Many celebrities like Cameron Diaz, Naomi Campbell, Janet Jackson, Virginie Efira, and many others have popularized pregnancies between the ages of 40 and 50. We are seeing an increase in these so-called late pregnancies.
These pregnancies, considered to be high-risk, often involve intensive medical monitoring to minimize complications.
Fertility naturally declines with age due to a decrease in ovarian reserve and a decline in oocyte quality (eggs produced during ovulation).
But paradoxically, we are seeing an increase in the number of late pregnancies.
According to INSEE, the number of late pregnancies tripled between 1980 and 2019, while the age of the first pregnancy continues to rise. This is explained by societal factors, such as prioritizing professional careers, new relationships, and the increase in infertility.
The main complications encountered are linked to a decrease in quality, with more chromosomal abnormalities.
The risk of miscarriage
Miscarriage is defined as the spontaneous termination of an intrauterine pregnancy. It is considered early if it occurs before the 14th week of amenorrhea during the first trimester. The number of miscarriages increases significantly with age; the risk is 50% per cycle following 42 years (according to the Ameli website). A natural selection of embryos occurs in the first trimester. In the event of a chromosomal abnormality, a miscarriage may occur.
The risk of chromosomal abnormality
As previously described, with age there is an increase in the number of chromosomal abnormalities at the oocyte and therefore embryonic level. We distinguish numerical abnormalities such as trisomy 21, 13, and 18 or structural abnormalities.
For example, the risk of having a child with Down’s syndrome is estimated at 1/100 following the age of 40, compared to 1/1500 at the age of 20.
Hence the importance of screening for these chromosomal abnormalities by ultrasound measurement of nuchal translucency between 11 and 14 weeks. HT21 is a blood test that, combined with measurement of nuchal translucency, hormonal dosages, and characteristics related to the patient (age, weight, origin, etc.), allows for a risk calculation.
A non-invasive diagnosis can then be proposed by taking a blood test to look for fetal DNA circulating in the mother’s blood and amniocentesis (taking a sample of amniotic fluid to rule out or confirm the diagnosis).
The risk of gestational diabetes
It results in an increase in blood sugar during pregnancy. The prevalence is 14.2% following 35 years. Gestational diabetes can be accompanied by an increase in the baby’s weight (macrosomia), an increase in the number of forceps, cesarean section inductions, etc.
The risk of high blood pressure
There is an increased risk of high blood pressure, corresponding to a blood pressure greater than 140/90 mmHg.
More complicated forms may be accompanied by intrauterine growth retardation (insufficient baby weight), preeclampsia with renal, hepatic, and platelet damage. Therefore, there is a greater risk of cesarean sections and induced prematurity.
What follow-up for a late pregnancy?
Fortunately, late pregnancies do not systematically rhyme with complications. On the other hand, a preconception consultation is recommended to inform patients, identify pre-existing medical conditions that might promote the occurrence of complications (such as pre-existing diabetes, hypertension, excess weight), and limit the consumption of tobacco, alcohol, and coffee.
In some cases, the introduction of aspirin might limit the risk of complications, in addition to folic acid.
Late pregnancies warrant close monitoring by a gynecologist with clinical, biological, and ultrasound monitoring, to maximize the well-being of the mother-to-be and the baby.
Late Pregnancies: A Growing Trend and Its Associated Risks
In recent times, we’ve witnessed a surge in celebrities like Cameron Diaz, Naomi Campbell, Janet Jackson, and Virginie Efira embracing motherhood in their 40s and 50s, normalizing what is often referred to as “late pregnancies.” This trend is mirrored in society, with an increasing number of women delaying childbirth. While this choice offers many personal and professional advantages, it’s crucial to understand the potential medical implications associated with late pregnancies.
The Increasing Prevalence of Late Pregnancies
According to INSEE (French National Institute of Statistics and Economic Studies), the number of late pregnancies tripled between 1980 and 2019. This shift can be attributed to various societal factors, such as women prioritizing their careers, entering new relationships later in life, and increasing infertility rates.
Declining Fertility with Age: A Biological Reality
Fertility naturally declines with age due to two primary factors: a reduction in ovarian reserve and a decline in oocyte (egg) quality. As women age, their ovaries contain fewer eggs, and the quality of the remaining eggs deteriorates. This decline in egg quality leads to a higher risk of chromosomal abnormalities and genetic disorders in the fetus.
