Building benefits for advanced reproductive technology and advanced maternal age
The term "high-risk pregnancy" usually brings to mind gestational diabetes or preeclampsia. For employers, there's another cohort to consider: employees or dependents who conceived through assisted reproductive technology (ART) or give birth at age 35 or after.
The latest statistics on ART and AMA
Advanced maternal age (AMA) means being 35 or older and pregnant. Among American women with a bachelor's degree or higher, the average age of first-time mothers is 31. Nationally, that average climbed to 27.5 in 2023 (up from 26.6 in 2016), and the average age across all births rose to 29.6 over the same period, per CDC data.
This shift is concentrated in professional workforces, where the gap between the population average and AMA starts to close fastest.
Fertility treatment is rising alongside it. Pew Research found that 42% of U.S. adults have used fertility treatment or know someone who has, up from 33% five years earlier. In 2024, more than 100,000 babies were born via in vitro fertilization (IVF), and roughly 2% of all U.S. births are conceived via IVF.
The overlap matters for benefits planning. The mean age of an ART patient is around 36; the majority hold a bachelor's or master's degree and report household income above $100,000. This is the professional workforce employers are already trying to retain.
In other words: they are the employees a professional-services or knowledge-worker employer is most likely to have.
Why standard maternity benefits fall short for this population
Most maternity benefits are built around a low-risk pregnancy: an average-age mother with a singleton pregnancy and no fertility history. Support escalates only after a complication is already diagnosed. Traditional high-risk case managers step in only after preeclampsia or preterm labor shows up in the chart, not before. Almost none of that design accounts for fertility history, maternal age, or the odds of a NICU stay from day one. It's a benefit built for the median pregnancy, applied uniformly to a diverse population.
AMA and ART pregnancies don't fit that description, and clinical data shows why that matters. Age complicates the picture, regardless of how conception happened.
According to the March of Dimes, pregnancy at age 35 or older carries higher odds of gestational diabetes, high blood pressure, and preeclampsia, with risk climbing further after age 40.
ART pregnancies carry elevated risk of several major complications. Research shows significantly higher rates of preeclampsia, cesarean delivery, preterm birth, and NICU admission compared with spontaneous conception. In IVF pregnancies specifically, preterm birth risk is roughly double. Twin or triplet ART pregnancies, though less common, add gestational hypertension, gestational diabetes, and placenta previa to that picture.
The hidden costs of inadequate benefit design
This risk profile shows up directly in claims. Preterm birth and NICU admissions are among the most expensive events in a maternity episode, and ART and AMA pregnancies carry elevated risk for both. Add higher rates of cesarean delivery, hypertensive disorders, and postpartum hemorrhage, and the AMA/ART cohort drives high-cost claims.
You may already be paying for this risk, without knowing you're carrying it, and without any benefit design in place to mitigate it.
What the right clinical support looks like
Closing the risk gap means building benefits around the reality of AMA and ART pregnancies:
- Continuous clinical care that identifies fertility history and maternal age as risk factors at the first prenatal visit, before a complication appears.
- Proactive monitoring pathways built around the specific complications ART and AMA pregnancies are more likely to face: preeclampsia screening and low-dose aspirin protocols, and gestational diabetes management.
- Dedicated virtual NICU support with seamless handoffs from OBs and specialized NICU teams, lactation help for babies who can't yet feed by mouth, guidance through care and discharge milestones, and coordination between the baby's NICU stay and the parent's own recovery and leave.
- Integrated mental health care that accounts for the heightened anxiety of pregnancies conceived via ART or at an advanced maternal age.
The takeaway for benefits leaders
AMA and ART pregnancies are a growing, identifiable share of your covered population. The clinical risk is well-established, the cost exposure is real, and standard maternity benefits aren't built to address either. Employers who get ahead of this aren't adding a niche perk–they're closing a critical gap in care, preventing high-cost complications, and delivering the evidence-based care their employees need.
Want to see how Pomelo supports your employees? Request a demo.
