Late pregnancies: "Be careful not to sell dreams!" »

People magazines had given the info a few weeks ago without the interested parties officially confirming

Late pregnancies: "Be careful not to sell dreams!" »

People magazines had given the info a few weeks ago without the interested parties officially confirming. No more doubt: at 46, Belgian actress Virginie Efira is pregnant. She proudly poses with her rounded belly in magazine photos. In France, in 2019 there were around 43,000 births to women over 40.

Increasingly publicized, the pregnancies of celebrities in their 40s "sell the dream" and too often risk "obscuring the difficulties and risks associated with late pregnancy". Discussion without taboo on a subject of society with Professor Michaël Grynberg, head of the reproductive medicine department at the Antoine-Béclère hospital in Clamart (Hauts-de-Seine).

The Point: Some doctors use the term "geriatric" pregnancies to refer to pregnant women after 40...

Prof. Michaël Grynberg: It is not a medical term. It is a deliberately pejorative expression. We may not be in favor of this type of late pregnancy for a whole host of reasons, but to speak of "geriatrics" - a medicine dedicated to the elderly - when we evoke the case of a woman in her forties years is inaccurate and mostly provocative.

From what age is a pregnancy considered late?

There is no definition per se. The border has changed a bit over time. If we go back 30 years, a pregnant woman after 35 was already beginning to be considered a bit old. Since then, the age of the first child has continued to decline, as has the age of women who come to consult centers for medically assisted procreation (PMA). It has been commonly accepted that the passage of 40 years corresponds to that of late pregnancies. Today, I would say the threshold is more like 45 years.

Why over 45?

The medical risks then become truly significant. They are of the same nature as at 38 or 40, but in general, with advancing age, they increase for both the child and the mother. The most common, especially after the age of 45, is simply not going through with the pregnancy. After age 43, a pregnant woman has about a 3% chance of giving birth. However, two situations must be distinguished. On the one hand, there are natural pregnancies. They have a very high risk of miscarriages, almost half the time. On the other hand, the majority of births after 45 years are the result of in vitro fertilization with the donation of oocytes taken from a young woman, even if this is almost never officially said. The risk of miscarriage in a woman of about 45 years old with an embryo from an oocyte of a 25-year-old woman is then between 10 and 15%.

What are the other health risks for mother and child?

Cases of trisomy 21 are significantly increased for natural pregnancies in this age group. Then, the whole course of pregnancy is more at risk, because the uterus, too, has aged over time. So there are more complications like severe hypertension, pre-eclampsia. Sometimes this emergency results in the triggering of a caesarean section to save the mother, but it induces prematurity in the child. Overall, we must remember that we are less fit at 45 than at 30, even if, individually, the situation can be discussed.

It is still too little known, but the rules have changed since 2021. The new bioethics laws prohibit women over 45 from having recourse to PMA in France...

This law went relatively unnoticed. Many women are still unaware of it but, now, in France, doctors can no longer offer them PMA after 45 years. Patients too often still think that there is simply an age limit of 43 for IVF reimbursement. However, that has changed: today, they are reimbursed up to age 45, but beyond that we are unable to offer them assisted reproduction. Even when faced with a couple who have frozen embryos or oocytes, we can't do anything more.

For some women, this new law fell like a cleaver. Some had cancer at 40, when they wanted to have a child. They froze their eggs before receiving their treatment. Time has passed, they are cured but can no longer have recourse to IVF. For them, the change in French law was experienced as an injustice. But these are rare cases. The only solution for these women is to go abroad. Some European countries have set a limit of 50 years. From my point of view, the threshold of 45 years imposed by law is the correct one. It corresponds to the medical reality and the risks associated with pregnancy.

What effect does the media coverage of late pregnancies of actresses or famous women have on your patients?

This gives rise to false ideas. This helps to make pregnancy after 45 look like a simple story. However, I repeat, the vast majority of births obtained at this age are the result of egg donation and this is almost never said. Regularly, patients tell me about 46 or 48-year-old stars who have just had a baby. But, it's like we're selling them a dream. If one of those celebrities who happily announce their pregnancies would simply say that she had IVF with egg donation, it would surely be helpful for other women.

The postponement of the age of first pregnancy is a fact of society...

Today, women give birth to their first child on average five years later than forty years ago. They were on average 24 years old in 1974 compared to almost 29 years old in 2019. According to INED's assumptions, it is not excluded that the average age at childbearing will soon reach or even exceed 32 years. The most educated women are more concerned than the others by this delay in the age of parenthood. In 2015, the gap compared to mothers without a diploma was already four years on average.