Pregnancy in Your 40s in Singapore: What the Numbers Mean for You

This guide is for you if you’re in your 40s and pregnant, planning a pregnancy or quietly wondering whether it’s still possible. By now, you’ve probably heard the statistics. Maybe a few well-meaning comments from family along the way. It’s a lot to take in.

Quick Summary

• Pregnancy after 40 is more common in Singapore than it was a decade ago, and most pregnancies that reach the second trimester go on to a healthy baby.
• Fertility declines with age, so conceiving can take longer, and treatment such as IUI or IVF is more often part of the path.
• The clearest age-related rises are in miscarriage and chromosomal conditions, both driven by changes in egg quality, not by anything you did.
• Most age-related complications, including gestational diabetes and pre-eclampsia, are very manageable when picked up early through routine checks.
• Good care at 40+ means an early scan, sensible screening, closer monitoring, and a birth plan made with you.

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What to know first

Start with the fact that matters most. Having a baby after 40 is more common in Singapore than it was a decade ago. And most women who reach the second trimester go on to have a healthy baby. If that is the one thing you take away, it is a good one to hold onto.

The risks do rise with age. It is better to understand them early, well before they come up at an appointment, so nothing arrives as a surprise.

A word on the numbers that follow. Where a figure comes from Singapore data, it is stated as such. Where local figures by age are not available, the number is drawn from overseas research and labelled as an estimate. Each one is explained in terms of what it means for your pregnancy, not for a population.

A silent shift in Singapore’s birth numbers

Singapore’s birth figures are moving in two directions at once, and both are worth knowing.

Fewer babies overall. The resident total fertility rate (TFR), the average number of children a woman is expected to have across her lifetime, has been falling for decades, according to SingStat. It dropped below 1.0 for the first time in 2023, to 0.97, held there in 2024, then fell to a preliminary 0.87 in 2025. A decade ago it was 1.24. In 2005 it was 1.26.

But more of those babies are now born to older mothers.  The age-specific fertility rate (ASFR) counts live births per 1,000 women in an age band, and for women in their 40s, it has climbed.

2025 figures are preliminary. Source: SingStat; The Straits Times (2026).

The pattern is clear. Fertility has risen for women in their 40s while falling sharply for those in their late 20s and early 30s. Births are not only fewer, but they are also happening later.

Behind this is timing. Women are marrying and starting families later, often after more years in education and at work. The median age of first-time mothers in Singapore has risen from 29.3 in 2004 to 31.9 in 2024.

So if you are pregnant at 41, you are far from alone, and the numbers put you in growing company. That wider trend does not decide your own pregnancy, though. Yours is the one that matters here.

Fertility after 40: the honest picture

If you are still hoping to conceive, it helps to separate two things that age affects in different ways: how easily you fall pregnant, and how likely a pregnancy is to continue. Knowing which is which lets you and your doctor focus on the right thing.

The chance of conceiving in any single month falls with age. A healthy woman in her 20s has roughly a 25 per cent chance each cycle. By 40, that is around 5 per cent, and some studies put it lower. The decline is gentle through the 30s, then steeper.

The reason comes down to eggs. You are born with all the eggs you will ever have, and both their number and their quality fall over time. By around 40, the ovarian reserve is estimated at 5,000 to 10,000 eggs. Quality matters even more than numbers. The share of eggs with chromosomal errors (a feature called aneuploidy) rises with age, from roughly a third at 35 to more than half by 40. Those errors are the main reason conception and miscarriage become harder later on. None of this reflects anything you have done. It is simply how eggs age, and it happens to every woman.

In practice, this means conceiving may take longer, and treatment such as intrauterine insemination (IUI) or in-vitro fertilisation (IVF) is more often part of the journey. If you need that help, you are in very ordinary company, and it is exactly what the help is there for.

As a rough guide, it is worth seeing a doctor for a review:

• After 12 months of trying if you are under 35.
• After 6 months if you are 35 or older.
• Sooner if you have irregular cycles, known endometriosis or PCOS, or a previous fertility concern.

Access to treatment in Singapore has also widened.

From 1 January 2020, the Ministry of Health removed the previous age limit of 45 for IVF and other assisted reproduction technology, and extended government co-funding to women aged 40 and older who had tried such treatment or IUI before turning 40. More women in their 40s are seeking treatment as a result.

It helps to be clear-eyed about what treatment can and cannot do. IVF success rates fall with age and become low past the mid-40s, particularly using a woman’s own eggs. Like any medical procedure, IUI and IVF carry their own considerations, and whether they are suitable is decided with your doctor. Treatment widens your options. It does not switch off the effect of age. A frank conversation with your doctor about what is realistic for you is worth having early.

