To test or not to test (Advanced maternal age)

[HappyFox05]

Hi. We're pregnant for the 6th time (3 prior miscarriages) and at yet another hospital (Army family) and the policy at this place for "older" women besides the normal care at the hospital, is to send them to a high-risk pregnancy specialist 90 minutes away for the triple screen test, an ultrasound, and other testing. We've ALWAYS been high-risk, as at our first pregnancy, I was 37. But we've never had to see a specialist - like I said, this is this hospital's policy. I'm not a huge fan of tons of testing - I've always turned most of them down - and I'm also not a fan of having to drive 3 hours to see someone. Plus, DH is so busy at work, he rarely has time to watch the kids, so there's that too. I'm going to try to call the CNM at the hospital with whom my next appointment is (the last was with an OB & he's the one who set up all this stuff) but I wanted to get the opinion of the mother-at-large. Are we lousy parents if we tell these people, "Thanks, but no thanks."? I haven't done any research on the tests in years, so I can't remember how reliable they are. Thanks!

[greenmamato2]

The tests are pretty reliable, but can give you a false positive about 5% of the time, if I remember right.  They can re-test later to ease your mind if you are concerned.  I wouldn't necessarily balk at the ultrasound tests, but I would definitely turn down an amnio unless you absolutely wanted one just because there is added risk there.  

We have a lot in common.  We are a military family (just got out actually, after 9 years in) and I've been to many-a-hospital myself.  Bonus with traveling to go get the tests is you and hubby will get travel pay.  You can even eat out on the government's dime. ;)  Another thing we have in common... it is my 6th pregnancy, and I've had 3 losses.  (((HUGS))) - I know how hard it is to go through that. 

That said, if you don't want to get the tests, it is fine!  It is up to you what you want for your pregnancy.  Our doctor suggested we get the test too since I am in my thirties, and I told him I would have to think about it.  I already have one child with special needs (not something that is visible in the womb, or genetic), so it would be really helpful to know if we have another one coming with special needs.  That said, even our doctor said that the most common reason people get the test (that he's seen personally) is to know if there is a life threatening problem to the baby, and to make a decision to terminate or not if it is something fatal.  The chances of that are very very slim, so he did tell us that it is up to us what we want to do.  I still haven't decided if we are getting the test, but am leaning toward taking them just for some added peace of mind (and hey - we get to see the baby again on ultrasound!)

[HappyFox05]

Hmmm, I should ask them about per diem. But if I can't get anyone to watch the kids, it's moot. :)

We wouldn't get the amnio and the ultrasound there (rather than at the hospital on-post) is because they're "more experienced at reading high-risk ultrasounds". I'm not really worried about the folks on post being able to read and interpret things. I should just ask the midwife why they can't do the triple screen on post.

Thanks for your help!

[katelove]

The problem with the tripe test/ USS is that it is not diagnostic. So, if you get a high risk score you then have to decide whether you want a definitive answer before birth (ammio). I personally would decide whether I would proceed to amnio before I decided about the triple test but there is always the possibility that the triple test will give you a lower risk.

Don't forget that only hospital staff are governed by hospital policy. They have to offer it and even recommend it but you are under no obligation to say yes unless you want to.

[sweetest77]

Would you do an amnio if the results show you have a higher risk of a chromosomal problem?  If not there really isn't much point in doing the testing, it only gives you a risk factor not a diagnosis...

[monkeyscience]

I agree with what several have said - there is nothing wrong with not doing the test. The real question is - What would you do with the results? Would you get further testing if you were shown to be at high risk? If not, would you make any different choices about your delivery, or planning for the baby, than you are now? Would you worry a lot about the possibilities? If you did get further testing, would the results of that affect your decision to carry the baby, or affect your decisions about delivery? Would you prepare differently to bring a special-needs child into your family?

If you aren't planning on doing anything different if the results are 'bad', I wouldn't bother with it. I turned down the screening because the results wouldn't change anything for me - I would just worry more. I wouldn't have consented to an amnio, so there wouldn't have been any definitive conclusion, either. This is also my first pregnancy, so I wanted to spend as little of it worrying as possible, and if there's a problem, well, we'll deal with it when the baby comes. dh and I felt good about making that decision for our family. Other people would want more time to prepare themselves and look in to resources, etc. But again, whether or not you have the screening done in no way changes the outcome for your baby - either they have a chromosomal abnormality already, or they don't. There's nothing negligent in not finding out. (And you would only be finding out the odds, anyway.)

