Pregnancy at 40 can be both a joyful and complex journey. Advances in fertility treatments and prenatal care have made it possible for many people to conceive and deliver healthy babies later in life.

However, being pregnant at 40 also comes with increased health risks for both you and your baby — including a higher likelihood of gestational diabetes, preeclampsia, genetic conditions, and miscarriage.

This guide will help you understand these risks, what causes them, and how you can prepare for a healthy pregnancy at 40 and beyond.

Understanding the Risks of Pregnancy at 40

Pregnancy after 40 is considered high-risk, meaning there’s a greater chance of complications that need close monitoring. But “high-risk” doesn’t mean “unsafe.” With proper care, most people can still have healthy pregnancies and babies.

Before trying to conceive, talk to your healthcare provider about your fertility status, hormone levels, and any underlying medical conditions.

C-Section Delivery Risk

People over 40 are statistically more likely to need a cesarean section (C-section).

A C-section is a surgical procedure where the baby is delivered through an incision in the abdomen and uterus.

While safe and common, it’s still a major surgery that can lead to:

  • Increased blood loss

  • Higher risk of infection

  • Blood clots or slow healing

Those who conceive via in vitro fertilization (IVF) or carry twins are at an even higher risk of requiring a C-section.

Older individuals also have reduced uterine elasticity and may experience slower labor, which contributes to this increased likelihood.

Genetic Abnormalities and Egg Quality

As you age, your eggs undergo natural changes. After age 35, and especially by 40, chromosomal abnormalities become more common.

This can lead to conditions like Down syndrome (Trisomy 21) or other genetic variations.

  • In your 20s, the chance of having a baby with Down syndrome is 1 in 1,480.

  • At 40, the risk rises to 1 in 85.

  • After 45, it’s approximately 1 in 35.

These risks occur because older eggs are more prone to DNA errors during cell division.

Genetic testing, both before and during pregnancy, can help identify potential chromosomal issues early. Options include:

  • Preimplantation Genetic Testing (PGT) for those using IVF

  • Noninvasive Prenatal Testing (NIPT) through blood tests

  • Amniocentesis or chorionic villus sampling (CVS) for diagnostic confirmation

Gestational Diabetes and Preeclampsia

Two of the most common complications of pregnancy at 40 are gestational diabetes and preeclampsia.

Gestational diabetes happens when hormonal changes make it harder for your body to regulate blood sugar.

  • It affects about 8.5% of pregnant people over 40 — more than double the rate of those under 35.

  • It can lead to high birth weight and increase the need for a C-section.

Preeclampsia involves dangerously high blood pressure that can harm both the parent and baby.

  • It can develop suddenly, even in someone previously healthy.

  • Symptoms include headaches, swelling, blurred vision, and upper abdominal pain.

Both conditions can usually be managed with close prenatal monitoring, lifestyle changes, and medication when needed.

Miscarriage Risk

The risk of miscarriage increases with age due to decreased egg quality and hormonal fluctuations.

  • At 20, the miscarriage rate is about 10%.

  • In your 40s, that number rises to around 50%–53%.

A miscarriage is typically defined as a pregnancy loss before 20 weeks. It often occurs before someone even realizes they are pregnant.

While heartbreaking, miscarriage is very common and usually not caused by anything you did or didn’t do.
If it happens, emotional recovery is just as important as physical healing. Counseling and support groups can help you process the loss and move forward when you’re ready.

Premature Birth and Birth Weight Concerns

Older parents are more likely to experience preterm delivery — giving birth before 37 weeks.

Premature babies often grow up healthy, but they can face short-term or long-term challenges, such as:

  • Breathing and feeding difficulties

  • Cerebral palsy (CP) or developmental delays

  • Hearing and vision problems

In addition, older parents face higher chances of:

  • Fetal growth restriction (17%) — the baby grows slower than expected.

  • High birth weight (15%) — over 9 pounds, which can lead to difficult deliveries or C-sections.

Both extremes — too small or too large — can affect newborn health. Prenatal ultrasounds help detect these issues early for proper intervention.

Fertility Challenges at 40

At age 40, your chance of conceiving naturally is about 44%, compared to 85% at age 30.
By 45, it becomes less than 5%.

