Thinking about flaking on the AFP

[ndigiorgio]

Hi All:

I am a 35-yr-old mama and am declining the amnio. Now--I'm thinking about skipping the AFP too---because my OB warned me that it would come out positive and would give me the risks of birth defects for someone with my same results, e.g. 2% of women at age 35 with your results gave birth to a baby with downs.

I am thinking if it's not an exact science it will stand to worry me more than anything. At age 35 are the risks really increased that much that my child will have birth defects?

Any other mamas out there with advice? Should I take the test anyhow?

[nausicaamom]

I'd go with your gut. I did the sequential screen (the NT ultrasound and two sets of blood work) because my husband really wanted to, but with the caveat that I wouldn't be following up a high-risk result with an amnio or CVS because of the risks - that was the deal we made. It did turn out to be all for the good since they tacked on an additional test (fragile X) which came up negative and means it's not a concern for my first (it can be a cause of some of his symptoms).

Of the screening tests, the AFP by itself is one of the most unreliable if I recall correctly and since you are against a follow-up with an amnio in case of a high-risk result, I would just opt out at this point. Good luck in your decision.

[True Blue]

The AFP has a 96% false positive rate...meaning....of the tests that come up positive, only 4% indicate an issue in reality. I don't want to be worried about a positive result on a test that is that unreliable. It means that even if you get a positive marker for something, 96% of the time it means absolutely nothing. Not good enough for me!!

[applecore]

I guess I would think about your motivation for wanting that information. Would it be so you could terminate the pregnancy? Be prepared for the possiblity of parenting a child with special needs? I think it's often way more trouble than it's worth. Given the high risk of false positive, I think it adds in a huge stress component that can be harmful to mom and baby's health. Even if you did get a positive reading, and were trying to prepare for that type of situation, it may still be a huge shock at the time of birth to see the reality of the situation. So I would weigh the possible benefits against the negatives, and see if it makes sense to do it based on your own personal situation. If you feel like it would give you a huge peace of mind to get a negative test result, then maybe it would be worth it to you. But think about how you may also react to getting a positive result and having to wait the rest of the pregnancy to find out for sure. :

[flapjack]

It's one of the tests that I would seriously advise against taking- there's something like a 5% false positive rate and a 5% false negative, plus issues like GD, non-GD, a high or low BMI in the mother, bleeding in the first trimester and many other things can skew your result. For me, there would have to be a reason other than being 35+ to consider it.

[steph117]

I'm with everyone else - think about what you'd do with the information, & how you'd respond to a positive (false or not). I'm over 35 & we're declining the test - due to the false positive rate, it just doesn't seem worth it to us, since we knew we wouldn't follow up with any invasive screens for verification & we don't want to spend the pregnancy worrying about a result that may/may not be accurate.

[ndigiorgio]

Do you all think the ultrasound provides enough information RE: does it look like the child is birth-defected? Our u/s is today...

[skirsten]

Hi ndigiorgio,

I understand the debate you're having and I am in the middle of the process of testing. See my situation in the March DDC called "positive quad screen". My husband & I decided to do the screening primarily so we could be prepared for any potential health problems our baby may have. Also, our insurance dictates that we have our baby in the hospital I work at. Between you & me, I would never be a patient here d/t poor staffing and aging, nonprogressive, non-family centered facility (don't ask why I work here- it's a long story). Therefore, we would like to be at a hospital that can manage the higher level of care some neonates may need if that is the case. At 31, my tests came back positive and I am currently waiting for the level 2 us on wednesday. I have to admit that hearing that I am at higher risk than should be expected for my age was very scary and stressful. I cried for about 24 hours, couldn't eat, and couldn't sleep. Then I pulled it together and decided "what's the point of putting myself through this?". I love my baby and termination is NOT a consideration. Nothing will change except we will be prepared at delivery for any complications. I will refuse the amniocentesis d/t the risk associated with it. Do what feels right to you- there really is no right or wrong. Just know that the results you hear may not be what you're expecting and can be very stressful. Good luck with your US! I'm sure it will be beautiful !

P.S. the creators of the quad screen publish an acknowledged 5% false positive rate.

[True Blue]

Hmmm...the number I was given was high but here is what I have found in my recent research:

The controversy in these tests lies in many places. One of which is the accuracy of the screenings. While some claim that they have only a 5% "false positive" rate, most research finds that there are 80+% rate of positive tests while the baby is unaffected. The false positive rates depend on many factors, including appropriate gestational age, maternal age, weight and the presence of diabetes.

http://pregnancy.about.com/cs/afp/a/afptesting.htm

[OldFashionedGirl]

Personally, I would decline it. (Easy for me to say at 24, lol.) I want a large family, and anticipate having children into my late 30s/early 40s, and have no plans in going along with any of those "advanced maternal age" tests. Unless you would consider terminating the pregnancy, I don't see the point.