First Response®
Karla Damus, RN, MSPH, PhD

PROS & CONS OF CONCEIVING IN YOUR 20's, 30's AND 40's
Q&A With Karla Damus, RN

Karla Damus sheds light on the pros and cons of conceiving
in your 20's, 30's and 40's.

Q: I am 26-years old and recently married. I'm afraid to wait much longer to start a family. Aren't these supposed to be my best child bearing years?

A: Here's the good news: Whether you're in your 20's, 30's or 40's there are advantages to conceiving at each age. However, there are disadvantages as well. The decision to get pregnant is influenced by many factors, each as varied as there are women.

Physically and physiologically in your mid-twenties you should be a prime candidate for pregnancy. Your eggs (which you have had since you were developing in your mother's womb) should be in peak condition and easily fertilized. Your bones and muscles are strong and should be able to handle the extra weight of pregnancy. Be very encouraged. At the same time, however, for the best pregnancy outcomes you need to consider your mental and emotional state as well as educational and professional goals, career plans and financial concerns. In your 20's, your life experiences are expanding and blossoming. You should carefully assess if you and your partner are ready to become parents, especially since you're in the early years of your marriage. At any age evaluating all these factors and making sure you are doing everything you and your partner can before you get pregnant is so important. It all starts with a reproductive health plan to have a timed, planned pregnancy when you and your partner are healthy.


Q: My mother says that if I wait until I am 35 to get pregnant, the odds of having a healthy baby drops significantly.

A: For women fertility potential begins to decrease in their late 20's and falls significantly by the mid-30's. So getting pregnant may take longer even if you're physically fit and have no medical issues. However, many women in their 30's experience no delay in conceiving. You should be mindful of an increased risk for pregnancy-related conditions like gestational diabetes high blood pressure and some problems with the placenta. You should also consider that statistically as you get older the chance that you will develop health problems increases and your health before and during pregnancy has a major impact on your developing baby.

Your mother may be referring specifically to the risk of having a baby with a chromosomal problem such as Down's syndrome. At age 30, the risk of Down syndrome is about one in 1,000 live births. At age 35, it's about one in 400. By age 40, the risk is about one in 100. For these reasons, 35 is the age doctors consider the start of "high-risk" pregnancy. But don't let the term frighten you. There are many tests to determine these risks and now they can be done very early in pregnancy so the sooner you know you are pregnant and get care, the better. If you follow a healthy regimen prescribed by your provider you will probably enjoy a normal pregnancy and a healthy baby as do the majority of women having babies in their 30's. In fact, 20% of women in the United States now have their first child after age 35.
Family Planning


Q: I'm 40 and not dating anyone, but I do have a friend who had her two children in her early 40's without any complications. What can I expect?

A: More women are giving birth in their 40's and although many have no problems complication rates are much higher. However, everyone is different so what you can expect will depend on many factors that you will determine with your health care provider. You should definitely be seen and assessed before you conceive and jointly develop a plan to make sure you are doing everything possible to reduce risks (e.g. taking folic acid daily, avoiding alcohol, tobacco, other drugs, being in the best health, etc). Following the advice of your health care provider increases every woman's chance for a healthy and safe pregnancy.

In your 40's, fertilization is at its lowest point and the risk of chromosomal abnormalities and miscarriage is at its highest. However, it is also true that some women seeking to conceive after age 40 have no difficulty getting pregnant and delivering healthy babies. Statistically the older the pregnant woman, the greater the chance that she will conceive multiples (twins or triplets) which is considered a high-risk pregnancy at any age. Also, you can expect more problems such as changes in your metabolism, more difficulty controlling weight gain and you may feel more fatigued than women who get pregnant at a younger age.

There are positives. In your 40's, you're more apt to be financially sound. Studies show that children of older parents have more advantages in terms of parental readiness and available time to spend with their children. Older parents tend to have fewer children, contributing to the improved resources enjoyed by these children. You have the confidence and ability to multi-task and prioritize a career, baby, marriage and life in general. These coping skills acquired through career and life experience make you a more tolerant, perhaps better mother than you might have been earlier in life.
Karla Damus, RN, MSPH, PhD Karla Damus, RN, MSPH, PhD
Karla Damus is the Senior Research Associate in the Office of the Medical Director at the National March of Dimes. There, she directs the National Prematurity Campaign Grand Rounds Program as well as the Healthy Babies are Worth the Wait Initiative in Kentucky. In addition, she is an Associate Professor and the Director of Community Programs and Public Health in the Department of Obstetrics & Gynecology and Women's Health at the Albert Einstein College of Medicine in New York City. Dr. Damus is a perinatal epidemiologist and a nurse, having received her PhD in Epidemiology from the University of California at Berkeley and two master's degrees from UCLA in Nursing and Public Health.