Podcast Summary: The OB/GYN Resident Survival Guide

Episode #16: Advanced Maternal Age: Risks & Recommendations

Host: Dr. KC Miller
Date: January 17, 2026

Main Theme & Purpose

This episode offers a high-yield, evidence-based overview of “Advanced Maternal Age” (AMA)—defined as pregnancy at age 35 or older at delivery. Dr. KC Miller discusses the clinical risks for both the mother and fetus, counseling strategies, and best practice recommendations, focusing on actionable insights for OB/GYN residents and medical students preparing for clinical rotations or exams.

Key Discussion Points & Insights

1. Defining Advanced Maternal Age and Its Growing Relevance

Definition: Maternal age ≥35 years at time of delivery (01:09)
- “If a 34 year old patient comes in for a new OB visit and her birthday will be before delivery or her estimated due date, she would still fall into that category.” — Dr. KC Miller [01:13]
Increasing Prevalence:
- AMA pregnancies have risen since 2000; by 2020, 19% of US pregnancies were in women age 35 or greater. (01:30)
Clinical Importance:
- Increased risks in morbidity and mortality in AMA, making it a key focus for OB providers.

2. Risks Associated with Advanced Maternal Age

A. Maternal Risks (02:10)

Higher incidence of:
- Gestational diabetes
- Gestational hypertension
- Preeclampsia
- Postpartum hemorrhage
- Labor dysfunction
- Cesarean delivery
- Multiple gestation (attributed partly to increased use of ART)
Notable Quote:
- “These patients are also more likely to experience multiple gestation pregnancies like twins, and this is probably because of the increased utilization of assisted reproductive technologies.” — Dr. KC Miller [02:46]

B. Fetal Risks (03:00)

Increased likelihood of:
- Spontaneous abortion
- Intrauterine fetal demise
- Congenital and chromosomal abnormalities
- Abnormal fetal growth
- Preterm birth
- Low neonatal birth weight
Risks intensify with advancing maternal age (example: chromosomal abnormality risk much higher at 50 than at 35).

3. Approach to Counseling and Risk Mitigation

A. Preconception Counseling (04:05)

Optimal time for risk discussion: annual gynecology exams or contraception counseling.
Focus on:
- Identifying modifiable risk factors: obesity, diabetes, hypertension.
- Lifestyle modifications to optimize outcomes.
Key Insight:
- “Age isn’t really a modifiable risk factor…what we can do is, one, inform them of the risks of being in the AMA category, and, two, probably more importantly, is identify other risk factors that are modifiable…” — Dr. KC Miller [04:40]
Sometimes, significant comorbidities may prompt discussion that pregnancy isn't advisable.

B. Antenatal Interventions (05:23)

Low-dose aspirin for preeclampsia prevention if other moderate risk factors exist (start at 12–16 weeks).
Antenatal fetal surveillance: consider NSTs.
Consider induction at 39 weeks for patients expected to be 40 or older at delivery—though evidence supporting this is limited and institutional protocol varies.
Routine protocols/intervention: (06:10)
- First trimester ultrasound
- Detailed anatomy scan
- Consider repeat growth US in third trimester
- Offer genetic screening/diagnostic testing

Notable Quotes & Memorable Moments

“Age isn’t really a modifiable risk factor… However, if someone is 37 and they want to get pregnant now, it’s not like they can just rewind the clock.” — Dr. KC Miller [04:38]
“When they do become pregnant, let them know how their age may impact their pregnancy and what interventions can be offered to potentially optimize outcomes.” — Dr. KC Miller [06:42]

Timestamps for Key Segments

Definition & Epidemiology: 01:09–01:30
Maternal Risks: 02:10–02:55
Fetal Risks: 03:00–03:40
Preconception Counseling: 04:05–04:57
Antenatal Interventions & Surveillance: 05:23–06:30
Recap & Practical Takeaways: 06:42–07:15

High-Yield Clinical Pearls

Always clarify and document patient’s age at delivery when assessing for AMA status.
Preconception optimization (addressing weight, diabetes, hypertension) remains essential for improving outcomes.
Use risk-based models and institutional protocols to guide interventions (e.g., aspirin, induction timing, third-trimester U/S).

Practical Takeaways for Residents & Students

Proactively counsel all women ≥35 about AMA-associated risks and strategies to minimize them.
Leverage preconception visits to optimize modifiable risk factors.
Follow institutional guidelines for surveillance and interventions, and individualize care as appropriate.

References and further resources are available in the show notes, as well as Dr. KC Miller’s OB GYN Residency Starter Pack for new and aspiring residents.

