Many women today choose to delay child bearing until later in life. Number of women over 40 having a baby has increased fourfold in the last 30 years. The reason the motherhood is postponed are many forth and complex. The reasons may include availability of safe and effective contraceptives, building a carrier, to perceive further education, to achieve financial independence or to be in a stable relationship with a supportive partner or so on. Even after 40’s many pregnancies will result in a normal healthy baby. However, adverse pregnancy outcomes are also raised with age and women over 40 years considered to be at a higher risk of pregnancy complications. Women need to know how fertility outcome change with age. Biologically the optimum age for child bearing is between 20 and 35. As the maternal age increases the fertility rate decreases. Not only the number of eggs but also the quality of the eggs. These eggs are more likely to have structural abnormalities i.e. chromosomal abnormalities. The X-linked chromosomal abnormalities causes increased risk of miscarriage and birth defects. Most common abnormality is Down syndrome. The risk of mother getting a Down syndrome baby after the age of 40 is 1 in 100. Also there is increased risk of babies born with other significant malformations like heart problems, kidney problems and other organ related conditions. All women are offered screening test for genetic conditions such as Down syndrome, Trisomy 18 and Trisomy 13. Other diagnostic tests available are Chorionic villus biopsy, amniocentesis and NIPT. NIPT is a test from the maternal blood which is known as Non Invasive Prenatal Testing. Women who are above the age of 40 have increased risk of gestational diabetes, high blood pressure, preeclampsia, pre term labour, pre term delivery and placental problems, low birth weight infants. Mal presentation and foetal distress are also common in these women. Women with pre-existing medical conditions like diabetes, hypertension may worsen during pregnancy after the age of 40. Diabetes increase the risk of developing birth defects also. Pregnant women over 40 are up to 3 times more likely to need a caesarean section. Regarding autism the maternal age does not appear to be a factor but the father’s age can. The risk of autism increases to babies born to fathers over 40 years. Unfortunately we have no way to test the foetus of autism.

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