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Ashley Hickman Zink, M.D. Answers Questions On Age and Pregnancy

Ashley Hickman Zink, M.D. Answers Questions On: Age and Pregnancy

Are pregnancies automatically deemed “high-risk” for women 35 and older?

Not necessarily. Nothing magic happens when you turn 35. The issue of age is more related to whether people have amassed health problems over those years. For example, a 22-year-old woman with lupus and a prior kidney transplant is much more at risk for adverse pregnancy outcome than a healthy 37-year-old with no serious existing health issues. 

Certainly achieving pregnancy can be more difficult as women age, and this should be considered in family planning. Also, risk of aneuploidy increases with maternal age. Whereas a 26-year-old woman’s risk of Down syndrome is 1 in 830, a woman who will be 36 at delivery has a risk of 1 in 210.  This is where we are able to help women navigate the ever-expanding testing options that are available to assess their personal risk.

So unless it’s a situation of something like extreme maternal age, in general, women who take care of themselves and don’t have health problems usually do well regardless of age – and so do their babies.

Should patients without a family history of a medical condition still consider genetic screening?

There are different ways that conditions can be “genetic,” so it depends. Sickle cell disease and cystic fibrosis, for example, are familial conditions – ones for which patients may have a family history.

Conditions such as Down syndrome are genetic – they involve the genes (chromosomes) – but they’re not familial. So there’s a risk for it in every single conception, even if someone doesn’t have a relative with the condition.

What are the most common risk factors for high-risk pregnancies?

Multiple gestations and maternal health conditions such as diabetes, hypertension, or autoimmune disorders are among the most common risk factors for high-risk pregnancies.

Another risk factor is a previous pregnancy that had a poor outcome. Depending on what happened, we may want to follow the patient more closely in subsequent pregnancies.

For instance, a woman who had a pre-term delivery in her last pregnancy because she had twins is not necessarily going to have that happen again with a single-fetus pregnancy. But pre-term delivery due to cervical incompetence is something that tends to follow you. Likewise, women who have carried babies that didn’t grow very well often face that issue again.

What can you tell from an ultrasound procedure?

Routine ultrasound allows physicians to visualize an unborn baby’s anatomy using sound waves. Targeted ultrasound – previously known as Level 2 ultrasound – enables us to look at very specific structures in a more detailed fashion than is possible with routine ultrasound. It is typically used to screen for anatomical issues related to chromosomal disorders (aneuploidy) or if birth defects are suspected.

While today’s ultrasound and other prenatal-diagnosis technologies can provide us with valuable and amazing information, there are limitations to what they can do. 

Neither routine nor targeted ultrasound can tell us about anything functional, only structural. For instance, I’m able to tell if a baby has eyes and ears, but I can’t tell if he or she will be born blind or deaf.

Why is preconception and interconception counseling important?

Preconception care is important for parents with a family history of genetic disorders and for women with health issues. It gives us the opportunity before a woman becomes pregnant to determine if either parent has a genetic condition that is likely to be passed along – and helps me decide if any tests would be valuable.

For example, if a patient’s full sister has a child with sickle cell disease or cystic fibrosis, the sister is a genetic carrier of that condition – and the patient has a 50 percent chance of also being a carrier. If mom and dad are both carriers, there’s a 25 percent risk that their child could be affected by something very serious.

Knowing this allows me to discuss options with mom and dad, and to work with them to develop a strategy prior to a pregnancy. Some patients opt to conceive with a sperm donor who’s negative for the condition in question, while others decide to take their chances, watch, and wait. Patients planning to undergo in vitro fertilization may choose pre-implantation diagnosis so that only embryos unaffected by the condition are implanted.

Interconception counseling involves planning future pregnancies when there’s been an issue with a previous pregnancy. I’m often asked to see families in the hospital because of pre-term labor. If my ultrasound shows that’s happening due to an issue likely to cause a problem in future pregnancies – such an incompetent cervix – I want to have a conversation with the patient and work with her to create a plan that reduces the risk of the problem occurring again.