The Challenges of Late Pregnancy: Understanding the Risks
While late pregnancies can be successful, they are often considered high-risk and require meticulous medical monitoring to minimize potential complications. Here’s an overview of some of the most common risks associated with late pregnancies:
Risk of Miscarriage
Miscarriage, defined as the spontaneous loss of a pregnancy before the 20th week, occurs more frequently in older women. The risk of miscarriage increases significantly following the age of 42, with a 50% chance per cycle. This heightened risk is partly attributed to a natural selection process that eliminates embryos with chromosomal abnormalities during the first trimester.
Risk of Chromosomal Abnormalities
As women age, the likelihood of chromosomal abnormalities in the egg and consequently, the developing embryo increases. These abnormalities can range from numerical variations, such as trisomy 21 (Down syndrome), 13, and 18, to structural abnormalities. The risk of having a child with Down syndrome, for example, rises to 1/100 following the age of 40, compared to 1/1500 at the age of 20.
Screening for Chromosomal Abnormalities
To identify potential chromosomal abnormalities, pregnant women undergo various screening tests, including:
- Ultrasound measurement of nuchal translucency (NT): This test measures the thickness of the clear space at the back of the baby’s neck between 11 and 14 weeks of gestation.
- Combined test (HT21): This blood test, combined with NT measurement, analyzes various factors like hormonal levels and patient characteristics to calculate the risk of chromosomal abnormalities.
- Non-invasive prenatal testing (NIPT): This blood test analyzes fetal DNA circulating in the mother’s blood for potential abnormalities.
- Amniocentesis: This procedure involves collecting amniotic fluid for analysis, offering a definitive diagnosis of chromosomal abnormalities.
Risk of Gestational Diabetes
Gestational diabetes, a condition characterized by increased blood sugar levels during pregnancy, is more prevalent in women over 35. The prevalence of gestational diabetes following 35 years old is 14.2%. This condition can lead to complications like excessive fetal weight (macrosomia), an increased risk of inducing labor, and a higher likelihood of cesarean deliveries.
Risk of High Blood Pressure
Late pregnancies are also associated with a higher risk of developing high blood pressure, defined as blood pressure exceeding 140/90 mmHg. Complicated cases can lead to intrauterine growth retardation (IUGR), where the baby’s weight is insufficient, and preeclampsia, a serious condition characterized by high blood pressure, organ damage, and a risk of premature delivery.
Navigating Late Pregnancy: Essential Considerations
Despite the potential risks, many women successfully experience late pregnancies. Early intervention and responsible management are crucial for minimizing complications. Here are some key considerations for late pregnancies:
Preconception Consultation
A preconception consultation with a healthcare provider is essential for assessing health conditions that might increase the risk of complications, such as diabetes, hypertension, or obesity, and for devising a personalized plan to optimize pregnancy health.
Lifestyle Modifications
Adopting a healthy lifestyle before and during pregnancy is paramount. Recommendations include:
- Quitting smoking, alcohol, and excessive caffeine consumption
- Maintaining a healthy weight
- Following a balanced, nutritious diet
- Getting regular exercise
Supplementation
Pregnant women, especially those over 35, should discuss with their doctor the potential benefit of taking folic acid and, in some cases, aspirin, which might help lower the risk of certain complications.
Close Monitoring
A careful monitoring plan, including regular clinical examinations, ultrasound scans, and blood tests, is essential to track both mother and baby’s wellbeing throughout the pregnancy.
Late pregnancies require a collaborative approach between the pregnant woman and her healthcare provider. Being aware of the potential risks and taking proactive steps to manage them can help ensure a safe and positive experience for both mother and child.
Tables with WordPress Styling:
Table 1: Risk of Chromosomal Abnormalities
| Age | Risk of Down Syndrome |
|---|---|
| 20 | 1/1500 |
| 35 | 1/350 |
| 40 | 1/100 |
| 45 | 1/30 |
Table 2: Common Complications of Late Pregnancies
| Complications | Description |
|---|---|
| Miscarriage | Spontaneous loss of pregnancy before the 20th week |
| Chromosomal Abnormalities | Genetic disorders affecting the fetus |
| Gestational Diabetes | Increased blood sugar levels during pregnancy |
| High Blood Pressure | Elevated blood pressure during pregnancy |
