NEWS CORNER

Planning for Pregnancy in your Thirties: 3 Things to Consider Before You Start Trying 

By Sheila Scott

Women are waiting longer than ever to start their families, and in 2017 the birth rate for US women in their thirties surpassed women in their twenties for the first time ever. For women who have carefully planned every step of their education and careers, it feels natural to approach pregnancy with the same level of planning, research, and information.

For many women, knowing where to start that research can be a little challenging. Social networks have always been a source of information about pregnancy and parenting: friends share details about their healthy pregnancies, and maybe they’ve even shared the heartbreak of a pregnancy loss. Taboos surrounding post pregnancy bodies and issues like postpartum depression are eroding and women are openly sharing more about them with each other. 

However, pre-pregnancy still feels out of bounds for discussion. No one wants to bring up a topic that could be painful for someone who is struggling with infertility. And then there are those who didn’t struggle with fertility: according to the CDC, around 45% percent of all pregnancies in the US are unplanned, so if a woman asks her parent friends what they did to prepare for pregnancy, there’s a good chance they may say—nothing!   

That can leave the information-seeking woman typing something like “What to do before you get pregnant” hopefully into a Google search and getting a response that doesn’t quite answer all of her questions. The CDC’s “Before Pregnancy” guide to Preconception Health and Healthcare tops the list of many searches and provides a good basic overview in its Planning for Pregnancy list. However,  women looking for more sophisticated advice than “stop taking street drugs,” or “start taking folic acid” may be left thinking “Hey, that’s great, but where’s the checklist for me? I know things are different than when my mom was pregnant, what else can I do?” 

Is the information out there up to date? What parts of my family health history are important for my future children? What tests are available now that didn’t exist just a few years ago? Are they legit? Could I learn something that could completely change my plans for parenthood? 

We’ve compiled the top 3 ways to get information about your health and body before pregnancy to help you approach planning your family in your thirties and beyond.

1. Genetic Counseling – More than Family History

Genetic counselors are healthcare professionals who have specialized training in medical genetics as well as in counseling. This puts them in a unique position to provide guidance on your specific genetic risks and appropriate testing options. It also means they are uniquely qualified to help you consider how testing might impact you and your family. 

Many women will be referred to genetic counseling by their doctors during the first trimester of pregnancy, but there is no reason to wait until you are already pregnant to seek genetic counseling. In fact, it may make much more sense for you to meet with a genetic counselor before you start trying to get pregnant, especially if you have a family history of any genetic disorders.

However, genetic counseling isn’t just for people who have a family history of genetic conditions. For the majority of genetic conditions affecting newborns and children, there is no family history of the disease in question. Many of these conditions are autosomal recessive, meaning that parents are carriers for the disease but healthy themselves. Carrier screening is now available for a large number of recessive genetic conditions, but carrier screening panels vary widely and a genetic counselor can provide guidance on which one makes the most sense for you and your partner.

Could Genetic Counseling and Genetic Testing Impact Your Plans for Starting A Family?

Your genetic counselor will be able to help you understand the risk of passing on any genetic disorders that may run in your family, while also providing guidance on carrier testing and other possible testing that may impact risks to a future pregnancy. Since the outcome of genetic testing could have a big impact on your plans to start your family, the specialized counseling that genetic counselors provide can be incredibly meaningful.  During preconception genetic counseling, you genetic counselor can also discuss the types of testing that will be available during your pregnancy, such as non-invasive prenatal screening (NIPS.) It can be helpful to know what your options are before you are half naked in an exam room and your doctor is asking you about what testing you want!

2. Carrier Screening – Pre-Pregnancy Genetic Testing

Carrier screening is genetic testing done to identify carriers of gene mutations for certain genetic disorders. Carriers are generally not affected by a condition, but if their partner also carries a mutation in the  same gene, their children are at risk of inheriting the condition. If you have pre-pregnancy genetic counseling, your genetic counselor will discuss carrier screening and testing options with you in depth. 

The American College of Obstetricians and Gynecologists (ACOG) recommends screening for Cystic Fibrosis, Spinal Muscular Atrophy and, ideally, hemoglobinopathies, in all women considering a pregnancy. 

ACOG also recommends additional carrier screening, depending on your ethnic background and/or family history. Expanded carrier screening panels that test for 200+ disorders per panel are available. There are pros and cons to each type of panel, and a genetic counselor can help you decide which approach to testing best aligns with your goals and values. 

Could Carrier Screening Impact Your Plans for Starting A Family?

Carrier screening can help you understand your risks for passing on a genetic disorder to your children. What this risk means to you and your plans for starting a family will depend on what level or type of risk you and your partner can accept. These discussions and decisions can be deeply personal, which is one reason it can be helpful to have the support of a genetic counselor. A genetic counselor can also discuss with you the options for diagnosing a genetic condition during pregnancy, or even before pregnancy in an embryo when IVF is used. 

3. Preconception Checkup – Health Tests Before You Get Pregnant

A variety of health conditions could impact your ability to get pregnant or maintain a healthy pregnancy. A preconception checkup with your doctor will screen for the most common health conditions that can affect pregnancy and fertility. If you don’t already have a regular doctor, getting a preconception checkup also gives you a chance to meet with and get to know a doctor who may be seeing you throughout your pregnancy.

Could a Preconception Checkup Impact Your Plans for Starting A Family?

If your checkup reveals an untreated or previously unknown health condition, you may need to consider how your condition or its treatment could impact your plans for getting pregnant. Additionally, if you are taking certain medications while trying to get pregnant, the optimal time to discuss the impact of those medications would be before pregnancy. You may need extra care during pregnancy. Some health conditions, such as Polycystic Ovarian Syndrome, can also  impact your fertility.  

What about Fertility Screening? 

The American College of Obstetricians and Gynecologists (ACOG) guidelines recommends an infertility evaluation if:

  • You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
  • You are older than age 35 and have not become pregnant after trying for 6 months without using birth control.
  • You are older than age 40 and have not become pregnant within 6 months of trying without using birth control.
  • Your menstrual cycle is not regular.
  • You or your partner have a known fertility problem. 

Increasingly, self-directed testing is available from companies like Modern Fertility with the caveat that there is no absolute predictor of fertility (except a baby of course!) If you have any abnormal results from a self directed test, you will still want to see your doctor for thorough evaluation and guidance.

Could Fertility Screening Impact Your Plans for Starting A Family?

Hormone testing could indicate a condition like Polycystic Ovarian Syndrome, which can have a major impact on fertility. Ovarian reserve hormone testing can indicate success rates for egg freezing and IVF. If you are considering IVF or egg freezing as part of your plan, this information could be helpful. 

Finding a Genetic Counselor

Your doctor may be able to refer you to a genetic counselor within your hospital system, but referrals are not necessary to schedule a pre-pregnancy genetic counseling appointment with a genetic counselor at Grey Genetics! Grey Genetics offers telehealth appointments with a network of Genetic Counselors, including several with expertise in prenatal genetic counseling. If you’d like to learn more about prenatal genetics, visit our resources page.

Further Reading & Quality News Coverage

CDC Guide to Preconception Health & Pregnancy Planning 

Grey Genetics Expanded Carrier Screening FAQ

Grey Genetics Prenatal Genetics Resource

American College of Obstetricians and Gynecologists (ACOG) Infertility Evaluation FAQ

American College of Obstetricians and Gynecologists (ACOG) Carrier Screening Guidelines

Do you meet genetic testing criteria for hereditary breast cancer risk?

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