The risks of pregnancy at 40+, with the actual numbers

Each risk below is real, and none of it is hidden from you. What matters as much as each number is how big the risk actually is. Often the relative risk doubles while the absolute risk stays low. Where a figure comes from large, well-cited studies, it is given directly. Where Singapore data by age is limited, the figure comes from international research and is labelled an estimate.

Miscarriage

This is the risk that rises most clearly with age.

Between 35 and 40, the risk roughly doubles, driven by the egg-quality changes described above. More chromosomal errors mean more pregnancies that cannot continue. If you have been through a loss, please hear this clearly: it was not your fault. Miscarriage after 40 comes from the natural change in egg quality, not from anything you did or did not do.

Chromosomal conditions such as Down syndrome

The chance that a baby has a chromosomal condition like Down syndrome rises with age at delivery.

Source: ACOG; NDSS.

A 40-year-old’s risk is therefore roughly 10 to 15 times that of a 25-year-old. That can sound frightening until you turn it around. Even at 40, the large majority of pregnancies are unaffected, around 99 in 100 for Down syndrome. And modern screening picks up most cases early: non-invasive prenatal testing (NIPT), a simple blood test, combined with ultrasound, detects the great majority, and a diagnostic test (CVS or amniocentesis) can confirm a result if you want certainty.

These are your choices to make, not obligations, and you can talk them through at your first visit. Which screening or diagnostic tests are suitable depends on an individual assessment with your doctor.

Separately, the routine mid-pregnancy ultrasound (the anomaly scan) checks your baby’s development and can pick up structural differences, whatever your age.

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Molar pregnancy

A molar pregnancy (hydatidiform mole) is an uncommon condition where placental tissue grows abnormally instead of forming a viable pregnancy. Its frequency follows a U-shaped pattern with age, a little higher in very young mothers and again in older mothers, particularly from 40 and especially from 45.

Reliable Singapore-specific figures by age are not published, and international estimates vary, so the fair thing to say is simply that it is more common at 40+ than in the 20s and 30s.

It remains uncommon. The reason to mention it at all is to explain why an early ultrasound is worth having at this age.

Gestational diabetes and pre-eclampsia

Both become more common with age, and both are manageable when caught early, which is exactly what the routine checks are for.

• Gestational diabetes (GDM), or raised blood sugar in pregnancy, is roughly twice as common in women aged 40+ as in those under 35 in many studies (an estimate from international data; local figures vary). A routine glucose test in pregnancy picks it up, and it is managed with diet, monitoring and, where needed, medication.
• Pre-eclampsia, a blood-pressure disorder of pregnancy, is around 1.5 to 2 times more likely at 40+ than under 35 (international estimate). Regular blood-pressure and urine checks catch it early, well before it becomes serious.

At 40+, these routine checks matter more, not less, and they are simple to do.

Stillbirth, preterm birth and birth weight

Stillbirth is the worry that sits silently behind many of these conversations. So let us be straightforward about it. The risk does rise with age, but it stays low in absolute terms. Large studies put the risk for mothers aged 40 and over at roughly 1.7 to 1.9 times that of younger mothers, while the absolute figure remains under 1 per cent.

It is also why your doctor may raise the timing of delivery more actively at 40+. A small rise in late-pregnancy risk can tip the balance toward a planned birth.

Preterm birth and low birth weight are modestly more common at 40+. International estimates put the increase at roughly 1.2 to 1.8 times. That is part of why growth and wellbeing are watched more closely in later pregnancy.

How your baby is likely to be born

The way babies arrive shifts with age. Women over 40 are the age group most likely to have a caesarean, around twice as likely as women under 40. Instrumental deliveries (forceps or vacuum) are also a little more common, by a smaller margin of roughly 1.2 to 1.5 times (an estimate from the broader literature rather than a local figure).

None of this makes a caesarean or an assisted birth a foregone conclusion. It means your birth preferences are worth talking about early, so you understand what might change the plan and what would not.

The birth is then planned with a doctor who works with you, not around you. Dr Tan offers individualised birth plans and supports the natural birthing method where it is safe and right for you and your baby.

A note from Dr Tan and the team

The women who come to the clinic in their 40s are usually carrying more than the statistics. There is hope, and very often a little fear sitting right beside it. Part of our job is to hold both with you.

Most have already read the numbers. What they really want is for someone to put them in perspective, to say what they mean for this pregnancy, not for a population. So that is where we start. A one-in-a-hundred chance of Down syndrome is the same as saying about ninety-nine in a hundred pregnancies are not affected. A higher caesarean rate does not mean a caesarean is already decided.

