BACKGROUND Pregnancy at maternal age 40 years or older is associated with progressively higher maternal and perinatal risk, with particular concern for term stillbirth as gestation advances. The clinical question is not whether age alone makes pregnancy high risk in a binary sense, but whether the balance between continuing pregnancy and planned birth shifts sufficiently by 39 weeks to justify age-specific delivery timing. AIM To critically synthesize the evidence supporting delivery during the 39th week for pregnancies at maternal age 40 years or older, compare contemporary international recommendations, and define how induction should be incorporated into individualized clinical decision-making. METHODS A targeted narrative review was undertaken using PubMed/MEDLINE, official guideline repositories, and publisher websites, with literature considered through 10 September 2026. Priority was given to specialty-society guidance, systematic reviews and meta-analyses, randomized trials, large population cohorts, and recent implementation studies. Earlier seminal studies were retained when they directly informed gestational-age-specific risk. Because evidence spans heterogeneous designs and outcomes, findings were synthesized narratively rather than pooled de novo. RESULTS Observational evidence consistently shows that stillbirth risk rises with advancing maternal age and with continuing term gestation, with the strongest age-specific signal at 40 years or older. In older maternal-age groups, neonatal morbidity appears lowest at 39 weeks of gestation and increases at later gestational ages. The 35/39 randomized trial and meta-analyses comparing induction with expectant management provide reassurance that planned induction at term does not increase cesarean delivery in women of advanced maternal age, although direct randomized evidence in women aged 40 years or older is limited and trials are underpowered for stillbirth. Contemporary guidance has moved toward age-specific timing: ACOG/SMFM recommends delivery at 39+0 to 39+6 weeks for well-dated pregnancies when anticipated age at delivery is 40 years or older; SOGC permits induction at 39 weeks; and the 2023 Irish guideline recommends offering induction at 39+0 to 40+0 weeks with shared decision-making. General-population WHO, NICE, and French guidance remains more conservative because it addresses uncomplicated pregnancy irrespective of maternal age. CONCLUSION For a well-dated, otherwise uncomplicated pregnancy with anticipated maternal age 40 years or older at delivery, planning birth during week 39 is a defensible, guideline-concordant strategy supported by the available risk and induction-safety evidence. Induction should not be presented as proven to prevent stillbirth in this exact age group, and maternal age alone is not an indication for cesarean delivery. Counseling should integrate parity, cervical status, comorbidity, prior cesarean, fetal condition, patient preferences, and local resources.
