Mom at 40? Here's everything you NEED to know

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Philippe Gloaguen
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Mom at 35 or 40, or even more? Yes, it can be done, and indeed today it is done more and more often. Especially in Del Paese, which holds the European record for women with their first child at 40 and is one of the first countries in Europe where more than half of women have their first child after the age of 30.



In many cases, things go smoothly, without particular problems, but it cannot be taken for granted and for this reason some extra attention is needed. "Anyone looking for a child after the age of 35 should know that with age the risks of infertility, spontaneous abortion and chromosomal abnormalities of the fetus increase. And that a possible pregnancy will be by definition at risk"he warns Chiara Benedetto, director of one of the gynecology and obstetrics structures of the Sant'Anna Hospital in Turin and full professor at the University.



"For all women - continues the gynecologist - pregnancy has the effect of one stress test, because it involves important adaptations of various systems of the organism. Heart, veins, arteries, lungs must work under stress and also the endocrine glands and the metabolic system undergo changes ". With advancing age all this can be more tiring." Not only that: with age the risk of diseases such as high blood pressure, diabetes, obesity and problems increases. to the immune system, which can give rise to even serious complications of pregnancy ".

But what are, really, risks and complications that can be encountered if you start looking for the stork around 40 years of age? And can anything be done to prevent them?

Read also: Pregnant after 40: the testimonials

In this article

  • Fertility
  • Abortività
  • Risk of chromosomal abnormalities
  • Other risks for the baby
  • Risks for Mom
  • Delivery modalities
  • Advice for expectant mothers

1. Fertile o no?

"The first thing to know is that fertility decreases as we age, that is the probability of becoming pregnant ", explains Benedetto. The fault of the progressive reduction in the number of oocytes available and their quality. The decline begins after the age of 30, but becomes more and more significant after the age of 35 and in particular after the age of 40. AND Attention: it does not only affect women, but also men.



As the scientific journalist Chiara Palmerini recalls in the book What mothers do not tell (Code editions, 2022), "male fertility also drops significantly at the end of thirty years".

Yeah, but by exactly how much does a couple's ability to conceive drop? Palmerini says that in reality there are not many studies on the subject and, among those available, many have been conducted on women and men who have turned to assisted fertilization services, or are based on very old population registers. More recent studies, however, say that "between a twenty and a forty year old the chances of conception in the good days of the cycle are halved". Which means a couple "must try harder". But knowing that there is no guarantee that things will turn out really well in the end. That is why specialists insist a lot on this point: think about it in time and, if possible, do not postpone the search for a pregnancy.

Read also: How to get pregnant at 40

2. The risk of abortion

In the first weeks of pregnancy, spontaneous abortion is quite frequent in general: estimates speak of a risk of 10-20%. The age of the mother, however, is an important component of this risk, which increases significantly as the years go by. This is clearly stated in a document recently released by the American College of Obstetricians and Gynecologists, according to which spontaneous abortion affects 9-17% of pregnancies for women between 20 and 30 years, 20% around 35 years, 40% for the forties and 80% over the age of 45.



3. The risk of chromosomal abnormalities

This is also a known fact: together with the maternal age, the possibility that a possible child is affected by chromosomal anomalies also increases. The risk of having a child with Down syndrome, for example, goes from one in 1500 at 20 to one in 800 at 30, one in 270 at 35, one in 100 at 40, and one in 35-50 at 45.

If you are pregnant, to learn more about your individual risk of having a baby with Down syndrome - or with other chromosomal abnormalities - you can do a test at screening, such as bi-testing or fetal DNA analysis from maternal blood. These tests provide an estimate of the risk, which is now very accurate. However, if you want to have a sure diagnosis you have to rely on invasive techniques, such as amniocentesis and CVS, which however involve a minimum risk of fetal loss.

4. Other risks for the baby

Let's face it right away: in most cases the children of mothers over 35 or over 40 will have no problems and will arrive healthy at term of pregnancy. However if the mother is no longer very young there is some more risk. And unfortunately we are talking about risks that can also be serious.

"Studies tell us that the risks of increasing with age premature birth, with all the consequences this can have for newborns, di reduced fetal growth, of low birth weight (especially for mothers over 45), of placental abruption and also of stillbirth"says Benedetto.