This decline is due to both quantity and quality of remaining eggs. Women are born with all the eggs they will ever have, and over time, this supply diminishes.

Eggs also accumulate genetic mutations and DNA damage, which can reduce fertilization and implantation success.

However, with modern fertility treatments, pregnancy after 40 is more achievable than ever.

Fertility Treatment Options After 40

If you’re having trouble conceiving naturally, your healthcare provider may recommend:

  • Fertility medications like clomiphene to stimulate ovulation

  • Intrauterine insemination (IUI), where sperm is inserted directly into the uterus

  • In vitro fertilization (IVF) using your own eggs or donor eggs

  • Surrogacy or gestational carriers, for those unable to carry a pregnancy

IVF success rates decrease with age:

  • Ages 41–42: about 12% live birth rate per cycle

  • Ages 43–44: about 5%

  • Using donor eggs: up to 51% success rate

Egg quality matters most, so donor eggs from younger individuals significantly improve outcomes.

Why Fertility Declines With Age

Fertility decreases due to:

  • Fewer eggs remaining (diminished ovarian reserve)

  • More chromosomal abnormalities in eggs

  • Hormonal changes affecting ovulation consistency

  • Reduced uterine receptivity

These natural changes make conception and healthy implantation more difficult.

Still, maintaining a healthy lifestyle — managing weight, avoiding smoking, and optimizing nutrition — can support fertility.

Are There Benefits to Pregnancy at 40?

Absolutely. Pregnancy in your 40s can bring emotional, social, and financial advantages.

Key benefits include:

  • Greater emotional maturity and life experience

  • More financial stability to support a child

  • Improved career flexibility and personal readiness

  • Higher educational success among children born to older parents

  • Stronger long-term health and cognitive benefits in older mothers

Research even suggests that later pregnancy may correlate with longer lifespan and sharper cognitive function in women.

How To Prepare for Pregnancy at 40

Preparation is essential to minimize risk and improve outcomes. Begin by meeting with an OB-GYN or fertility specialist before trying to conceive.

1. Get a Preconception Health Check

Your doctor may recommend:

  • Blood tests for hormone levels (AMH, FSH)

  • Thyroid and blood sugar screenings

  • Review of current medications

  • Updates on vaccines

  • Assessment of chronic conditions (like hypertension or diabetes)

2. Consider Egg Freezing or Genetic Testing

If you’re planning for the future, egg freezing (cryopreservation) in your 20s or 30s can preserve younger, healthier eggs.

The process involves:

  • Taking hormone injections to stimulate egg production

  • Extracting and freezing mature eggs

  • Optionally performing genetic testing (PGT) before freezing

Costs can range from $10,000–$17,000 per cycle, with annual storage fees.

3. Focus on Prenatal and Lifestyle Care

Once pregnant, consistent prenatal care becomes your greatest tool for a healthy pregnancy.
Research shows that women over 40 who receive early prenatal monitoring have outcomes similar to those of younger mothers.

Recommendations include:

  • Eat nutrient-dense meals rich in iron, folate, and omega-3s

  • Stay active with low-impact exercise like walking or swimming

  • Avoid alcohol, smoking, and caffeine

  • Keep stress levels in check with yoga, meditation, or gentle stretching

  • Take prenatal vitamins and folic acid before conception to prevent birth defects

Maintaining Emotional Well-Being

Pregnancy at 40 can be emotionally taxing — balancing excitement with anxiety about risks and outcomes.

Consider:

  • Joining support groups for older expectant parents

  • Seeking therapy or counseling for fertility stress

  • Talking openly with your partner about expectations and fears

Mental health plays a major role in pregnancy wellness and postpartum recovery.

The Bottom Line

Being pregnant at 40 comes with higher risks — but also incredible possibilities.
While fertility naturally declines and certain complications become more likely, modern prenatal care, lifestyle management, and early intervention make healthy pregnancies entirely possible.

Consult your OB-GYN before conception, stay consistent with check-ups, and prioritize both physical and emotional well-being.

With preparation, awareness, and support, pregnancy at 40 can be a safe and deeply rewarding experience.