Genetics Counseling Helps Women of Advanced Maternal Age Determine Risks

Despite slightly higher risks, a great majority of women who have postponed motherhood until their mid-30s and beyond will have successful pregnancies. But as soon as they become pregnant, it’s important for these women to have a thorough medical evaluation with their obstetrician/gynecologist.

At Women’s Care, all pregnant patients aged 35 and older are offered a consultation with a genetics counselor to discuss their particular risks, if any, for complications. “Our genetics counselor works with a patient to examine how her risk factors affect the pregnancy, and how the pregnancy affects her risks,” explains Vern Katz, MD, a perinatologist with the Center for Genetics and Maternal-Fetal Medicine. (Perinatologists are obstetrics subspecialists who care for pregnant women when either the mother or the fetus has a condition that places the pregnancy at risk.)

Dr. Katz explains that as we age, our cells don’t divide as well as they once did. In egg cells, this means an increased risk of chromosomal abnormalities. So, as part of their genetics counseling, patients aged 35 and older are offered noninvasive screening procedures such as blood tests and detailed ultrasound to detect genetic abnormalities, including Down syndrome.

More advanced prenatal tests are available for women with specific risk factors. However, because many of these tests are invasive and come with some risks of their own, discussions with a genetics counselor are useful to weigh the pros and cons of each. One such diagnostic test is amniocentesis—a procedure in which a small amount of amniotic fluid is drawn out of the uterus through a needle inserted in the mother’s abdomen and is analyzed for genetic abnormalities.

While most women of advanced maternal age will get care from a general Ob/Gyn, sometimes a perinatologist may make evaluations and recommendations to help the Ob/Gyn if complications arise during pregnancy. Some women with certain risk factors may be cared for by a perinatologist. This is especially true for pregnant women in their late 40s, who are at a much higher risk for cardiac problems, blood clots and osteoporosis.

Dr. Katz notes that it’s important for any woman who sees a physician for a medical disease—including diabetes, epilepsy, or elevated blood pressure or cholesterol—to talk with her Ob/Gyn before becoming pregnant. “These patients can work with their physicians to monitor medical conditions and to change or adjust medications before conceiving to better insure a healthy pregnancy,” he says.

Dr. Katz also advises women of all ages who are trying to conceive to adopt a healthy lifestyle before getting pregnant. “Because the baby is forming in the first 12 weeks of pregnancy, healthy changes made before pregnancy are even more important than those made afterwards,” he explains.

Here are a few good health habits to maximize chances of a healthy pregnancy:

  • Control existing health problems such as high blood pressure or diabetes.
  • Take prenatal vitamins that contain folic acid before getting pregnant to help prevent neural tube defects such as spina bifida, a condition in which the tissue over the baby’s spinal cord doesn’t close.
  • Avoid tobacco, alcohol and illegal drugs. All have been linked to poor pregnancy outcomes.
  • Drink no more than two cups of coffee a day. More than that has been shown to increase risk of miscarriage.
  • Eat a common-sense diet including plenty of fruits and vegetables. Limit intake of fish, which may contain mercury.
  • Once pregnant, schedule regular prenatal visits.

“Genetics counselors and perinatologists are good resources to help pregnant women over age 35 explore their individual circumstances and options and make informed decisions,” says Dr. Katz.