Pregnancy over 35

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The average maternal age for women in the United States has steadily risen over the past fifty years. According to the U.S. Census Bureau, the average age of mothers reached a record high of 30 years in 2019. For comparison, in 1970, the average maternal age of U.S. women was 24.6 years.

There are many reasons why women are waiting to have children at a later age. Many of these involve education and job opportunities, greater accessibility to reproductive technologies, and the ability to complete certain milestones before starting family planning. Today, 20% of women in the U.S. give birth to their first child after age 35.

The good news is there are multiple benefits for moms when starting a family later, including cognitive and longevity benefits.

The downside is that pregnancies after age 35, or what healthcare practitioners call “advanced maternal age,” come with a higher risk of complications to both mom and baby. Some of these risks include gestational diabetes, preterm birth, increased chromosomal abnormalities and other birth defects, and miscarriage. Risk factors extend to recovery post-birth as well.

The most significant contributing factors to these risks are likely related to ovarian aging, resulting in decreased quality of eggs later in life, and a general increased risk for chronic disease that occurs with age.

Despite these risks, there are various nutritional factors which may help to reduce the risks of pregnancy in women over the age of 35. During pregnancy we know that there is an increased need for essential nutrients like iron, vitamin D, and calcium making nutrition and supplementation increasingly important. Taking a high-quality prenatal vitamin that includes iron, folate, choline, and other nutrients to support a healthy pregnancy at any age is essential.

Folate

We’ve known for decades that adequate folate intake prior to conception is important to prevent neural tube defects.¹ In addition, emerging data suggests that it may also reduce risk for other fetal structural abnormalities,² including heart defects,³ and may help to protect against early delivery, a risk factor with advanced maternal age. Common food sources of folate include dark leafy greens, beans, and peas.

DHA

We know that omega-3 is important for fetal brain development for pregnant women of all ages.⁴ Importantly, there is also some evidence that supplementing with omega-3 fatty acids may help to reduce risks commonly associated with pregnancy after 35, like preterm delivery.⁴ Food sources of DHA include fish, shellfish, and algae.

CoQ10

Levels of this important antioxidant and energy producing nutrient decrease with age and may also be associated with decreased egg quality and fertility rates. Studies show that supplementing with CoQ10 prior to natural and assisted fertility efforts can help support egg and embryo quality by protecting eggs from oxidative damage.⁵ Some food sources for CoQ10 include organ meats, fatty fish, and soy.

Inositol

Supporting insulin sensitivity is important for everyone, but may become increasingly important in advanced maternal age, where there is an increased risk for gestational diabetes. Supplementing with inositol can help to support pregnancy rates, which is a challenge with women over 35.⁶ Increasing consumption of fruits, veggies, grains, and nuts can help boost choline intake.

Recovering from pregnancy may prove to be a challenge for older women as well.

While age alone may not factor into increased risks, women over 35 may be more prone to other factors that make them more susceptible to post-pregnancy complications like postpartum depression and slow physical recovery. These risks increase dramatically over age 40, and in mothers with multiple births.

In addition to following the nutrient recommendations, keeping up with protein intake, omega-3s, and a quality prenatal or multivitamin with iron and quality B vitamins can help to support recovery time and reduce risk for postpartum depression.

Understanding how women can be best supported and recover from pregnancy later in life is critical for mom and baby as advanced maternal age will likely continue to be more common in the years to come.

About the Author
Dr. Amanda Frick, ND, LAc is the vice president of medical affairs at Thorne. She leverages her expertise in naturopathic medicine to bring a personalized, science-backed approach to the health and wellness and nutritional supplements space.

References

1. US Preventative Services Taskforce. Folic Acid Supplementation to Prevent Neural Tube Defects: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA Networks. 2023. 330 (5), 454-459. DOI: 10.1001/jama.2023.12876

2. Greenberg, J.A.; Bell, S.J.; Guan, Y.; Yu, Y.H. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention. Rev Obstet Gynecol. 2011. 4 (2), 52-59. PMID: 22102928

3. Obeid, R.; Holzgreve, W.; Pietrzik, K. Folate supplementation for prevention of congenital heart defects and low birth weight: an update. Cardiovasc Diagn Ther. 2019. 9 (Supp 2), S424–S433. DOI: 10.21037/cdt.2019.02.03

4. Devarshi, P.P.; Grant, R.W.; Ikonte, C.J.; Mitmesser, S.H. Maternal Omega-3 Nutrition, Placental Transfer and Fetal Brain Development in Gestational Diabetes and Preeclampsia. Nutrients. 2019. 11 (5), 1107. DOI: 10.3390/nu11051107

5. Xu, Y.; Nisenblat, V.; Lu, C.; Li, R.; Qiao, J.; Zhen, X.; Wang, S. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Repod Biol Endocrinol. 2018. 16, 29. DOI: 10.1186/s12958-018-0343-0

6. Zheng, X.; Lin, D.; Zhang, Y.; Lin, Y.; Song, J.; Li, S.; Sun, Y. Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Medicine (Baltimore). 2017. 96 (49), e8842. DOI: 10.1097/MD.0000000000008842