This seems like a happy story—and it is. But if I hadn’t internalized mountains of “you better get on it before it’s too late” advice, I would have saved myself a lot of anxiety during an already physically and emotionally fraught period. Just seeing the words “elderly primigravida”—AKA elderly first pregnancy-on my medical forms made my toes curl. These types of terms are not only offensive to birthing people over 35, but also not always accurate in pinpointing medical problems. Yet much of the medical community still insists on using them. “The problem with [these terms] is that [they make] women believe that all of a sudden, poof, magically at 35, things are different, when that’s not true,” says Somi Javaid, MD, an OB/GYN, sexual health specialist, and founder of HerMD. “These terms are offensive, and oftentimes, they scare people.” We looked into why these terms exist in the first place, why they’re actually pretty harmful, and what we should be saying instead.
Why Did We Start Using the Terms “Geriatric Pregnancy” and “Advanced Maternal Age?”
Dr. Javaid says the term “advanced maternal age”—which is sometimes used interchangeably with “geriatric pregnancy”—was coined in the 1970s, when giving birth at age 35+ started to become more common with people delaying childbearing to pursue careers. At that time, doctors started offering pregnant patients amniocentesis, a procedure that involves placing a needle into the abdomen to sample a small amount of amniotic fluid in order to test for chromosomal conditions, such as Down syndrome, but is sometimes associated with risks of miscarriage. However, age 35 is when the risk of having a baby with a chromosomal condition begins to outweigh the risk of a miscarriage as a result of amniocentesis, Dr. Javaid explains. “You would not subject a patient to a procedure that is riskier to her and her baby than the risk of the chromosomal abnormality.” But today, that risk-benefit calculation is considered outdated because amniocentesis has become a lot safer since the 1970s. This is just one of many reasons the “35 cutoff” is irrelevant; people can and do have successful pregnancies after that age.
What Age-Related Concerns Do Exist for Pregnant People?
Studies do show age-related concerns when it comes to pregnancy, which is why doctors offer more testing to pregnant patients who are 35+. As a patient gets older, the risk of complications—including ectopic pregnancy, fetal chromosomal conditions, placenta previa and abruption, and preeclampsia—increases, as does the risk of miscarriage. However, these concerns tend to rise gradually over time, and not all at once at the age of 35. “It’s not like you snap your fingers, and at 35, your risk suddenly increases,” Dr. Javaid said. “That risk is minimally increasing every year.” And when it comes to fertility, there is no “nosedive” at 35 either. For example, one fertility study found that 78% of women ages 35 to 40 will conceive within a year, compared to 84% of women ages 20 to 34. A recent Harvard University study even found that pregnant people over 35 had better prenatal care and a lower rate of stillbirths and early newborn deaths. “[The terminology] doesn’t take into account someone’s environment and how delaying a pregnancy may be better because they may have more access to care, or the means to have the best nutrition—things they may not have had earlier,” Dr. Javaid says. “That’s not to say that a 21-year-old cannot have a very healthy pregnancy. But I think we really need to individualize care in this country and spend time with our patients, get to know them—not only their medical history, but what’s going on in their lives.”
How Terms Like “Geriatric Pregnancy” Can Be Psychologically Harmful
Sarah Oreck, MD, MS, an L.A.-based reproductive psychologist, says that when she first heard “advanced maternal age” and “geriatric pregnancy” in medical school, she was “appalled,” partly because she knew that she would fall into this category when she was ready to have children. She says she felt stigmatized for choosing to delay childbearing—and that these terms negatively affect her patients, too. “I find that these loaded, sexist, and ageist terms can be more harmful than helpful,” Dr. Oreck says. “Many of my patients over 35 are conditioned by this language to believe that they will struggle conceiving or experience a complicated pregnancy, that somehow their bodies are frail and won’t be capable of childbearing. Let’s present people…with all of their options, including preservation of their fertility via egg or embryo freezing, but without instilling fear that every 35+-year-old won’t be able to conceive or carry a pregnancy.”
What Should We Say Instead?
Dr. Javaid says that reforming the terminology starts with changing the content of textbooks and curricula in medical schools and residency programs. When Dr. Javaid was going through infertility treatments in 2009 at the age of 33, her uterine lining had thinned because of a medication she was taking. She says that her physician (who knew that she, herself, was a physician) told her, “Well, maybe your uterus is just too old.” Dr. Javaid recalls walking to her car, where she cried. What the doctor should have said instead, according to Dr. Javaid: “We’re giving you this medicine to help you get pregnant, and it can thin the lining.” As a result of her experience and those of others, Dr. Javaid now advocates on behalf of patients who are 35+, keeping in mind that no matter what age a birthing person is in this country, they are more likely to face discrimination if they are a person of color or have fewer economic means. Failing to listen to patients’ needs and continuing to use offensive language could result in harmful outcomes for many birthing people. “The last thing we want to do is scare women into not wanting to be a mom because they feel like they’re too old. [We also don’t want them to be] overly fearful during their pregnancy, or choose to do things that they don’t want to do, like have a baby earlier than they’re ready,” says Dr. Javaid.
A Word from Verywell
Doctors commonly use terms such as “advanced maternal age” and “geriatric pregnancy” for pregnant patients who are 35+. While the chances of conception decrease and the risks of complications increase with age, it’s important to know that these increases are gradual. For this reason, it’s important to stop treating 35 as a “cutoff”—and for medical professionals to retire these terms altogether. If your healthcare provider makes you feel uncomfortable because of your age, consider bringing this up with them or switching physicians. If you are struggling with your mental health during the conception, pregnancy, or postpartum period, consider seeing a counselor, therapist, or reproductive psychiatrist.
