Getting pregnant at 40 is more common than ever, and most women who do will have healthy pregnancies and healthy babies. But 40 does mark a real shift in both fertility and pregnancy risk. The chances of conceiving naturally drop, the odds of complications like gestational diabetes and preeclampsia roughly double, and miscarriage rates climb significantly. None of that means pregnancy at 40 is unsafe, but it does mean the experience will likely involve more monitoring, more testing, and more honest conversations with your care team than it would have a decade earlier.
Your Odds of Conceiving at 40
About half of women who want to conceive at age 40 will get pregnant naturally. That’s a meaningful number, but it drops quickly: by 42 or 43, only about 20 to 25 percent will conceive on their own, and by 45, natural pregnancy is rare. The decline is driven by egg quality and quantity, both of which fall sharply in the late 30s and early 40s.
If natural conception doesn’t happen within a few months, fertility treatment is a common next step. IVF success rates using your own eggs at 38 to 40 hover around 30 percent per cycle, which is lower than for younger women but still viable. After 41, the picture changes more dramatically: live birth rates from IVF drop to roughly 12 percent per cycle. Using donor eggs from a younger woman significantly improves those odds, which is why many fertility specialists raise the topic early for patients in their early 40s.
Miscarriage Risk Rises Sharply
This is one of the hardest realities of pregnancy at 40. In the 40 to 44 age range, roughly half of confirmed pregnancies end in miscarriage. For comparison, the rate for women in their late 20s is about 12 percent. The primary driver is chromosomal abnormalities in the embryo, which become more common as eggs age. Many of these losses happen early, sometimes before a woman even realizes her period is late, but they can also occur later in the first trimester.
The risk of stillbirth (loss after 20 weeks) also increases. One large study found the rate of fetal death was about four times higher for women 40 and older compared to younger mothers, at roughly 2 percent versus 0.5 percent. This is one reason providers often recommend closer monitoring in the third trimester and may suggest delivery before your due date rather than waiting for labor to start on its own.
Chromosomal Differences and Screening
At age 40, the chance of having a baby with Down syndrome is approximately 1 in 100. At 35, it’s about 1 in 400, and at 25, it’s 1 in 1,250. The increase is real but worth putting in context: a 1 in 100 chance still means 99 out of 100 pregnancies at that age will not have Down syndrome.
You’ll be offered prenatal screening options, and it’s worth understanding what’s available. A simple blood draw as early as 10 weeks can screen for the most common chromosomal conditions with high accuracy. If you want a definitive answer rather than a probability estimate, diagnostic tests like amniocentesis or chorionic villus sampling can provide one. These carry a very small risk of miscarriage, so the decision is personal. A genetic counselor can walk you through the numbers specific to your situation and help you think through what information you want and when.
Pregnancy Complications to Expect Monitoring For
Compared to younger mothers, women 40 and older face roughly double the risk of several common complications. In one large study, gestational diabetes affected about 14.5 percent of mothers over 40, compared to 6.9 percent of younger women. Preeclampsia, a dangerous blood pressure condition, occurred in 4.6 percent versus 1.5 percent. Gestational hypertension followed a similar pattern at about 3.1 percent versus 1.1 percent.
Preterm birth (delivery before 37 weeks) is also more likely, at roughly 10 percent for mothers over 40 compared to about 6.5 percent for younger women. These aren’t certainties by any stretch, and your individual risk depends heavily on your overall health going in. A woman who is 40, physically active, at a healthy weight, and has no chronic conditions will have a very different risk profile than someone the same age with high blood pressure or diabetes.
Because of the elevated preeclampsia risk, the American College of Obstetricians and Gynecologists recommends daily low-dose aspirin during pregnancy for women 35 and older who have at least one other moderate risk factor, such as being a first-time mother or carrying extra weight. Your provider will also likely order a detailed anatomy ultrasound and a third-trimester growth scan to check that the baby is growing on track.
Cesarean Delivery Is More Common
In 2022, 53 percent of women 40 and older delivered by cesarean section. That’s roughly double the rate for women in their late 20s. Part of this reflects the higher rates of complications like preeclampsia and gestational diabetes, which can make vaginal delivery riskier. Part of it is that labor itself tends to progress differently with age, with higher rates of induction and a greater likelihood that induction leads to a surgical delivery rather than a vaginal one.
A planned cesarean and an emergency cesarean are very different experiences. If your provider anticipates the need early, a scheduled cesarean is a calm, controlled procedure with a recovery period of roughly six weeks. An unplanned one during labor carries more stress and slightly higher complication rates. Understanding this likelihood ahead of time helps you prepare mentally and practically, whether that means arranging extra help at home or discussing birth preferences with your care team.
What You Can Do Before Conceiving
Your health going into pregnancy matters more at 40 than it does at 30, because you have less margin. If you’re actively planning, a few steps are worth taking before you conceive. Get screened for diabetes if you’re overweight or have risk factors like high blood pressure. Have your blood pressure checked and your thyroid function tested. Standard infectious disease screening for hepatitis B and syphilis is recommended for all pregnancies.
Start a prenatal vitamin with folic acid at least a month before you try to conceive, ideally three months. If you smoke, stopping before conception makes a measurable difference in both fertility and pregnancy outcomes. The same goes for cutting back on alcohol. Getting to a stable, healthy weight before pregnancy reduces the risk of gestational diabetes, preeclampsia, and cesarean delivery, all of which are already elevated at 40.
If you’ve been trying for three to six months without success, most reproductive specialists recommend evaluation at that point rather than waiting the full year that’s typically advised for younger women. Time matters more after 40, and early assessment can reveal issues like low ovarian reserve that affect your options going forward.
The Bigger Picture
Pregnancy at 40 carries higher risks than pregnancy at 30. That’s a biological fact, and no amount of good health or positive thinking changes it entirely. But “higher risk” is not the same as “unsafe.” The vast majority of women over 40 who become pregnant will deliver healthy babies, especially with the level of monitoring that’s now standard for this age group. The risks are real, they’re manageable, and they’re well understood by modern obstetric care. What makes the difference is going in informed, getting early and consistent prenatal care, and being prepared for a pregnancy that may require more flexibility than you originally imagined.