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.