For example: a large epidemiological study conducted in the United States with a sample of over 8 million pregnant women of varying ages showed that the risk of uterus death is twice as high for mothers over 45 than for mothers under 35. As reported in the scientific journal PLoS One, we go from 4 cases per 1000 for younger mothers to 5 cases per 1000 for the 35-44 age group, to 10 cases per 1000 over 45 years. It is clear that we are talking about small risks and events which are however rare in the general population, but it is right to point out that they exist.

Obviously the risks also depend on the general state of health before pregnancy. A healthy, normal weight woman with a balanced lifestyle has less risk than an obese woman with diabetes. However, the fact remains that, with the same health conditions, a woman later in life has some more risk than a young woman.

5. The risks for the mother

The same goes for the mother as for the baby: over 35, but above all over 40 and even more so over 45 there is some extra risk. About what? for example of gestational diabetes, previous placenta, post-partum stops (with need for transfusions), preeclampsia.

"The physiological changes caused by pregnancy put the organism to the test. If it is no longer very young, it may not be able to adapt optimally and therefore decompensate" explains Benedetto.

Unfortunately, maternal mortality is also increasing. Also the study published on PLoS One showed that, in the sample examined, the cases of maternal deaths went from 6 per 100 for women under 35 to 60 per 100 over 45 years. An objectively higher risk, even if luckily we are always talking about very small numbers. At the level of individual perception, in reality, not much changes, but it is right to know how things are.

Moreover, the analysis of the data collected in Del Paese during a project of the Higher Institute of Health on the surveillance of maternal mortality had also achieved similar results, highlighting that women over 35 have a risk of death by childbirth. three times higher than the younger ones.

6. Caesarean by force?

Another fact that emerges from the studies is that there is more among mothers over 35 widespread caesarean section. "The probability that a woman over 35 will give birth by caesarean section is about 1,6 times higher than younger women", explains Benedetto.

But be careful: the caesarean is not "obligatory" just because you are no longer very young: it depends from case to case, from condition to condition. "Age alone is not enough to establish that childbirth should take place like this" underlines the gynecologist.

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7. Advice for expectant mothers

In summary: looking for a pregnancy at 35 or 40 is not crazy. But it's not a walk in the park either. You have to take into account that it may not arrive, and know that there is some extra risk. Significant risk regarding spontaneous abortion and chromosomal abnormalities of the fetus, very minimal but real risk regarding fetal (including stillbirth) or maternal problems.

"This is why it is important for women with this condition to ask the gynecologist for one preconception counseling, before getting pregnant "warns Benedetto." First of all to clarify the ideas on the path they are about to take, and then to get information on preventive strategy to be put in place to reduce any individual risks as much as possible ".

In general, it is very important lifestyle (applies at any age, but even more so if you are no longer very young): yes to a balanced Mediterranean-style diet and moderate physical exercise, no to smoking, alcohol and excessive stress. Yes also to the intake of folic acid already two / three months before conception, essential for the prevention of the risk of neural tube malformations such as spina bifida.

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"For the women who have some chronic disease moreover, like diabetes, it is very important to verify that the disease is under control ", explains Benedetto." Furthermore, in some cases it may be necessary to review the therapy, to avoid possible harm to the fetus by drugs ".

Parents farther and farther: here's why

As a matter of fact, in many parts of the world, children are getting late and late. But why this trend? According to an article on the subject of over 35 motherhood published on the Evidence Based Birth website, it would be one combination of medical, cultural and social factors to account for this trend. Here are the main reasons called into question:

  • availability of contraceptive methods;
  • achievement by women of higher educational levels;
  • entry of women into typically male work environments, where motherhood is not sufficiently supported;
  • cultural changes that cause women not to feel ready, when young, to have a child;
  • lack of labor policies and social networks to support working women, so women often have to decide whether to work or have a child;
  • instability in relationships, economic or related to housing;
  • availability of assisted fertilization treatments.

TAG:
  • pregnancy age
  • mom over 40
  • fertility
  • infertility
  • Caesarean section
  • termination of pregnancy
  • down syndrome
  • prenatal diagnosis
  • stillbirth
  • maternal mortality
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