Pregnant after 40 years: A phenomenon of society

A few months ago, a 55-year-old Berliner gave birth to a little Lelia, who had fallen as a gift from heaven into a family of twelve children. Last year, about fifty French women gave birth at the age of being grandmother: thirty-five natural and spontaneous pregnancies, the others by oocyte donation abroad, mainly in Spain and Belgium.

Without even mentioning these staggering situations, there is a dramatic increase in the number of late pregnancies, and not only among people like Madonna, Kim Basinger or Claire Chazal.

In France, there are 130,000 pregnancies for 35 years and over, and those over 40 have tripled in twenty years! All this has been made possible by the development of contraception (which has allowed the date of the first pregnancy to be delayed) and the use of medically assisted procreation (which has optimized the chances of having a baby in older patients) . Gradually, women came to think that being a mother at 35 or 40 was not so extraordinary, and even practical when they were torn by their studies, professional projects, the delicate choice of Prince Charming, divorce and second union, consecrated by a new baby.

This phenomenon of society has intrigued specialists , not only sociologists. What about the medical consequences for the mother and the child, questioned the French National College of Gynecologists-Obstetricians (1)? "For a miraculous pregnancy, how many difficult journeys and disappointments? asks Dr. Joëlle Belaïsch-Allart, fertility specialist and department head at the Jean-Rostand hospital in Sèvres. How many women come out in tears from my office because they understand that it is too late to give birth! We do not have a magic wand, there is an age to be pregnant.

The INED data reveal that a woman who wants a child at 30 achieves this in 93% of cases; at age 35, in 85% of cases; at 40, in 65% of cases. Which means that at this age, 35% of women will never have a baby, with or without IVF. The Family Planning was wrong slogan: we should not have said "A child when I want, if I want", but more modestly "No child until I want it." "The main risk of late pregnancy is therefore not to have children at all, you must know! "If you want one after 38 years, consult after six months in a specialized center. And if that does not come, do not let time, "insists the specialist. Women who still manage to be late pregnant are made to feel guilty. They mainly fear malformations of the baby. "They worry most often wrongly," remarks Joelle Belaisch-Allart. On the other hand, they fear nothing for them, and yet, there, the risk is very real.

Pregnant after 40 years: What risk for the child?

The probability of malformation does not increase with age, except trisomy 21. "But this is a real paradox: the risk is zero if there was screening by amniocentesis (2). ), explains Professor Michel Tournaire, head of service at the Saint-Vincent-de-Paul maternity ward in Paris, author of "Happiness to be a mother: pregnancy after 35 years" (3).

In fact, 40-year-old women are less likely to have a child with Down's Syndrome than 25-year-olds. In the youngest group, only 80% of trisomies are detected with the two-step method (4), simply because we do not think of looking for abnormalities because of their relative rarity. "Still, screening by amniocentesis is reimbursed at age 38 only, and about 1% of these tests result in miscarriage.

But at this age, it's a real catastrophe. Finally, there is a major inequality: in Paris, 90% of women aged 40 are offered screening for trisomy, while in the North, for example, they are only 62%. "This gap proves that not all doctors systematically offer amniocentesis, planned and reimbursed by Social Security," said Dr. Joëlle Belaïsch-Allart. In addition, at age 40, the risk of miscarriage increases to 34% (instead of the usual 15%). The number of premature babies also increases a little, as does the number of twin pregnancies, which are more risky, as we know.

Pregnant after 40 years: What risk for the mother?

Pregnancy at age 35 is usually not a major problem. After 40 years, this is another story, warns Dr. Joëlle Belaïsch-Allart: "There is more often diabetes, hypertension, phlebitis, pulmonary embolism, fibroids, placenta praviae (responsible for hemorrhages at birth), caesareans, and there will be no other child behind.

Above all, there is more maternal mortality during childbirth.
This is a taboo subject in France . "On average, one death per 10,000 births is recorded in France. This mortality is multiplied by two in women aged 35 to 39, three among 40-44 year olds, and ten among 45 year olds and over. It is therefore more dangerous to be pregnant when you get older. A concern largely relativized by Professor Tournaire. "It's obvious, to look at the theoretical risks and some figures, it is better to be a mother at 25 than at 35 or 40! But all these mentioned risks are mastered, and most of the time mastered. Who says hypertension or diabetes, does not necessarily say disaster. It is only a question of adapting to these factors by monitoring the mother more closely and treating her if necessary. If the doctor is attentive to all these pathologies, it reduces the risk of complications, which becomes lower than that of a conventional population, since one systematically looks for anything that could pose a problem. "

As a result, late pregnancy is usually more supervised and more restrictive. As a result, we are far from our ancestors who, at the beginning of the twentieth century, did not benefit from as effective medical care and died more often in bed after 35 years. The American quinquas, extremely well supported, show a number of incredibly low complications, it's quite reassuring. "We must act and not judge," concludes Professor Michel Tournaire. It is the whole society that has engaged women to go to school, to work for independence and to get through divorce. She is responsible for the increasingly late age of pregnancy. I will not be led to believe that these women give birth at age 40 for the futile motive of "having fun" or "enjoying life" as they are often accused of!

Put the odds on his sideEnencte after 40 years:

As advised by Professor Tournaire, in his book "The happiness of being a mother: pregnancy after 35 years", to improve his chances of having a baby, you have to train like a sportswoman before the competition, because the more you age, the preparation will be more demanding.

So:
Stop smoking;
Limit alcohol consumption
Balance your treatments (in case of chronic diseases) and limit the drugs as much as possible;
Lose weight if necessary
Return to playing sports
Learn how to take care of yourself.

We also propose:
Collection of amniotic fluid with analysis of the cells it contains. This test is a personal choice, since it can lead to a possible medical termination of pregnancy.

Ed. Odile Jacob. Will my child be normal?
* Age of Probability Trisomy 21 mother
** 30 years 1/900 35 years 1/380 40 years 1/110 45 years 1/28 50 years 1/7
(*) Other risks of disability or malformation are always possible, but do not increase with age. (**) Theoretical rate before antenatal diagnosis.