Interview.- While fertility after 40 has never been higher since the late 1970s, obstetrician-gynecologist Hélène Flye Sainte Marie shares the experience of pregnancy after 40, the complications and risks involved, and gives reassurance.
Women are having children later and later. Proof of this was provided on January 10th by an Insee study, which states that in France, fertility at the age of 40 has never been higher than it has been since 1979. In fact, three times higher than in the 1970s , frequent changes in partnership and desire after professional stability before the birth of a child, pregnancies between the ages of 40 and 45 are no longer marginal or exceptional.
Only at this age do they pose an undue risk and can be a cause for concern. What does it really look like to be pregnant at 40? And at 45? What are the risks of these pregnancies? Do you need special supervision? Hélène Flye Sainte Marie, obstetrician-gynecologist at the CHU Sud de la Réunion, replies and reassures.
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Madame Figaro.- What does a so-called “late” pregnancy look like?
Overall, experiencing pregnancy at 40 is not very different from that between 35 and 40. After that, we see more fatigue. Women may recover less quickly from childbirth and this is related to the fact that we recover less easily as we age. It can also be accentuated by the added and age-related pathologies. In practice, we see two scenarios: women with multiple births, who may be more tired due to the accumulation of pregnancies and the treatment of children at home, and women who are dealing with the first child. However, these patients, for whom the wait was often long, did many things in advance to better live their pregnancy.
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What are the risks of pregnancy at 40 and beyond?
There are pathologies related to the age of the woman that are already present before pregnancy and those related to pregnancy. Overall, a woman between the ages of 40 and 44 sees a 2% increased risk of developing a serious disease versus 1% at around the age of 35. Therefore, it is important to carry out a preventive examination with your gynecologist in order to assess pre-existing pathologies and adjust the follow-up care afterwards. During the first trimester of pregnancy, the risk of miscarriage due to a chromosomal abnormality is higher. The reason is simple: our gametes, like all other cells in the body, age as we age. They therefore have more anomalies and we pass them on.
After 40, the greatest risk is that of miscarriage
Hélène Flye Sainte Marie, obstetrician and gynaecologist
The risk of developing gestational diabetes also increases, it is 3 to 4 times higher after the age of 40. After this age, the rate of preeclampsia (Disease associated with high blood pressure and the presence of proteins in the urine, resulting from placental dysfunction, Ed.) is also higher (5 to 10%). It leads to delayed growth of the baby or premature birth; the disease heals when the placenta is removed. We are also seeing more caesarean sections, growth retardation, high blood pressure, bleeding during childbirth… All these risks increase after the age of 40, but significantly more after the age of 45.
How are these women persecuted?
Like the others, except that before conception we carry out a consultation to discover possible pathologies such as hypertension, diabetes, etc. Follow-up care is then adjusted. For example, it will be more regular if the baby is stunted. Then, as with all women, we look for trisomy 13, 18 and 21 in the first trimester with a combined screening. We mix three dates – the measurement of the baby’s neck, the mother’s age and the result of a blood test – then we come up a risk of 1 in X. Below 1 in 1000 we are entering a high risk area and non-invasive prenatal screening (NIPT) is suggested. It consists of looking for fetal cells in the mother’s blood to see if they have an abnormality. If the risk is less than 1 in 50, an amniocentesis is offered. Finally, in addition to the three mandatory ultrasound scans and since these patients are at higher risk of genetic and chromosomal abnormalities due to their age, they may be offered an early second trimester ultrasound scan after 18 weeks of amenorrhea.
Some women may worry about pregnancy at this age. what do you tell them
Of course, compared to getting pregnant at the age of 25-30, there is a slightly increased risk. But after 40, the greatest risk is that of miscarriage; So, after the first trimester, the risks are increased, but they are well controlled. The preliminary assessment is very important. Thus, the risks are known, anticipated and we can control them better. You don’t have to be afraid; We are seeing more and more pregnancies in their 40s and they scare us no more than others.