Healthy Science/ Nutritional Tips for Optimizing Pregnancy After 35

Nutritional Tips for Optimizing Pregnancy After 35

  • Research has established effective ways to maintain a healthy pregnancy into the 40s
  • Taking omega-3 fatty acids, especially DHA, can help optimize pregnancy outcomes
  • Emerging evidence indicates omega-3s can increase your chances of maintaining a viable pregnancy
  • Prenatal vitamins with active folate can increase the chances of normal fetal development

Much to the consternation of many pregnant women today, most of the information about pregnancy after 35 seems to center around the risks associated with “advanced maternal age” rather than a woman’s increasing odds of enjoying a healthy pregnancy into her 40s. What’s more, a lot of this information can make it seem like you did something vaguely wrong by opting to “delay” childbirth until you were ready. Hopefully that hasn’t been your experience, but if it has, rest assured that you will find no judgement or loaded language here. (We’re prepared to pretend the term “geriatric pregnancy” doesn’t exist if you are). 

While pregnancy in the late 30s and 40s does come with heightened risks, technological advancements in assisted reproduction and a greater understanding of factors affecting reproductive health are allowing many women over 35 to enjoy pregnancy outcomes similar to younger women.1,2

This article will discuss several key nutrients that research shows can help women over 35 achieve a healthy pregnancy outcome. For other helpful pointers, check out “Maintain a Healthy (and Happy) Pregnancy after 35”. (Also “geriatric pregnancy” free.)

Take your omega-3s—especially DHA

One of the most important ways women of all ages can optimize their baby’s health and pregnancy outcome is by taking their omega-3 fatty acids. Thanks to decades of research showing that the omega-3 fat called DHA provides numerous benefits for processes associated with infant growth and development, the American Pregnancy Association recommends that expectant mothers consume a minimum of 300 mg a day. (For more information about DHA’s foundational role in prenatal development, refer to “Why Do I Need DHA During Pregnancy?”) Mind you, 300 mg of DHA is the minimum daily recommendation, and a number of studies show that significantly higher doses of DHA are both safe and effective for optimizing pregnancy outcomes.3,4

Numerous studies demonstrate omega-3 benefits for pregnancy outcomes 

While omega-3s are important for all pregnant women, a number of observational studies, randomized clinical trials, and meta-analyses indicate that supplementing with EPA+DHA can help mitigate some of the heightened risks commonly associated with pregnancy after 35.3,5,6

In a recent case-control study looking at the relationship between omega-3 blood levels and a woman’s subsequent risk of early preterm birth (birth before 34 weeks gestation), researchers found that the women with the lowest levels of EPA and DHA during their first and second trimesters were 10 times more likely to deliver prematurely than women with higher omega-3 levels.5 This suggests that omega-3 levels may play a role in processes that may contribute to premature labor and delivery, and importantly, that EPA and DHA measurements may be an effective way to identify women at risk of delivering before 34 weeks. 

Additional support comes from a meta-analysis (a study using data collected from several previous studies) assessing the effects of EPA and DHA on preterm delivery.6 Using data from six randomized clinical trials and over 4000 women, this study found that supplementation with omega-3s significantly increased women’s chances of carrying a pregnancy to full term, and that babies born to women treated with omega-3s spent an average of 2 weeks longer in the womb and weighed 122.1 g more at birth than babies born to women not taking omega-3s. Thus, these findings strongly suggest that omega-3 fatty acids can be used to promote a healthy pregnancy.  

Omega-3s may increase your chances of maintaining a viable pregnancy

Gulp. The dreaded “M’ word. A common (and significant) source of anxiety for many pregnant women in their 30s and 40s is the increased risk of miscarriage, the spontaneous loss of a pregnancy before the 20th week.  While the likelihood of pregnancy loss tends to increase with advancing maternal age, findings show that high doses of EPA+DHA can help promote women’s chances of maintaining a viable pregnancy to term—another reason for expectant mothers to feel good about taking their omega-3s. 

In a longitudinal study following women with a history of recurrent pregnancy loss, women with antiphospholipid syndrome (an autoimmune disorder associated with increased risk of pregnancy complications) were treated with 5.1 grams of EPA+DHA from preconception thru delivery.7 During this treatment period 21 of the 22 pregnancies resulted in live births, 90% of pregnancies were carried to full term (>37 weeks), 100% of babies were of healthy birth weight (> 5.5 lbs).

