Wednesday, April 2, 2014

Advanced Maternal Age, Genetic Testing and Freaking Out

In case you missed the announcement last week, I am pregnant with baby number 5. I'm actually due in October, but the baby will arrive in September because all of mine come about a month early.

I've alluded to the fact that this pregnancy is different from the others in many ways, and I'd like to talk about one of them today.

I'm old. Practically a dinosaur, at least according to some people.

Didn't you know we come with expiration dates???

I have this condition of oldness which actually has a formal name. Ready for this awesomeness???

Advanced Maternal Age.

AMA.

The last time I had to worry about anything with those initials, I was signing myself out of triage, pregnant with Little Boy, Against Medical Advice after arguing with a doctor who insisted I was being irresponsible. He was so sure that I was in preterm labor and wanted to admit me, administer all kinds of medications. Didn't matter how many times I told him about my history, he didn't care.

I have an irritable uterus, which means that I have mostly regular contractions for weeks, even months, before delivery. People always freak out. They tried to stop the contractions with Mini Me, and it didn't work. All that happened is that the medication they gave me triggered my genetic predisposition to hypertension (which is super fantastic, by the way).

He made me sign out AMA after I refused all the interventions and pulled the monitors off, then wagged a finger at me and said he'd see me in a few hours. Then threatened that they would have to transfer me to another hospital because of how early it was.

I didn't have the baby for 5 more weeks. Ironically, the finger wagger was the one who delivered. I did enjoy telling him how wrong he was. Oh yes I did.

Anyhow, the AMA I have to worry about now is another AMA. Old lady syndrome.

These days, any pregnant woman who will deliver at the age of 35 or over is considered high risk. The cutoff is pretty arbitrary if I'm being honest, and there is almost certainly a difference between a first time AMA mother and one pregnant for the sixth time. I mean, it would be hard to have as many kids as I do and not be old by the time you were done, just doing the math.

Technically, I got pregnant when I was still 36. I am 37 now.

Are there increased risks because of age alone? Sure, but to be honest, they are risks I'm already flagged for. I have problems with prematurity, blood sugar and blood pressure. Not because I'm old, just because I'm me. Which is awesome.

I'm old now too, which means that I get the at your age lead-in to everything anyone says to me about being pregnant this time. As if this is my first trip to the rodeo. As if I don't already know all the things she is going to try and scare me about. As if I'm not the patient who has endured all these complications eight months at a time four times before. As if I'm not the one who already went in and had blood work run by my regular doctor to make sure my kidney, pancreas and thyroid were fine, had my A1C checked, and had my bp meds changed to the ones safe to take. As if.

Anyway. I guess I'm not a typical patient. She's figuring that out quickly.

Plus I'm old now, which is super fun. Because of my age, they have to give me all the speeches about genetic abnormalities now in addition to all the other speeches. I've never had to go through this part of it before, and let me tell you....people with anxiety shouldn't be given more stuff to worry about.

For serious.

At my appointment next week, I will have two genetic screening tests done because of my age. One is the NT Scan, which is a non-invasive ultrasound screen that looks for development of major organs and scans for the soft markers of certain abnormalities. The NT stands for nuchal translucency, which is a measure of how much fluid is present near the nape of the neck of the fetus. Excessive fluid is considered a soft marker for Down's Syndrome.

The other is a blood test, still considered a screening test and not a diagnostic one, but one that gives a better indication of how likely certain chromosomal abnormalities are. It screens for more than Down's, and can tell the gender of the baby through fetal DNA shed into the mother's blood. It used to be that only ultrasound, chorionic villius sampling (CVS) or amniocentesis could tell us information about these abnormalities and gender. Ultrasound is not exact, and amnios and CVS are invasive tests that carry a slight risk of miscarriage and other complications. The new test is done using only a blood sample from the mother with no risk to the pregnancy.

Hooray science!

I'm trying not to do this thing that I do when I'm pregnant, which is worry about everything that could go wrong.

I didn't do that the first time I was pregnant. I didn't think about all this stuff. I was just happy to be pregnant, until I wasn't anymore. Having a miscarriage will screw up not just that pregnancy, but squeeze a little bit of the joy out of every single one that comes later on because you know that something could go wrong.

On top of all that, since the last time I was pregnant, my anxiety spiraled out of control. I have probably had it for my entire lifetime, but it has never been as bad as it was the past few years. I've got a pretty good handle on it now, and I find that talking about it out loud to other people helps to calm the beast inside my head. I know that things are in large part out of my control. I know that I am doing everything I can to manage the complications I have. I know that things will, in all likelihood, get a whole lot more complicated.

And I know that the odds are that there is nothing wrong with this baby. I know that the genetic screening will probably come back fine. The numbers are on my side. The fact that I already have four healthy children is on my side. My age, namely the fact that I'm youngish to be considered AMA, is on my side.

I know all these things, but I worry anyway. It's what I do.

Like a boss.

Like a pregnant boss.

Like a pregnant old lady boss.

Seriously. If worrying about things I can't control was an Olympic sport, I'd win the gold medal.


Then I'd be a pregnant old lady gold medal wearing boss, and that would be pretty kickass.

2 comments:

  1. First of all, congratulations!

    46 years ago who my mom had my younger brother, she was 38. Very old for way back then. But she started having kids when she was 17 so she knew what she was doing!
    So do you! Good luck with all that! You can only control what you can control!

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  2. I had my last two at.... *counting on fingers* ...... *kicks off shoes to use toes*..... 35 & 36? Something like that. I got the "at your age....." crap all of the time. And it was fine. Those two little buggers are 6 & 7 now. Science has gotten better even since then.

    You got this, Mama. You got this.

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