Q&A: Testing for pregnancy risks after 40

Discussion on our Choice Moms Over 40 board… a newly pregnant 41-year-old has been warned by her doctor of the increased risk at her age of issues such as Down’s syndrome. She’s wondering which of the many options she should consider in testing for pregnancy risks after 40.

Based on the earliest testing options she had done so far, her baby has a 1 in 396 chance of Downs and a 1 in 2016 chance of Trisomy. “She is making me so nervous because of my age (41) and I am not sure if I should move forward with another test or just go with the results I have so far.” She turned to the discussion board for input.

S. offered this good advice:
Have you done the 2nd trimester ultrasound? Usually you can choose to do the amnio on the spot after the US and consultation. I did the amnio w/ my son (at 36yo) but did not do the amnio w/ my daughter (at 41yo) because the calculated risks were different.

With my son the risk of down after the ultrasound was 1:10. With my daughter, the ultrasound showed the risk to be 1:1700. The risk from amnio, if I am not mistaken, is between 1:200 and 1:400. I don’t know what CVS risk might be.

Do your math, and decide for yourself. How willing are you to have a child with special needs? For some, special needs are not an issue at all, if all life is sacred. For others, quality of life is an important consideration. You should also consider the value of an amnio (or CVS) result for you: if you will not terminate if Down is detected – why bother?

Personally, I’d do all recommended non-invasive tests, go through consultation with all results and risk factors available, and then make a decision regarding invasive / baby-endangering tests.

Said R: “My daughter is from donor embies created with a 22 year old donor, so I did not do further testing beyond the nuchal u/s and bloodwork. The MaterniT21 was not available when I was pregnant, but even though I was VERY low risk, I probably would have had it if it were available. It’s just a blood test, as opposed to a CVS or amnio. I don’t see a down side.”

D. said: “My viewpoint is that you people only do invasive testing if you: a) are willing to abort your child if something is detected, or b) want to mentally prepare for whatever it is, i.e. Down’s or whatever.

R. added: “If having the information will prompt you to do something, it is probably better to do something like MaterniT21, which is the least invasive of the options, as it is only a blood test, but very accurate. Keep in mind, it may not be covered by your insurance. I am 40, and 33 weeks pregnant. If my blood test and nuchal translucency ultrasound had come back with high chances for those things, I was prepared to have more testing. CVS most likely, as you can do it sooner than amnio. But that’s just me. As D. said, it’s an intensely personal decision.”

The original poster responded to all the great insight: “This is so helpful everyone. I am already head over heels in love with this baby and it was such a long road to get here (myomectomy, ruptured cyst, cancerous cells in the uterus, 3 failed IUIs and 2 failed IVFs)….so I don’t see myself doing anything besides having this baby unless I felt his/or her life would suffer.

But I am a big planner and I like to be very prepared for things. I think I am going to do the Maternity 21 but maybe stop there.

It is so wonderful to have you guys to ask questions of and provide support. It is hard to express is words how much that means to me.”

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