Transcript

A (0:00)

Welcome back to another episode of the OB GYN Resident Survival Guide. Before I jump in, I wanted to remind you about a free resource that I created last year called the OB GYN Residency Starter Pack. It's a short PDF with some tips and links to help freshen up your skills before day one of residency. I know Match Day is still a few months away, but I also know many of you still have a couple of sub I's to complete and or are just trying to manifest for the match. So the link for that is in the show notes and I hope it's helpful. I think it has been. I just realized this week that over a thousand people have downloaded this resource, so go check it out. All right, let's jump in. Advanced maternal age is defined as a maternal age of 35 years or greater at the time of delivery. So if a 34 year old patient comes in for a new OB visit and her birthday will be before delivery or her estimated due date, she would still fall into that category. Now why is this topic relevant? The average maternal age has been rising globally since about the year 2000, and by 2020, about 19% of all pregnancies in the United States were in women age 35 or greater. So we as obstetricians are regularly managing patients in this age group, which means that we of course need to know what's relevant to them and how to counsel them. This is important because there is evidence to suggest that greater disparities in morbidity and mortality exist within the AMA population when compared with younger moms. So patients need to be aware about how their age can impact their pregnancy and also what can be done to optimize their prenatal course and delivery. So let's talk about the risks, and I'm going to break them down into maternal and fetal risks. For the mother, being AMA increases the risk of developing gestational diabetes, gestational hypertension, preeclampsia, postpartum hemorrhage, labor dysfunction, and need for delivery by cesarean. These patients are also more likely to experience multiple gestation pregnancies like twins, and this is probably because of the increased utilization of assisted reproductive technologies, or art, in this age group. For the fetus, there is an increased risk of spontaneous abortion, intrauterine fetal demise, congenital and chromosomal abnormalities, abnormal fetal growth, preterm birth, and low birth weight of the neonate. It is important to know that most of these outcomes become more likely with increasing age. For example, the risk of having a genetically abnormal fetus at the age of 50 is going to be much greater than at the age of 35. So what can we do about this? Like many things, a discussion about this can be had optimally in the preconception period. So when a patient comes in for their annual gynecology exam or even for contraception counseling, it's a great time to inquire if they intend to conceive a pregnancy in the near future. And in these visits, you're not only paying attention to their age, but also other comorbid conditions. Unfortunately, age isn't really a modifiable risk factor. Of course, you can counsel your younger patients about how deferring pregnancy could lead to fertility challenges and also the risks of being in the AMA category. However, if someone is 37 and they want to get pregnant now, it's not like they can just rewind the clock. So what we can do is one, inform them of the risks of being in the AMA category and, and two, probably more importantly, is identify other risk factors that are modifiable like obesity, diabetes and hypertension, and encourage lifestyle changes so that when they do decide to conceive, they are optimized for the best possible outcome given the circumstances. And sometimes, depending on those comorbidities, there will be conversations about how pregnancy is actually not advisable. And because of the compounding risk factors that are present, the next opportunity you'll have to counsel these patients is at a new OB visit. So a patient is 35 or greater, they're already pregnant and they're coming to establish prenatal care with you or are visiting you for a routine follow up visit. So again, it's important to review how being AMA can impact the pregnancy. But we can also offer certain interventions that can be utilized to mitigate some of these risks. For example, the initiation of low dose aspirin for preeclampsia prevention if they have one or more other moderate risk factor, ideally being started between 12 to 16 weeks of gestation. We can also offer antenatal fetal surveillance with NSTS and consider induction of labor at 39 weeks in patients expected to be 40 years or greater at the time of delivery, although there isn't excellent evidence to support the last two because there may be some benefit. Usually there will be some sort of institutional protocol or guidelines lines to follow, supported by the maternal fetal medicine group at your institution. It's also recommended that we provide the following interventions for these patients. However, these generally are standard across the board regardless of whether or not you're in the AMA category or not, such as a first trimester ultrasound a detailed anatomy scan to assess for fetal anomalies considering a repeat growth ultrasound in the third trimester. Again, that's usually institution dependent. And then of course, offering genetic screening and diagnostic testing. All right, that's it for today. Here is a quick recap. Advanced maternal age increases the maternal risk of developing gestational diabetes, hypertensive disorders in pregnancy, postpartum hemorrhage, labor dysfunction, delivery by cesarean and multiple gestation pregnancies. For the fetus, there's an increased risk of spontaneous abortion, fetal demise, congenital and chromosomal abnormalities, abnormal fetal growth, preterm birth and low neonatal birth weight. It's important to identify modifiable risk factors in the preconception period so that your patients have a chance to optimize their health before becoming pregnant. And when they do become pregnant, let them know how their age may impact their pregnancy and what interventions can be offered to potentially optimize outcomes. As usual, references are listed in the show notes, as is the link to download the OB GYN Residency Starter Pack. See you next week.