Pregnancy After 40: Importance of Preconception Counseling

For some, pregnancy after 40 is a hard feat to tackle. Now more than ever, women are having children later in life. Fertility treatments and increased technology in prenatal care have helped to make this possible. Women no longer need to feel rushed into motherhood.

They are able to establish their careers, travel, build savings and buy a home (among many other things) before settling down to start their family.

Pregnancy after 40 does come with some increased risks, but preconception counseling can help identify and reduce risks for women at an advanced maternal age.


What are the Chances of Getting Pregnant After 40?

Doctor Stewart, chair of the British Fertility Society, says there are many women who conceive in their 40s if their fertility is in the normal range, however, she also says trying for a baby when you’re younger significantly increases your chances.

“If you look at women under 38 who have normal fertility (ovulating regularly, in good health, their partners producing normal sperm levels and having regular intercourse), 95% of them will get pregnant within two years, whereas half of women trying to conceive in their 40s won’t conceive at all.”


Risks of Pregnancy After 40

A safe and healthy pregnancy is possible for women over 40. While there are some risks that are greater with increased maternal age, in general, a woman who was healthy before conception can expect a normal pregnancy. Increased risks that occur with pregnancy after 40 are:

  • pregnancy after 40Decreased fertility
  • Increased risk for conditions that interfere with conception, such as endometriosis, fibroids, etc
  • Higher risk of having a baby with chromosomal defects, such as Down syndrome
  • High risk of miscarriage (35% for ages 40-44 and 50% for ages 45+)
  • Pregnancy complications may be more common as women age, such as gestational diabetes, pregnancy-induced hypertension, placental problems, etc
  • Increased incidents of premature birth with advanced maternal age
  • Increased incidents of stillbirth in pregnancy after 40
  • Higher prevalence of preexisting conditions that may complicate pregnancy, such as high blood pressure, diabetes, heart problems, etc

Importance of Preconception Counseling 

Preconception counseling is extremely important for women over 40 who wish to conceive.

Preconception counseling is a consultation with a physician and/or obstetrician to discuss plans for conception. The doctor can make a risk assessment based on personal medical history, family medical history and other factors. The doctor may also recommend diet or lifestyle changes that may increase the potential for a healthy pregnancy.

The healthier a person is going in to a pregnancy, the more likely they are to have a healthy pregnancy.

While preconception counseling is beneficial for any woman planning to get pregnant at 40, it is important that women over 40 consult a doctor before conception.


Importance of Prenatal Care

In addition to preconception counseling, early prenatal care is essential in pregnancy after 40. Women are most at risk in their first trimester of pregnancy. Early prenatal care gives the doctor a chance to determine and monitor risks. With advanced medical care, pregnancy is now safer than it was in the past.

Benefits of Preconception Counseling

  • Reducing unintended pregnancy
  • Prevent birth defects
  • Prevent LBW and prematurity
  • Promote healthy behaviors and reduce risk-taking behaviors
  • Prepares and reinforces parents for parenting
  • Prevent poor pregnancy outcomes and recurrence
  • Promote family planning


Pre-Conception Health Assessment Checklist for Pregnancy After 40

Reproductive history- has the patient had:

  • Uterine or cervical abnormalities?
  • Two or more pregnancies ending in the first trimester- miscarriage without intervening successful gestation?
  • One or more fetal deaths?
  • Preterm deliveries (one or more)?
  • Small-for-gestational-age infants (one or more)?
  • One or more infants requiring care in neonatal intensive care unit?
  • Infants with birth defect (one or more)?


Pregnancy after 40 is not only manageable, with proper care and education it can be enjoyable.