Yes, it is safe to have a baby at 40, though the risks are higher than in your 20s or 30s and the pregnancy will likely involve more monitoring. Thousands of women do it every year. The U.S. birth rate for women aged 40 to 44 reached 12.7 per 1,000 in 2024, and that number has been climbing steadily. Having a baby at 40 is more common than ever, but it helps to understand exactly what changes and what you can do about it.
Getting Pregnant Takes Longer
The biggest shift at 40 is fertility. A healthy 40-year-old has roughly a 5% chance of conceiving naturally in any given menstrual cycle, compared to about 20% for a woman in her early 30s. The reason is straightforward: you’re born with all the eggs you’ll ever have, and both the number and quality decline with age. Fewer eggs remain, and a higher proportion carry chromosomal errors that prevent a viable pregnancy.
This doesn’t mean natural conception is impossible. It means it often takes longer, and some women will need help. IVF success rates are lower at 40 than for younger women. In one large study of over 1,000 IVF cycles in women 40 and older, the pregnancy rate per cycle was 11.3%, compared to 28.2% in women under 40. After three IVF cycles, about 21% of women 40 and older took home a baby. Success drops sharply past 42, and past 45, live births with a woman’s own eggs are extremely rare. Using donor eggs from a younger woman significantly improves those odds.
Miscarriage Risk Increases
About 32% of pregnancies in women in their early 40s end in miscarriage. For comparison, the rate is around 10 to 15% for women in their 20s. Most of these losses happen in the first trimester and are caused by chromosomal abnormalities in the embryo, not by anything the mother did or didn’t do. The same decline in egg quality that makes conception harder also makes early pregnancy loss more likely.
This is one of the hardest realities of pregnancy at 40. It’s worth being emotionally prepared for the possibility, especially if you’ve been trying for a while. Many women who miscarry at 40 go on to have successful pregnancies afterward.
Chromosomal and Genetic Risks
The chance of having a baby with Down syndrome rises significantly with maternal age. At 25, the odds are about 1 in 1,250. At 35, they’re about 1 in 400. At 40, they’re approximately 1 in 100. That still means 99 out of 100 pregnancies at 40 will not involve Down syndrome, but the jump is large enough that prenatal screening becomes an important conversation.
You’ll typically be offered two types of testing. Screening tests, like a simple blood draw called cell-free DNA screening or a combination of blood work and ultrasound, can estimate the likelihood of chromosomal conditions without any risk to the pregnancy. If screening suggests a higher chance, diagnostic tests like amniocentesis or chorionic villus sampling can give a definitive answer, though they carry a small risk of miscarriage (less than 1%). These tests are optional. You can pursue them, decline them, or do screening first and decide about diagnostic testing later.
What Prenatal Care Looks Like at 40
Expect more appointments and more ultrasounds than a younger pregnant woman would typically have. Guidelines from the American College of Obstetricians and Gynecologists recommend a first-trimester ultrasound to check for twins (which are more common at this age, even without fertility treatment) and a detailed anatomy scan to look for structural issues. For women 40 and older specifically, a third-trimester growth scan is also recommended because babies are more likely to be either unusually large or unusually small.
The extra monitoring isn’t a sign that something is wrong. It’s a way to catch potential problems early when they’re most treatable. Many women at 40 sail through pregnancy with no complications. The monitoring is there as a safety net.
Higher Odds of a C-Section
Nearly half of women aged 40 and older deliver by cesarean section. The national average across all ages is about 32%. Several factors drive this. Older mothers have higher rates of gestational diabetes, high blood pressure, and placenta problems, all of which can make vaginal delivery riskier. Labor itself is more likely to stall or progress slowly. And because the stillbirth risk rises slightly in the final weeks of pregnancy for women over 40, providers often recommend inducing labor a bit earlier than they would for a younger patient, which can also increase the likelihood of a C-section.
A C-section is major surgery with a longer recovery, typically four to six weeks before you feel close to normal. If you’ve had a previous C-section, that also affects your options for future deliveries. It’s worth discussing your birth preferences with your provider early, understanding what might change those plans, and knowing that a C-section, while not what most people hope for, is a well-established and generally safe procedure.
Pregnancy Complications to Be Aware Of
Beyond the chromosomal risks, pregnancy at 40 carries a higher chance of several conditions that affect your own health. Gestational diabetes, where blood sugar rises during pregnancy, is more common and is typically managed through diet changes, blood sugar monitoring, and sometimes medication. Preeclampsia, a dangerous rise in blood pressure, is also more likely and is one of the main reasons your blood pressure will be checked frequently throughout pregnancy.
The risk of stillbirth, while still low in absolute terms, is higher for women over 40 than for younger mothers. This is why many providers recommend closer fetal monitoring in the third trimester and may suggest delivering by 39 weeks rather than waiting for labor to start on its own. Delivering slightly early, when the baby is fully developed, reduces this risk without adding significant complications for the newborn.
What Works in Your Favor
Statistics describe populations, not individuals. A healthy 40-year-old who doesn’t smoke, maintains a normal weight, manages any chronic conditions, and gets early prenatal care has meaningfully better odds than the averages suggest. Many of the complications associated with age are also associated with conditions like obesity, diabetes, and high blood pressure, which aren’t universal at any age.
There are also real advantages to having a baby later. Women in their 40s tend to be more financially stable, more emotionally prepared, and more likely to have strong support systems. Research consistently finds that children of older mothers do well on measures of health, cognitive development, and emotional well-being. The decision to have a baby at 40 involves tradeoffs, but higher biological risk is only one part of a much larger picture.
Starting prenatal vitamins with folic acid before you conceive, getting any chronic health conditions well controlled, and establishing care with a provider experienced in pregnancies over 35 are the most practical steps you can take to tilt the odds further in your favor.