Recent data shows that the percentage of Malaysian women who give birth after age 35 has risen from 20.8% in 2017 to 23% in 2022, making Malaysia the second-highest country in Southeast Asia for babies born to women of advanced maternal age.
The financial demands of raising children have also played a role in shaping this trend. According to the Credit Counselling and Debt Management Agency, the estimated cost of raising a child in Malaysia from birth through university can reach as high as RM1.37 million.
These realities, coupled with the rising costs of childcare and education, have prompted many women to plan for motherhood later in life, ensuring a more stable and supportive environment for their family.
While all pregnancies carry certain risks, those after the age of 40 may present its own set of challenges. “Women over 40 are at a higher risk for medical and obstetric complications, including chronic conditions like high blood pressure, diabetes, obesity, and heart disease, which can elevate risks for both the mother and baby during pregnancy,” said consultant obstetrician, gynaecologist and maternal foetal specialist Dr Gayathri Mariappa.
Then there’s the increased likelihood of chromosomal abnormalities, such as Down syndrome. “Studies show a stronger link between chromosomal abnormalities and potential congenital malformation in children born to women over 40, with the risks continuing to rise as the maternal age increases,” Gayathri added.
Women over 40 may also encounter difficulties to conceive naturally. Consultant obstetrician, gynaecologist and fertility specialist Dr Farah Leong Rahman explained: “Women are born with a fixed number of eggs in their ovaries, which gradually decreases over time. By age 40, both the quantity and quality of eggs decline significantly, making conception more challenging.”
Medical innovations
The challenges of conceiving and pregnancy after 40 are now addressed with advancements in medical technology and treatments. For women who have difficulties conceiving, options such as in vitro fertilisation (IVF) have provided a viable solution.
IVF involves stimulating the eggs to grow, retrieving them, fertilising the egg and sperm in a suitable environment, and transferring the embryo back into the womb. The entire process takes about two weeks, Leong Rahman said.
Other fertility treatment options include hormonal medications to stimulate egg growth, or intrauterine insemination (IUI) – although these methods typically have lower success rates compared to IVF.
Leong Rahman emphasises that infertility can stem from both male and female factors, making it important for couples who are trying for a baby to get the partner to undergo a sperm test. In cases where sperm quality is suboptimal, IVF is often the most effective approach, she said.
Lastly, non-invasive prenatal testing (NIPT) is a recommended screening tool for expecting mothers from as early as 10 weeks into the pregnancy. “NIPT is a blood-based genetic test that screens for chromosomal abnormalities by analysing small fragments of foetal DNA circulating in the mother’s blood,” Gayathri said.
This early and precise screening helps expecting parents make informed decisions about their pregnancy and prepares them for any necessary medical care or interventions.
Preparing for pregnancy
Preconception care and lifestyle changes are essential for every mother-to-be. Leong Rahman advises maintaining a healthy lifestyle, including achieving an optimal body mass index, consuming a balanced diet supplemented with folic acid, engaging in regular exercise, and avoiding harmful habits such as smoking and alcohol consumption.
Gayathri underscores the importance of early and regular screenings, as well as the paternal role in ensuring a healthy pregnancy. “Pregnant women should be screened during the first trimester within 10-12 weeks for potential risks such as preeclampsia, cervical insufficiency, gestational diabetes, and undiagnosed medical conditions like kidney disease or heart conditions.”
She also highlights growing evidence that paternal factors, including smoking and body composition, play a crucial role in improving pregnancy and foetal outcomes.
Motherhood is a deeply personal decision – whether it happens before or after 40 – shaped by individual values, aspirations, and circumstances. With advancement in medical treatments, the right support systems, and proactive care, Malaysian women now have more opportunities than ever to navigate this journey.