Given that all of the participants had experienced a minimum of three pregnancy losses and only one had carried out a successful pregnancy prior to treatment, the finding that 95% of pregnancies resulted in live births suggests that high doses of EPA and DHA may be an effective way to promote normal fetal development in women at a higher-risk of pregnancy complications.

Taken together, the findings from these studies suggest that a woman’s EPA and DHA levels during pregnancy may have significant health implications for her baby, and that supplementing with omega-3s can promote her chances of carrying a healthy baby to full term.  

Choose the right prenatal multivitamin 

Another important way mothers over 35 can promote healthy fetal development is by taking a prenatal multivitamin that provides sufficient levels of key vitamins and minerals. While downing a bottle of prenatals with breakfast might seem like a great way to stack the deck in your baby’s developmental favor, taking excessive amounts of vitamins or synthetic vitamins can actually harm rather than help a developing fetus.8 As such, talking to your doctor about the specific nutrients, doses, and nutrient forms they recommend is highly advised. 

Active folate is preferable to folic acid 



Another important consideration when selecting a prenatal multivitamin is the form of B9 (i.e., folate, folic acid, or methyltetrahydrofolate) it provides. Vitamin B9 plays an important role in many processes essential for fetal development, including DNA synthesis, cell division, and cell growth.  Folic acid is the most common synthetic form of folate, and the form of B9 most commonly found in fortified foods and supplements. Because folic acid has no biological activity, it must be enzymatically converted into 5-methyltetrahydrofolate (the active form of folate) in order to be used by the body.9 Sound complicated? For some people, it is. 

You see, a significant proportion of the population unknowingly carry genetic mutations for certain enzymes that affect their ability to convert folic acid into a form the body can actually utilize. In America, roughly 25% people who are Hispanic, and 10-15% of Caucasians carry two copies of the most common gene variant associated with the MTHFR mutation,10 putting them at increased risk of having a child with a neural tube defect (e.g., spina bifida or anencephaly) or congenital anomaly.11

So, what does all this mean? These findings suggest that a considerable number of women who rely on the folic acid in their prenatal vitamin may not be getting the folate they need to support optimal embryonic development. There’s no need to panic though. Given that most people are unaware of their MTHFR status, good preemptive measures include: eating foods naturally high in B9 (leafy greens, beans, broccoli, asparagus, nuts, citrus fruits, etc.), supplementing with the active form of folate (5-methyltetrahydrofolate or 5-MTHF).

Not surprisingly, this advice is especially relevant for older mothers who are already at an elevated risk of bearing children with congenital anomalies and neural tube defects.12 Blerg. However, the good news is that by consuming B9 through natural food sources and supplementing with a biologically accessible form of folate, women over 35 can play an active role in promoting normal fetal development. 

And honestly? Regardless of whether you are reading this article because you are over 35 and pregnant (high-5 from afar) or over 35 and trying to conceive (non-creepy wink from afar), the fact that you are taking the time to educate yourself bodes well for your chances of enjoying a healthy pregnancy. 

Good luck—not that you’ll need it. 

Anencephaly: A defect in the formation of a baby’s neural tube (a failure to close during the 3rd week after conception) resulting in a severely underdeveloped brain and incomplete skull.


Case-control study: A type of observational study in which two groups differing in outcome are identified and compared on the basis of a supposed causal factor.


Congenital anomaly A structural or functional abnormality occurring during intrauterine life; a birth defect.


Longitudinal study: A research design that involves repeated observations of the same variables in subjects over a period of time.


Meta-analyses: A study that uses information collected and published in several previous studies to investigate a new question.


MTHFR (methyl tetrahydrofolate reductase): An enzyme necessary for an important metabolic process called methylation. It is this process that converts folate and folic acid into an active form the body can use. The MTHFR gene produces this enzyme, but a mutation in the gene can change the structure of the enzyme and so inhibit its ability to function normally.


Neural tube: Three weeks after fertilization, the nervous system begins to form. At this point, the human embryo is a flat disc, and one of the first major developments is the formation of a tube running from 1 end to the other. This neural tube forms on the surface, then sinks below the surface, and will eventually give rise to the structures making up the brain and spinal cord.


Observational study: A type of study where no attempts to affect the outcome are made, but individuals are observed, or certain outcomes are measured.


Randomized clinical trials: A type of study in which participants are randomly divided (by chance) into separate groups that compare different interventions or treatments.


Spina bifida: A neural tube defect that occurs when the vertebrae and membranes around the spinal cord don’t close properly. The most common location is in the lower back but can occur higher in some cases.

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