What's the evidence for: Risks (and benefits?) during first pregnancy at age 35 and older?

In the scientific literature pregnant women above 35 are classified as 'elderly'. Something along the lines of 'don't wait too long with getting children' is a typical advice voiced towards aspiring mothers. But do the risks during pregnancy at older age really warrant hastening your baby ambitions and rightly worry when you reach or go over that magical (perhaps much dreaded) barrier of 35 of age for a first pregnancy?

Let's find out!

First of all, are the pregnancy risks associated with older age substantiated by scientific evidence?

Unfortunately, yes, most of known health risks (Down syndrome, miscarriage, stillbirth, gestational diabetes, maternal death, etc) during pregnancy do increase with age. So there you have it? Well maybe, but let's dive in a bit deeper on what these increased risks entail and how these relate to possible benefits.

Are there any benefits from having your first child between 35 and 40 years of age?

'Sort of' is the short answer. Older moms tend to be (slightly) more happy after birth compared to younger mothers. Perhaps because nowadays older moms tend to be better off financially and thus may alleviate stress by having more resources and financial flexibility at their disposal. 

There is also an interesting argument to make that benefits might arise in the following way: the further in the future your kid is born, the more scientific and technological advances we'll have achieved in health, well-being and medicine with this astonishing rate of innovation at the moment. This alone might already outweigh the increased risks at older age?

Ok, but so what are the increased risks exactly?

Roughly for a 40 year old mom in a first pregnancy these are the probabilities:

Down syndrome : 1 in 100

Miscarriage (1, 2) : 40 in 100

Stillbirth : 8 in 1,000

Diabetes (Mellitus / Gestation) : 30 in 1,000

Twins : 46 in 1,000

Maternal death: 2 in 10,000

The chances on a miscarriage stand out of course with a whopping 40 in 100. Unfortunately even at a younger age there's still a very substantial chance (18 in 100 at age 30) of having a miscarriage. A very sad reality that many pregnant women have to go through regrettably.

But for the other risks this is where it gets tricky. I would argue that these risks are still very acceptable to take (even though they increased compared to a younger mother-to-be). However this is where individual sensitivity for risk comes in. Everyone will have a different threshold when a certain risk is still acceptable and when it isn't. Framing the risks very explicitly like above might help to judge for everyone themselves if these risks are still acceptable or not. But in the end it's up to every individual of course to weigh up these risks and potential benefits and decide what's best.

Let's not forget though that for most people they are not in the privileged position to have a choice to begin with about when to have a child. So especially for this group that doesn't have a choice about when to get pregnant –so most of us I would argue– it might be helpful to recognise it's not all doom and gloom reaching a more mature age in spite of the fact that in the literature and media older women tend to be consistently categorised as 'elderly'.

The bottom line is that most women will go on delivering healthy babies in this day and age, especially in The Netherlands. Also if you're 40.