Notre enfant sera-t-il normal?

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Notre enfant sera-t-il normal?

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Certaines femmes traversent les 9 mois de la grossesse sans inquiétude, comme protégées par les bonnes fées. Mais la plupart des femmes enceintes craignent la présence d’une malformation ou d’une anomalie chez l’enfant qu’elles portent. Cette préoccupation peut se manifester avec insistance par des doutes et des questionnements permanents, ou d’une façon plus voilée, plus intermittente.

Lorsque vous êtes préoccupée, vous avez besoin de vous exprimer, mais souvent votre pudeur ou la crainte d’être jugée ridicule vous en empêche. Vous savez qu’il s’agit de peurs irraisonnées, mais vous ne pouvez les chasser. Certaines questions vous assaillent. Suis-je capable de porter un enfant normal? Vais-je payer trop de bonheur?

Ces questions s’expriment avec plus ou moins de force selon l’histoire de chacune, mais je les retrouve très fréquemment chez mes patientes. Le rôle du praticien est d’essayer de faire la part des choses dans vos craintes et de rechercher si votre enfant a des risques objectifs d’anomalies.

Voici quelques points de repère qui vous aideront à ne pas vous inquiéter inutilement :

La plupart des anomalies de la fécondation sont supprimées spontanément au cours des premières semaines de la gestation par une fausse-couche très précoce, qui passe inaperçue. La sélection naturelle élimine les « mauvais œufs ».

De nombreuses situations préjudiciables pour l’œuf sont évitables.

Vous avez pris les précautions nécessaires pour vous soustraire à un risque contagieux de la rubéole, de la toxoplasmose, de la syphilis. Vous faites attention aux incompatibilités médicamenteuses, aux vaccins autorisés et vous ne vous êtes exposée à aucun produit toxique.

S’il n’y a aucune maladie héréditaire dans votre famille ni dans celle de votre mari, si vous avez moins de 38 ans et si vous n’avez pas épousé votre cousin germain, vous ne faites pas partie d’un couple à risque.

Même lorsque toutes ces conditions favorables sont réunies, votre anxiété diminue mais ne disparaît pas. Peut-être avez-vous lu qu’il existe un pourcentage, faible mais constant, d’enfants malformés. Sachez que ce pourcentage (autour de 1 %) comprend aussi bien des malformations graves que des malformations mineures, sans conséquence importante, comme le daltonisme, un petit doigt de pied ou un mamelon supplémentaires.

Pourtant, malgré ces informations, votre crainte demeure.

La régularité et la qualité des examens en cours de grossesse sont aujourd’hui des facteurs rassurants. On dispose désormais de la surveillance échographique et tout particulièrement de l’examen dit de morphologie, qui permet vers la 21e semaine de grossesse d’analyser en détail les différentes structures du bébé. Parfois on ne pourra pas observer toutes les parties du fœtus à cause de la position du bébé qui ne s’y prête pas ; il faudra alors renouveler l’examen quelques jours plus tard.

On peut également procéder à des examens plus spécialisés, comme l’échographie cardiaque ou encore l’échographie trans- fontanellaire, qui étudie les structures du cerveau du bébé. Ces examens ne sont généralement envisagés qu’en cas de nécessité, s’il y a anomalie lors de l’échographie de dépistage.

L’échographie peut diagnostiquer des malformations mais peut-elle diagnostiquer toutes les anomalies et en particulier celles qui sont en rapport avec une aberration chromosomique ? Elle ne le peut pas, mais c’est un domaine qui évolue très vite avec la haute précision des machines échographiques et l’habitude des médecins. Ainsi peut-on, dès à présent, déceler à l’échographie des signes évocateurs de certaines anomalies chromosomiques par l’analyse des mensurations de la face, du cou et de certains os du fœtus, de mouvements anormaux des membres, ou d’une position particulière des mains et des pieds, ou encore une anomalie du flux sanguin de l’artère ombilicale.

Certains signes sont formels, d’autres moins, mais ils attirent l’attention et invitent, s’ils persistent, à un complément d’examen, en particulier à une étude du caryotype fœtal (carte d’identité des chromosomes). Ces signes d’appels échographiques sont aujourd’hui un des moyens de dépister les malformations chromosomiques, quel que soit l’âge de la femme enceinte. Dans ces conditions la majorité des situations à problème sont détecter.

Si, malgré toutes ces informations, vous êtes toujours inquiète, la préparation à la naissance peut vous aider considérablement, car vous rencontrerez d’autres femmes enceintes, qui ont les mêmes bouffées d’angoisse que la solitude aggraverait. S’il persiste toujours un irrépressible petit lot d’angoisse, ne le renfermez pas en vous, parlez-en confiez-vous à votre médecin. Cela ne supprimera pas le fardeau, mais il deviendra moins lourd.

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