What happens if I’m pregnant over the age of 40?

Most women over 40 have healthy pregnancies and babies. However, it can sometimes take longer to get pregnant and some people experience complications.

Rates of women getting pregnant in their 40s is increasing and have more than doubled since 1990.  Nearly one birth in five is to women over the age of 35.  

As an older mum, you’re more likely to conceive more than 1 baby. This may be through natural conception or through assisted conception such as IVF. Carrying more than 1 baby can make pregnancy more complicated, especially if you’re older.

Being an older mum sometimes means that your body has to work harder than if you were younger. You are more likely to develop a health condition and are more likely to need help to give birth. You’re also more likely to have pre-existing health conditions, such as high blood pressure or diabetes, especially if you’re overweight. But try to remember that most women will still have healthy pregnancies.

Are there more risks if you’re pregnant over 40?

Statistically, there are higher risk factors from the age of 35 and the risks increase as you get older. But try not to let this worry you as most pregnancies will be healthy.

Your age may affect how well the placenta is able to develop. This could make other complications more likely, including:

Sadly, miscarriage and ectopic pregnancy are more common in older women. The rate of miscarriage rises with age, with 1 in 2 pregnancies in women over 45 ending in miscarriage.

Your midwife and GP are trained to care for pregnant women in their 40s but you may also be referred to a consultant. In some hospitals and maternity units, women over 40 will be under consultant-led care. This depends on your hospital’s policy.

Which complications are more common in women over 40?

Older mothers seem more likely to complications problems in pregnancy and childbirth. You’re more likely to experience problems such as high blood pressure, diabetes, placental problems and birth complications. But try not to worry too much. Even though some complications are more common in older mums, this doesn't necessarily mean that they will happen to you.

Gestational diabetes

Women in their 40s are more likely to develop gestational diabetes than women in their 20s or 30s. In the UK, all pregnant women who are considered at risk are offered a test for gestational diabetes during pregnancy.

Having a very big baby

Pregnant women over 40 are more likely to have a very big baby (over 4.5kg or 10lb). Having a very big baby is often also linked to having gestational diabetes. Your midwife will arrange a scan to check the size of your baby if they think your baby is big.

Needing to have a caesarean

Women over 40 are the most likely age group to have a caesarean birth. It is almost twice as likely that you will need a caesarean. This may be because the uterine muscle is less effective as we get older, particularly in first-time mums. If you have additional complications, such as a large baby, your healthcare team may discuss with you about having a planned caesarean.

Having a stillbirth

If you go past your due date, women in their 40s are twice as likely to have a stillbirth compared to women under 35. It’s really important to monitor your baby’s movements. Contact your midwife or maternity unit immediately if you think your baby’s movements have slowed down, stopped or changed. All pregnant women over 40 are offered an induction around their due date, as the risk of stillbirth goes up after 40 weeks.

Chromosomal abnormalities

Being an older mum means you have a higher chance of having a baby with a chromosomal abnormality, such as Down’s syndrome and Patau’s syndrome. However, all pregnant women are offered screening tests for chromosomal abnormalities.

Will I get extra care if I am pregnant over 40?

If you are over 40, your midwife, GP, obstetrician or specialist teams may all be involved in your care during your pregnancy.

Because you are at a higher risk of complications, you will probably be offered more tests to check that you and your baby are healthy as part of your antenatal care. For example, you will have extra scans, tests, and your blood pressure may be checked more often because of the higher risk of pre-eclampsia.

Your midwife will explain more about what your care plan will look like at your booking appointment. You’ll also have the chance to ask any questions or talk about any concerns you have. It’s very important that you attend all your antenatal care appointments so that midwives can spot any problems early and treat them.

What can I do to make sure I have a healthy pregnancy over 40?

The best thing you can do if you are pregnant at any age is to concentrate on trying to be as healthy as possible by:

"I had my second child when I was 41. It was a lovely experience, and I didn't have any issues that may affect older women. I don't regret for one moment having a child in my 40s. I felt so much more confident by then."

Helena, mum of two

Will my age affect my labour and birth?

You are likely to be offered medical interventions, such as an induction, to get your labour started. If you’re aged 40 or over, you may be offered an induction at 39 weeks. This is to reduce the risk of stillbirth, especially if you have other complications.

Are there any advantages to being an older mum?

It’s possible that you are eating more healthily and exercising more than when you were younger. Older women are also less likely to be smokers.

The confidence you may have gained from having more life experience may make it easier to enjoy pregnancy and having children. It’s also more likely that you are emotionally and financially stable and ready for children. Try not to worry too much about your age. Just concentrate on having a healthy pregnancy and bonding with your baby. If you have any worries or concerns, it might be helpful to talk to your GP or midwife.

Office for National Statistics. Conceptions in England and Wales (2017) https://www.gov.uk/government/statistics/conceptions-in-england-and-wales-2017

NHS Digital (2018a) NHS maternity statistics, 2017-18: hospital episode statistics tables. Part 3: smoking patterns among adults. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2018/part-3-smoking-patterns-in-adults

Royal College of Obstetricians and Gynaecologists (2014) The Investigation and Management of the Small-For-Gestational-Age Fetus. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/small-for-gestational-age-fetus-investigation-and-management-green-top-guideline-no-31/

NHS Choices. Miscarriage.https://www.nhs.uk/conditions/miscarriage/(Page last reviewed: 01/06/2018. Next review due: 01/06/2021)

Royal Berkshire NHS Foundation Trust. Having a baby after the age of 40. Available at: https://www.royalberkshire.nhs.uk/media/knljt3u2/having-a-baby-after-40_a4_sept21.pdf(Last reviewed: June 2019 Next review due July 2021)

NHS. NHS Maternity Statistics, England 2017-18. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2017-18#key-facts 

Royal College of Obstetricians and Gynaecologists (2013) Induction of labour at term in older mothershttps://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_34.pdf

NHS Choices. Down’s syndrome. https://www.nhs.uk/conditions/downs-syndrome/ (Page last reviewed: 21/10/2019. Next review due: 21/10/2022)

Clinical Knowledge Summaries (Feb 2019) Antenatal care – uncomplicated pregnancy https://cks.nice.org.uk/antenatal-care-uncomplicated-pregnancy

ONS. Adult smoking habits in the UK: 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018 

Review dates
Reviewed: 18 September 2020
Next review: 18 September 2023

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