Pregnant at 40: women who want to have children should take this into account

Today it is not uncommon for women who are 40 or later to have their first child – but the older the mother, the more risks there are in pregnancy. In the interview, reproductive doctor Prof. Würfel clarifies the most important questions about a late pregnancy.

While it is for our parents’ generation and grandparents was still common to get married in your early 20s and a short time later with the Starting to start family planning has changed in the meantime: Many women want to start their careers, pursue a career after completing their training or studies, or realize themselves with a longer trip before they think about starting their own family and having children. Many women who want to have children, on the other hand, do not have the right partner – and once they have found their partner, it is important to make a decision quickly.

Naturally, the chances of a natural pregnancy at 35 and older are getting smaller. And even if it is possible to get pregnant with 40plus, there are some health hurdles that a late pregnancy for mother and baby brings with it. Prof. Dr. explains what risks are involved in pregnancy from the age of 40 and other important information that you should consider if you want to have children late. Dr. Wolfgang Würfel. The reproductive physician has been working at the Kinderwunsch Centrum in Munich-Pasing, which he co-founded in 1985.

DONNA Online: Prof. Würfel, already at 30, fertility gradually decreases – how high is the chance, statistically speaking, of getting pregnant naturally at 40plus?
Prof. Wolfgang Würfel: The fertility of a woman is slowly declining, rightly, as you say, from the age of 30. You can see this in the success rates of artificial insemination. After the age of 40, these success rates decrease dramatically every year. This is no different in a natural way: the chances of a patient who has not yet given birth to get pregnant from the age of 40 are around five to eight percent per cycle, with a 45-year-old maybe one to two percent.

What are the risks for women of late pregnancy??
On the one hand, an increased maternal age for pregnancy goes hand in hand with increasing genetic risks with regard to the embryo. In other words, trisomies like trisomy 21, 18 or 13 increase significantly. This has to do with the age of the egg cells, because egg cells are not newly formed, but are always as old as the patient herself. In addition, it must be taken into account that so-called "pregnancy poisoning" with increasing age of the woman, If you has not yet given birth. This is medically called pre-eclampsia.

To what extent, from a medical point of view, the age of the mother can have a negative impact on the child?
This actually arises from the previous question – whether that can be rated as "negative", I leave that open. It is true, however, that pre-eclampsia has an impact on the course of pregnancy, namely with regard to prematurity and deficiency developments. However, one should not “over-dramatize” the frequency.

Does it make a difference whether a woman with 40plus is expecting her first child or is pregnant at this age after she has already had one or more births?
Yes, it makes a difference whether a woman with 40plus is expecting her first child or whether she has already had several births. It is well known that the more you have given birth, the easier it is to get pregnant – the ancients knew this only too well. Example: A woman with ten to 15 children – as was customary in the past – always reported that the intervals between pregnancies narrowed even though the woman was getting older – so the opposite should actually be the case.

What tips do you give women 40plus who come to you because they want to have children??
Women who come to us with 40plus because they want to have children have to be very realistic about what reproductive medicine can do, at least with regard to a genetically separate child. You shouldn’t have exaggerated expectations here. And you shouldn’t let the "plus" get too big – 41 has a much more favorable forecast than 43.

Are there any health conditions or illnesses in which you should definitely advise older women against pregnancy?
Of course, there are general diseases in which you would be advised against pregnancy. These would be autoimmune diseases such as systemic lupus erythematosus or similar. However, really massive diseases – apart from malignant diseases – where you have to advise against, there are only a few. Some autoimmune diseases improve during pregnancy, such as multiple sclerosis or primarily chronic polyarthritis (PCP)..

Preventive care should be given more frequently to women who become pregnant with 40plus during pregnancy?
Pregnancy at 40plus is considered a “risky pregnancy”. For this reason alone, there is a requirement to visit prenatal care more often. I recommend this, basically for psychological reasons.

Is a natural birth possible during pregnancy with 40plus – or do you recommend a caesarean section in such cases?
Of course, a natural birth is possible with a pregnancy of 40plus, you should also strive for it. I definitely do not recommend a primary section (red note: caesarean section), at least not due to age.

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