Complications – Advanced Maternal Age

If you are going to be age 35 or greater at the time of delivery, you are given a diagnosis called AMA, or Advanced Maternal Age. While this may not seem like a flattering term (we at Oasis OB/Gyn think this age is downright young), there is a reason behind the diagnosis. Women at this age are at increased risk of having a baby with a genetic abnormality when compared to younger women. The most common abnormality women think of is Down Syndrome. The risk increases throughout your childbearing years but on a much steeper slope after age 35. For example, the risk of Down Syndrome at age 35 is 1 in 270, at age 40 it is 1 in 100 and at age 45 it is 1 in 40 vs. approximately 1 in 2-3000 for women in their twenties. The risk for all abnormalities is further increased. However, please keep in mind that your chance of having a healthy baby is still greater and most women go on to have very successful pregnancies. Because of the increased risk, we do offer genetic testing early in your pregnancy. This can be accomplished by a screening test or a definitive test, such as amniocentesis or chorionic villus sampling.

Amniocentesis is performed typically between 15-18 weeks by inserting a needle through your abdomen into the uterine cavity to withdraw fluid from around the baby. This fluid is then sent for a chromosome (genetic makeup of the baby) analysis. The complication rate is approximately 0.5%.

Chorionic villus sampling, or CVS, can be performed earlier, 11-14 weeks, with a slightly higher complication rate of 1%. This is accomplished by passing an instrument through the cervix to remove a very small piece of placenta, which is then sent for a genetic analysis.

Screening tests are becoming popular options for all ages of women, as they do not increase risk to the fetus. The ultrascreen is performed near the end of the first trimester. It involves a fingerstick for blood and an ultrasound to measure the back of the baby’s neck. A risk assessment is then given to determine if you are at increased risk of having a baby with certain genetic disorders, such as Down Syndrome. If so, an amniocentesis may be recommended. Many times, the risk is found to be less than your age related risk, in which case women of advanced maternal age may avoid a more invasive procedure.

Another screening test may be performed during the second trimester, if you decline the first trimester screening. It involves drawing blood to analyze certain proteins in your blood, which then gives a risk assessment for disorders, such as Down Syndrome and spina bifida. If the risk is elevated, an amniocentesis may be recommended.

For many women, it is difficult deciding whether or not to have genetic testing. All these tests are optional. Some women choose testing, as they may terminate the pregnancy if their baby has a genetic abnormality. Some abnormalities found are incompatible with life. Other women may not terminate, but want as much preparation time as possible should there be an abnormality. Still others may worry about the possibility of an abnormality so much that testing is a way of putting their mind at ease. Whatever your decision, it is a personal one. We respect & support your decision.