal checkups?

Most prenatal tests for advanced maternal age women are the same as for younger mothers, but older mothers have an increased probability of chromosomal abnormalities.

Therefore, blood-based Down syndrome screening is usually not performed. Instead, an NT scan is recommended in early pregnancy (11-13 weeks + 6 days). When conditions permit, non-invasive DNA screening is done in the second trimester, with amniocentesis or cordocentesis performed based on the results. Some hospitals may require direct amniocentesis or cordocentesis.

TREATMENT

Which department should advanced maternal age women visit?

Advanced maternal age women, like non-advanced maternal age women, should visit the obstetrics department.

Should advanced maternal age women choose vaginal delivery or cesarean section?

The probability of cesarean section for advanced maternal age women is indeed higher than for non-advanced maternal age women, which is related to factors such as more pregnancy complications, poorer maternal and fetal tolerance, and higher trial labor failure rates.

However, advanced maternal age is not an absolute indication for cesarean section. The choice between vaginal delivery and cesarean section should be determined by the doctor based on a comprehensive assessment of the mother.

If the doctor's evaluation shows that the pregnant woman's physical condition permits, there are no indications for cesarean section, and the fetus is in good condition, vaginal trial labor under medical supervision is entirely possible. If vaginal delivery is not suitable, the doctor will decide the timing of the cesarean section based on the situation and the mother's preference.

The premise for choosing a delivery method must always be ensuring the safety of both mother and child—it is not a matter of "choosing whatever one prefers."

DIET & LIFESTYLE

What dietary precautions should advanced maternal age women take?

• Maintain a balanced and varied daily diet, avoiding picky or selective eating habits.
• Consume high-quality protein daily, such as dairy products, soy products, fish, shrimp, and poultry. Include seafood fish 1-2 times per week to increase unsaturated fatty acid intake.
• Ensure adequate iron supplementation throughout pregnancy. Iron from red meat and animal liver is more easily absorbed and utilized by the body.
• Eat plenty of fresh vegetables and fruits.
• Prioritize steaming and boiling as cooking methods, with reduced oil, salt, and low-fat intake.
• Control weight to avoid obesity.

Can advanced maternal age women exercise? What types of exercise are suitable?

If generally healthy, advanced maternal age women are encouraged to exercise, as it helps control blood pressure, blood sugar, and weight while improving physical fitness.

It is recommended to rest for 30 minutes after meals before exercising. Walking, yoga, and swimming are good options. Exercise duration should be adjusted based on individual capacity.

Are there special postpartum considerations for advanced maternal age women?

Advanced maternal age women have weaker uterine contractions and recovery functions, increasing the risk of postpartum hemorrhage. Post-delivery, their immune resistance decreases, raising the likelihood of reproductive tract infections. Therefore, closely monitor vaginal lochia after childbirth. Seek immediate medical attention if excessive bleeding, foul-smelling vaginal discharge, or wound pain occurs.

A pelvic floor function assessment should be performed 42 days postpartum. Pelvic floor function declines with age, especially for many advanced maternal age women having a second child. Early evaluation and treatment can prevent future issues like urinary incontinence or uterine prolapse.

Due to higher risks of pregnancy complications, difficult labor, and slower recovery, advanced maternal age women are more prone to postpartum depression. Family members should pay extra attention to their emotional changes, identify early signs of depression, and prevent tragedies.

PREVENTION

What precautions should advanced maternal age women take when preparing for pregnancy?

Nowadays, more and more women of advanced maternal age are preparing for pregnancy. It is recommended to undergo examinations during the preparation period to understand your general physical condition and prepare for the upcoming pregnancy. The examinations during the preparation period mainly include:

• Routine physical examination:
  • Includes liver and kidney function, blood sugar, blood pressure, blood routine, thyroid function, breast ultrasound, oral examination, etc., to check for issues such as hypertension, diabetes, anemia, thyroid dysfunction, breast diseases, or oral diseases.
  • If abnormalities are found during the examination, you should first seek treatment from the relevant department and adjust your body to a suitable state for pregnancy before preparing for conception.
• Gynecological examination:
  • Gynecological ultrasound (transvaginal or transabdominal) to assess the condition of the uterus and ovaries.
  • If menstruation is irregular, often delayed, or accompanied by irregular bleeding, it is recommended to undergo sex hormone testing. If possible, AMH testing should also be performed to check for ovarian dysfunction or endocrine disorders affecting ovulation. If problems are found, they should be addressed before preparing for pregnancy.
  • All women of advanced maternal age preparing for pregnancy must undergo cervical examinations, including TCT and HPV tests, to determine whether cervical lesions are present.