Summary of Consensus Recommendations
✔️We suggest that pregnancy with anticipated delivery at age 35 years+ be recognized as a risk factor for adverse maternal, fetal, and neonatal outcomes when counseling patients and determining management plans.

✔️We recommend daily low-dose aspirin for preeclampsia prevention for pregnant individuals aged 35+ in the setting of at least one other moderate risk factor.

✔️Given increased rates of multiple gestations for pregnant individuals with anticipated delivery at age 35 years+, we suggest a first-trimester ultrasonogram.

✔️We recommend that prenatal genetic screening and diagnostic testing options be discussed and offered to all pregnant individuals regardless of age or risk of chromosomal abnormality. After review and discussion, every patient has the right to pursue or decline prenatal genetic screening and diagnostic testing.

✔️We suggest a detailed fetal anatomic ultrasonogram for pregnant individuals with anticipated delivery at age 35 years+ given the increased risk of aneuploidy and potential increased risk of congenital anomalies in this population.

✔️Due to increased risk of both large-for- and small-for-gestational-age neonates, we suggest an ultrasonogram for growth assessment in the 3rd trimester for pregnant individuals with anticipated delivery at age 40 years+.

✔️We suggest offering antenatal fetal surveillance for pregnant individuals with anticipated delivery at age 40 years¥ given the increased risk of stillbirth.

✔️We recommend proceeding with delivery in well-dated pregnancies at 39 0/7–39 6/7 weeks of gestation for individuals with anticipated delivery at age 40 years+ due to increasing rates of neonatal morbidity and stillbirth beyond this gestational age.

✔️We suggest counseling that vaginal delivery is safe and appropriate if there are no other maternal or fetal indications for cesarean delivery. Counseling should include a discussion of the risks of cesarean delivery, the patient’s comorbidities, and the patient’s preferences and goals. Advancing patient age alone is not an indication for cesarean delivery.

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