Prenatal Screening at 35 and Beyond

It seems that everywhere you turn, there's a story about a woman over 50 having a baby.

The birth rate for women aged 40 to 44 has more than doubled since 1981, and 2003 marked the first time that births to women over 40 topped 100,000 in a single year. The changing role of women in our society, later age at first marriage, very effective contraceptive methods and the availability and acceptability of assisted reproductive technology have made later childbearing safer and more common.

When it comes to prenatal testing, what should you expect when you're over 35 and pregnant?

Many couples say they don't want prenatal testing because "they would never have an abortion" if an abnormality was detected. For others, early diagnosis of fetal abnormality and the option of early termination of pregnancy are important factors. Such testing may provide reassurance to those who would prefer to avoid any invasive procedures, and some couples want to prepare themselves for whatever lies ahead.

As recently as eight years ago, a recommendation of amniocentesis was the norm. But the picture is changing. Lots of women are no longer willing to accept the loss rate of approximately 1 in 200 pregnancies associated with the procedure. They are willing to accept a bit more uncertainty in exchange for safety. While amnio leads to a definitive diagnosis of chromosomal defects, serum-marker testing (quad screen) yields a score of relative risk for some of the same entities.

Currently, the quad screen is the gold standard for early-second-trimester screening in all pregnancies. Although it's an optional test, some care providers may actively encourage their clients to have it performed.

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