[HappyFox05]

Ah, I didn't realize amnio was the follow-up test. Your responses caused me to do some more research. I don't want an amnio and we're not going to terminate. I called & cancelled the tests. Also, the OB clinic at the hospital on-post called in response to my email to the midwife. They said, "You certainly do NOT have to do any of the testing." Nice to know they're so supportive! Thanks for the advice, everyone! 

[contactmaya]

I got pregnant at 44 and gave birth 10 days before  my 45th birthday. I declined all tests because of false positives and then the necessity to follow the first trimester tests with an amnio that carries its own risk. I got the 20 week ultrasound which is fairly reliable but can miss some abnormalities. If you dont intend to terminate, then you can find out later if there are problems. The first trimester tests are there so that people can legally  terminate.

[Plummeting]

Originally Posted by contactmaya 

The first trimester tests are there so that people can legally  terminate.

No, that is not the only reason. Ultrasound misses many issues. The reason that people have amnios is because they can't just detect everything based on ultrasound alone, and unless you want to do an amnio on every pregnant woman, the screens are a good way to rule out women who probably don't need one. (And I'm saying this as a person who does not do any of the "screens" so I'm not a test pusher. What you're saying just isn't accurate.) There are some conditions that make a vaginal birth much more risky for the baby, and those will not always be detected by ultrasound, no matter how good your OB, MFM, or U/S tech (depending on who does the u/s) is. The first trimester test is done because it's more accurate than the triple and quad screens (2nd trimester tests), and gives people time to decide whether to pursue further testing and to take appropriate action for whatever lies ahead, which may or may not include terminating. My cousin, who would NEVER terminate, did all the usual testing during her second pregnancy, and was really glad she did, because her baby had some pretty gnarly issues that necessitated a cesarean delivery. They had plenty of time to prepare, and a u/s might have missed those issues. Regardless, what the OP is being offered is the triple screen, which is done in the 2nd trimester.

[Desmond61]

The tests are pretty reliable, but can give you a false positive about 5% of the time, if I remember right.

[JudiAU]

Originally Posted by Plummeting 

Originally Posted by contactmaya 

The first trimester tests are there so that people can legally  terminate.

No, that is not the only reason. Ultrasound misses many issues. The reason that people have amnios is because they can't just detect everything based on ultrasound alone, and unless you want to do an amnio on every pregnant woman, the screens are a good way to rule out women who probably don't need one. (And I'm saying this as a person who does not do any of the "screens" so I'm not a test pusher. What you're saying just isn't accurate.) There are some conditions that make a vaginal birth much more risky for the baby, and those will not always be detected by ultrasound, no matter how good your OB, MFM, or U/S tech (depending on who does the u/s) is. The first trimester test is done because it's more accurate than the triple and quad screens (2nd trimester tests), and gives people time to decide whether to pursue further testing and to take appropriate action for whatever lies ahead, which may or may not include terminating. My cousin, who would NEVER terminate, did all the usual testing during her second pregnancy, and was really glad she did, because her baby had some pretty gnarly issues that necessitated a cesarean delivery. They had plenty of time to prepare, and a u/s might have missed those issues. Regardless, what the OP is being offered is the triple screen, which is done in the 2nd trimester.

I am old and my DH is old we did and do CVS because it is much more reliable. Some people choose to do because they want to terminate. Some people chose to do it because they want information. It is offensive to suggest that people who choose first semester screening are doing it so they can terminate.

Information is power. Lack of information can be damaging or dealy. A dear friend of ours (42) had her fourth homebirth last year. No ultrasounds. No screening. Baby had trisonomy-related heard defects that resulted in brain damage. A hospital delivery with a NICU unit could have avoided the brain damage. I support women who choose note to have screenings but the fact remains...that brain damage was AVOIDABLE. Her midwife no longer delivers babies without an ultrasound.

