A common question in maternity care is what age is considered a high risk pregnancy. The most widely used threshold is 35 years or older at the time of delivery, a category clinicians call advanced maternal age. Age at the younger end of the reproductive range, generally under 17, is also associated with added considerations. It is important to understand that high risk pregnancy age is only one factor among many, and reaching 35 does not automatically mean a pregnancy will be complicated. It means specific risks become more likely and are worth monitoring.
This article explains where the age thresholds come from, what advanced maternal age actually changes, and how care is adjusted for pregnancy after 35.
What age is considered a high-risk pregnancy?
The clinical benchmark most often cited is 35 years and older at the estimated due date. This is the definition of advanced maternal age, sometimes still referred to by the older and now largely retired term geriatric pregnancy. Many clinicians and professional organizations have moved away from that phrase because it can feel stigmatizing and imprecise, favoring advanced maternal age or simply describing the specific risks involved.
The age 35 threshold is not a cliff. Risk rises gradually across the reproductive years rather than jumping sharply on a birthday. The number 35 became a reference point historically in part because it was the age at which the risk of certain chromosomal conditions began to approximate the risk of some diagnostic testing procedures. Screening options have since improved, but the threshold remains a useful marker for when additional counseling and monitoring are commonly offered.
At the younger end, pregnancy under 17 is associated with higher rates of preterm birth and certain other complications, and is also considered when assessing overall risk.
Why does pregnancy after 35 carry more risk?
Pregnancy after 35 is associated with a higher likelihood of several conditions. The increases are real but often modest in absolute terms, and most people over 35 have healthy pregnancies.
Chromosomal conditions. The chance of chromosomal differences such as Down syndrome rises with maternal age. This is the risk most people associate with advanced maternal age, and it is the reason genetic screening and counseling are routinely discussed.
Gestational diabetes and hypertensive disorders. Rates of gestational diabetes and of high blood pressure conditions, including preeclampsia, are higher with increasing age.
Pregnancy loss and stillbirth. The risk of miscarriage and, to a smaller degree, stillbirth increases with age, which is one reason later pregnancies may involve added third-trimester surveillance.
Multiple gestation. The likelihood of twins rises with age and with the use of fertility treatments, and multiple gestation carries its own set of risks.
Cesarean delivery. Rates of cesarean birth are somewhat higher in older patients.
According to ACOG and other professional bodies, these associations are why age is factored into risk assessment, but they are best interpreted alongside a person's overall health rather than in isolation.
How is care different for advanced maternal age?
For most patients, pregnancy after 35 looks broadly similar to any other pregnancy, with some additions. The care plan is individualized, so not everyone will need every element below.
Patients are typically offered detailed genetic screening and counseling. This may include cell-free DNA screening from a blood sample and a discussion of diagnostic options. These are choices, not requirements, and counseling is meant to help patients decide what is right for them.
Depending on other factors, the team may recommend additional blood pressure and glucose monitoring, extra ultrasounds, and third-trimester testing such as nonstress tests. If other risk factors are present alongside age, such as chronic hypertension or a prior complication, input from a maternal-fetal medicine specialist may be added.
It is worth emphasizing that age alone, in an otherwise healthy person, is a relatively soft risk factor. A healthy 37-year-old with no other concerns may need only modest additions to routine care, while age combined with other factors carries more weight.
Should I see a specialist because of my age?
Not every patient over 35 needs a maternal-fetal medicine specialist. Many are cared for entirely by their OB-GYN or midwife, with age simply noted as part of the overall picture. A referral to MFM is more likely when age is combined with other factors, such as a pre-existing medical condition, a prior pregnancy complication, or a multiple gestation.
For patients who want specialized input but lack a local MFM practice, telehealth has expanded access to that expertise. The right level of care depends on the full clinical picture, not the number on a birthday alone. For a broader view of how risk factors fit together, see our high-risk pregnancy guide.
Ouma Health is a physician-led, MFM-founded maternity telehealth practice, a real medical practice rather than an app, that partners with health plans, employers, and provider organizations to extend specialized maternity care. Ouma clinicians can co-manage pregnancies alongside a patient's existing team, including those flagged for advanced maternal age. Learn more about our high-risk pregnancy services.
Frequently asked questions
What age is considered a high-risk pregnancy?
The most common threshold is 35 years or older at the time of delivery, known as advanced maternal age. Pregnancy under 17 is also associated with added considerations. Age is one factor among many, and reaching 35 does not automatically make a pregnancy complicated.
Is "geriatric pregnancy" still a term doctors use?
It is being phased out. Many clinicians now use advanced maternal age instead, because the older term can feel stigmatizing and does not describe the specific risks involved. The care considerations are the same regardless of the label used.
Will I definitely have complications if I'm pregnant after 35?
No. Most people over 35 have healthy pregnancies. Age raises the likelihood of certain conditions such as gestational diabetes, hypertensive disorders, and chromosomal differences, which is why additional screening and monitoring are commonly offered.
Do I need a maternal-fetal medicine specialist just because I'm over 35?
Not necessarily. Many patients over 35 are cared for by their OB-GYN or midwife. A specialist referral is more likely when age is combined with other factors like a pre-existing condition, a prior complication, or a multiple gestation.