In our practice, including Dr Tan’s background as a Consultant at KK Women’s and Children’s Hospital, we look after women through pregnancy after 40. What tends to make the difference is planning early, screening sensibly, and keeping a close watch as the pregnancy goes on.

The part we care about most is that the plan stays yours. If a natural birth matters to you, we plan for it, and we stay honest with each other about when safety has to come first. If a particular worry is keeping you up at night, we talk about it properly, not in passing. Age changes the odds. It does not take away your say.

What good care looks like at 40+

None of the figures above is a reason to fear pregnancy at 40. They simply show where care and attention are worth focusing.

Good care at this stage tends to share a few features:

• An early first visit and dating scan, to confirm a healthy, single pregnancy and set a clear plan.
• A calm conversation about screening (NIPT, ultrasound and diagnostic options) so your choices are yours.
• Closer monitoring of your blood pressure, blood sugar and your baby’s growth as the pregnancy progresses.
• An active discussion about the timing and mode of delivery, made with you rather than for you.
• Continuity, so the same doctor knows your history through the whole pregnancy and nothing is lost in between.

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Key Takeaways

1. You are in a growing company. Births to women in their 40s are rising in Singapore, even as the overall birth rate falls.
2. Most pregnancies after 40 go well. The large majority that reach the second trimester result in a healthy baby, especially with early, attentive care.
3. The risks are real but mostly low in absolute terms. Miscarriage and chromosomal conditions rise most clearly with age, driven by egg quality, not by anything you did.
4. Screening gives you information, not obligations. NIPT, ultrasound and diagnostic tests are choices you make with your doctor.
5. Good care follows clear principles. At 40+, early scans, sensible screening, closer monitoring and individualised birth planning are what [tend to] make the difference.

Frequently asked questions

Is it safe to have a baby at 40 in Singapore?

For most women, yes, and you are in good company here. The risks of miscarriage, chromosomal conditions and pregnancy complications do rise with age, but most pregnancies that reach the second trimester result in a healthy baby, especially with early and attentive care.

What is the chance of conceiving naturally at 40?

Roughly 5 per cent per cycle, compared with about 25 per cent in the 20s, so it can take longer. Fertility treatment such as IUI or IVF is more often part of the picture, and needing it is common and nothing to feel bad about.

How high is the miscarriage risk at 40?

Around 40 per cent, rising to roughly half or more by 45. The main reason is the natural decline in egg quality with age. It is not within your control, and not anything you could have prevented.

Do I definitely need a caesarean if I am over 40?

No. Caesareans are about twice as common in women over 40, but many women over 40 have a vaginal birth. Talking it through early with your obstetrician helps you plan for the birth you hope for, in a way that keeps you and your baby safe.

What screening is available for chromosomal conditions?

Non-invasive prenatal testing (NIPT), a blood test, together with ultrasound, picks up most cases early. Diagnostic tests (CVS or amniocentesis) can confirm a result if you want certainty. These are your choices to make, and your obstetrician will talk through the options at your first visit.

Related reading from our clinic

• Obstetrics and pregnancy care
• Fertility and infertility investigation
• 10 frequently asked questions on infertility
• Common causes of infertility in women
• Twin pregnancy
• Individualised birth plans
• Gynaecology services

Authoritative sources used in this article

• Singapore Department of Statistics (SingStat): resident total fertility rate and age-specific fertility rates by age of mother.
• Population in Brief 2025, Prime Minister’s Office Strategy Group.
• The Straits Times: Babies born to mums in their 40s on the rise amid Singapore’s fertility decline (April 2026), reporting age-specific fertility rates, median age at first birth and assisted-reproduction trends.
• American College of Obstetricians and Gynaecologists (ACOG): Having a Baby After Age 35 and Pregnancy at Age 35 Years or Older.
• HealthHub / MOH (Singapore): Healthy Start for Your Pregnancy.
• Peer-reviewed data on chromosomal risk by maternal age, including the AAFP review and Morris et al. (2005), with US and European cohort data applied with the caveats noted in the text.
• Magnus MC et al., “Role of maternal age and pregnancy history in risk of miscarriage,” BMJ, 2019.
• Reddy UM et al., “Maternal age and the risk of stillbirth throughout pregnancy in the United States,” American Journal of Obstetrics and Gynaecology, 2006.
• NDSS: Down syndrome risk by maternal age

About this article

This article is intended for general education. It is not a substitute for medical advice. Your doctor will assess your situation in person. Statistics are drawn from the sources listed above. Where Singapore-specific age-stratified figures were unavailable, well-cited international data is used and labelled accordingly. Cost, screening and care decisions are subject to MOH/HCSA regulations and your own circumstances. Clinical accuracy is confirmed by Dr Pamela Tan before publication. Spotted something that needs correcting? Please contact the clinic.