[leafylady]

interesting read.  I'm 43 and 8 weeks pregnant with my 3rd child.  It's so hard to find info from moms in their forties here.  My first OB appt isn't for another week and I've already been wondering which screening tests he will recommend and which I would want to do.  This includes some serious discussion with my partner about what we'd do if we did find a serious problem in any of the screening tests.  

I was in my early thirties with my first 2 kids so while some tests were offered, they were not pushed.  We didn't do anything except the ultrasound.  Now I have to decide if I'd want to do any of the other screening tests.

edited to add - I'm very perturbed by the thought that I might be tossed into some high risk category just because of my age.  I'm trying not to be irritated before I even see an OB.  I chose an OB who I think would be least likely to do that, based on a doula's recommendations.

[contactmaya]

leafylady, congratulations on your pregnancy!

They will offer every test, and yes, you are  considered high risk once you hit age 35. Over 40, you are considered even higher risk.(they wanted to test my heart, and do a glucose tolerance test at 6 weeks pregnant, ive never had diabetes and am very fit. I declined both tests) I didnt opt for first trimester tests, because i think the 20 week ultrasound is a reliable test and doesnt give false positives. It  can miss some things though. If you were someone who would terminate a pregnancy  because of abnormalities, then the 20 week ultrasound would be too late, but not too late to change plans for the birth taking risks into consideration as in the abovementioned case. That is what i meant by the first trimester tests  primarily meant for those who wish to terminate. However, just because you choose those tests, doesnt  say anything about your motives. Personally, i wouldnt do the tests because the 20 week ultrasound is easier. Why bother with a plethora of tests, especially in the first trimester which is stressful enough for those in our age group, since the highest risk of all is miscarriage. I would never do the amniocentesis because it can cause a miscarriage, i would never do a test that had even a 5% false positive rate. MY understanding is that age is taken into consideration in their calculation so false positives are most likely higher than 5% the older you are.

Personally, i didnt have the time to bother with tests that werent in the developing baby's best interest. I did look carefully into the impact that a diganosis of trimsomy 18 or down syndrome would have on my birth plans. I had a homebirth with thankfully with no complications. My 20 week ultrasound came up normal. 

[leafylady]

Thanks for the support and encouragement contactmaya!    I'm not telling anyone around home until I'm past the 12 week zone, so it's great to get the support on the forums.

I'd never considered that they might want to do heart tests or that the gest. diabetes tests might start earlier.  I'm mainly thinking about whether I'd do the afp test and/or amnio, which as you say, really depends on what I'd do with that information.  This is my 3rd child, but a first time dad experience for my partner, so I feel like he really needs to hear all of the input from the OB before we make any final decisions on testing.

I had gestational diabetes with my first two pregnancies but it was easily managed through diet.  I'm not overweight and I'm reasonably fit. With my 2nd pregnancy I refused the 3 hour glucola test and went straight to the diet.  This time I intend to refuse the glucola tests all together.   I know how my body reacts to glucola and I'm sure I'll test positive for it again.   I have "inherited" a blood sugar testing machine and will be happy to work with them on managing diet, carbs and blood sugar.  

[sundaya]

I turned 44 6 weeks after DS was born, so was definitely AMA. My OB didn't once mention high risk, though, despite the fact that I was definitely high risk with my previous pregnancy (early bleeding, preterm labor, large fibroids, gestational diabetes, and polyhydramnios) He did do the GD test early, but it was because I had it in my previous pregnancy. I did not in this one, though (nor any of the other complications. woohoo!).

I do all the non-invasive screening. It doesn't give you any definitive, but I do think that a really good ultrasound tech can tell you quite a bit, even at 13 weeks. If nothing else, it was a huge sigh of relief for me. Also, since I had so many complications with the pregnancy I had when I was 41 (DD, now 3 1/2) I got to see her in ultrasounds all the time, but we only got 2 of DS, since that pregnancy was a (relatively speaking) walk in the park. If there had been any red flags at the first trimester screening, it would have just been that, and we would have made the decision from there on an amnio or CVS. . As much as I welcomed the pregnancy,and don't think there's any reason I would terminate,  the fear i had was in leaving DD to care for elderly parent(s) AND a sibling with profound needs.

Congrats on your pregnancy!