Rethinking advanced maternal age pregnancy

Expectant mothers may be surprised to hear their maternal age described as “advanced.” They may think advanced age starts around 65, 70, or older. Advanced maternal age (AMA), meanwhile, describes age at delivery of 35 or older. 

But the AMA designation has become common as more people have children later in life. Consider the mean age for first-time mothers in the United States. It was 27.3 in 2021, up from 25.6 in 2011, according to the Centers for Disease Control and Prevention (CDC). By contrast, it was 21.4 in 1970. As the trend continues, more intensive prenatal care can support better outcomes for both mothers and their babies. 

A change in thought regarding pregnancy at age 35+

Although maternal age is considered advanced starting at 35, this age isn’t a hard deadline for a healthy pregnancy. Rather, pregnancy risks begin to increase around this time. Some of these risks for the mother, baby, or both include:

• Pregnancy complications such as gestational diabetes or high blood pressure/preeclampsia 
• Premature birth or low birth weight
• Miscarriage and stillbirth 
• Chromosomal conditions such as Down Syndrome 

In addition, older mothers are more likely to have Cesarean (C-section) deliveries. The overall C-section rate in the United States is about one in three (32.1%). The rate is highest for women 40 and older, at nearly half (47.5%).

More pregnancy-related provider visits result in more specialized care

If a mother will be 35 or older on the due date, an obstetrician-gynecologist (OB-GYN) may want to observe the pregnancy more closely. That means more prenatal visits and screenings, which may include: 

• Ultrasound scans
• Fetal surveillance
• Genetic testing

The patient, especially if older than 40, may see a perinatologist, or maternal-fetal medicine (MFM) specialist. This is an OB-GYN who specializes in high-risk pregnancies. The patient may also deliver at a center that specializes in high-risk pregnancies.

A plan should be prepared to support the number of visits needed to observe the pregnancy, as well as other prenatal care needs that arise. 

Study shows impact of high-quality prenatal care for patients aged 35 and over 

Prenatal care can help improve pregnancy outcomes. This was the finding of a 2021 study published in the JAMA Health Forum. It looked at claims data of more than 50,000 mothers who were within 120 days of turning 35 on their delivery date, either younger or older.

• Patients, while roughly the same age, may have received different prenatal care based on their AMA designation.
• Patients younger than 35 may have had fewer prenatal services, while patients older than 35 may have had more prenatal care services.

The study found the patients who received more prenatal care services had better rates of fetal and infant survival. Beyond screenings, the prenatal visit is also an opportunity for the provider to share information to help the patient have a smooth pregnancy. The provider may give these suggestions: 

• Make positive changes for healthier living. These can include eating a more nutritious diet and getting regular physical activity.
• Treat any conditions that could cause pregnancy complications. 
• These conditions may be physical or mental. They may have existed before pregnancy or develop during pregnancy.

Plan sponsors play a role in providing proper pregnancy care 

With maternal age at an all-time high, plan sponsors should consider comprehensive prenatal care coverage for 35+ mothers. But they should also think about benefits they may offer for pregnancies in general. Here are a few questions they may ask to improve their women’s health benefit for affordability and health outcomes:

• Does the plan cover non-invasive prenatal testing (NIPT)? These blood tests can show risk for chromosomal conditions.
• Does the plan cover NIPT for patients of any age, or just those 35 and older?
• Given the findings of the JAMA study, what level of prenatal care can patients expect? Does prenatal care coverage change based on the patient’s age? 
• How does the plan cover C-section delivery? 
• How does the plan cover maternity services? These may range from pelvic floor therapy to breastfeeding support to postpartum mental health treatment.

Related: Comprehensive coverage for building families

Advances in care have made it possible for older mothers to have more predictable, comfortable pregnancies with better outcomes. Plan sponsors should focus on benefits that support pregnancies at any age.