[GROSSESSE APRES 40 ANS]. According to INSEE, the late fertility rate has tripled in France since the 1980s, thanks in particular to scientific advances. What medical follow-up for these geriatric pregnancies? Interview with Doctor Joëlle Belaïsch-Allart, gynecologist.
[Mise à jour du 13 janvier 2022 à 11h41]. Late pregnancies are more and more frequent in France. This is confirmed by the latest INSEE figures published on January 10, 2022, which specify that fertility after age 40 has been rising steadily since the 1980s. “In 2019, late fertility is thus 3.4 times higher than in 1980” notes the report. The women most affected by a late pregnancy are those born abroad as well as women in management or without a profession. “The extension of studies, later couple formation, the desire to be stabilized in one’s professional life before having children, more frequent repartnering and the desire to have a child by the new couple have contributed to postpone childbearing age. The medicalization of contraception (Neuwirth law in 1967) may also have facilitated this postponement”, explains INSEE.
At what age do we speak of late or geriatric pregnancy?
Joëlle Belaïsch-Allart*: Before, we were talking about late pregnancy at 35, but now it is rather after 40 years. These late pregnancies also called “geriatric pregnancies” are considered ultra-late after 45 years.
Late pregnancy: testimonials from mothers
Pregnant after 40: what pregnancy follow-up?
A late pregnancy requires much more assistance. The medical follow-up is different than for a pregnancy at 20 or 30 years old. Thereby, the risks increase with age. Despite appearances, women over 40 are more tired and must be more vigilant for small signs such as contractions for example. During pregnancy, they must do, like all pregnant women, diabetes screening to check that they do not have gestational diabetes, and trisomy 21 screening. [Celui-ci se fait au premier trimestre de grossesse par le biais d’une prise de sang pour doser des marqueurs sériques, et d’une échographie pour mesurer la clarté nucale. Si le résultat est supérieur au seuil fixé, une amniocentèse est aussi proposée à la future maman. Depuis 2013, elle a également la possibilité de recourir aux tests ADN, plus fiables et moins invasifs que l’amniocentèse puisqu’il s’agit d’une simple prise de sang, ndlr.]
What are the risks of late pregnancy?
The risks for the mother are different if she uses egg donation or if it is a spontaneous pregnancy.
- In the case where these are his own oocytes, i.e. aged oocytes, the risks of miscarriage, diabetes and maternal mortality are increased.
- For women who have recourse to oocyte donation, therefore oocytes from a younger woman, the risks are still present. Always monitor the diabetes and pre-eclampsia.
- It should also be noted that at the time of delivery, the number of caesareans increases with age of the mom.
- The tobacco also has consequences for pregnancies, but at any age. In addition to accelerating menopause by two years, smoking can lead to hypertrophy in babies.
- Amongst others possible consequences of late pregnancy : Placental abruption, low birth weight babies, and uterine fibroids are more common. In addition, the risk of prematurity is higher because the uterus has a less good capacity to support the pregnancy.
- Late pregnancies also increase risks for the baby (mortality in utero and perinatal (30 per thousand), prematurity (8.2%) and a higher probability of having a child with Down syndrome). Finally, remember that the fertility of men also decreases from the age of 45.
After 40, is it harder to get pregnant?
There is above all a denial of knowing and recognizing thatafter 35, it is more difficult to get pregnant. And then, even if there may be some, pregnancies are rarely spontaneous after 45 years. These women often resort to a assisted reproduction, in particular at egg donation. We always see in magazines resplendent women after 40 years, but the reality is very different: at this age, it is very difficult to have a baby. And it grows and takes longer over the years. It is important to specify that one does not fall pregnant, one becomes it! Also, gynecologists advise to consult:
- After a year of regular sexual intercourse if pregnancy does not occur,
- After 6 months in case of gynecological history (infections, fibroids…) or ovulation disorders,
- After 6 months if you are over 35.
*Comments collected in 2012. Doctor Joëlle Belaïsch-Allart, head of the gynecological department of the hospital center of the four cities site of Sèvres (92) and vice-president of the National College of French gynecologists and obstetricians.