THE PREGNANT WOMAN OVER AGE 40. The incidence of women delaying their first pregnancy until their late 30s or early 40s is increasing (see Focus on Cultural Competence). Seven percent of births in the United States today are to women over 35; 2% are to women over 40 (DHHS, 1998). In the past, it was as sumed that a woman of this age was past the optimum age for childbearing and was at risk for many complica- tions. With the exception of greater chromosomal abnor- mality, there is little evidence of increasing complications in women older than 35 as long as prenatal care is begun early in the pregnancy (Cunningham et al, 1997). If com- plications do occur, they are for the reasons discussed below. Their fetus needs to be assessed for adequate growth (see Focus on Nursing Research).