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Knowing the Risks

by Allyson Budassi

The road to building a family isn’t always easy, but advancements in care and testing are making high-risk pregnancy less of a gamble.

Pregnancy is viewed as a fairy tale for some, with the end result being that beautiful baby boy or girl to hold, care for and love the rest of our lives. But while it’s easy to think that those nine months should be pure bliss while parents start to prepare for their little one, the truth is there can be underlying risks that some couples may not know about that can make their fairy tale anything but.

When a couple decides to build a family together, they should be aware of those issues that can come to the forefront, especially if the mother is told she is high risk, so that any possible bumps in the road to building a family don’t have to result in a roadblock. Pregnancy is an exciting moment in one’s life, but it’s better to be cautious and know what’s available to make the process easier, and to ensure that fairy tale is attainable for all.

What makes a woman high risk?
A history of diabetes or cancer, carrying multiples or simply being over the age of 35 years old can constitute a woman being high risk during pregnancy. Obstetricians and fertility specialists provide special care for these moms-to-be by providing regular checkups and ultrasounds as well as specialized testing to make sure that both mother and child are healthy.

“We have two patients, mom and baby. The reality is, it’s an important issue,” says Dr. Daniel Berger, chief of obstetrics for Our Lady of Lourdes Medical Center in Camden.

The subject of high-risk pregnancy is broad, but there is so much information out there for parents as well as tests that can be done for expectant moms so that they may be educated and continue on the journey with eyes open. High-risk women are watched more closely by doctors, but it’s not just up to the doctors to ensure a healthy pregnancy. The moms play a big role as well.

If a woman who falls under any of those high-risk categories is planning to try for a baby, it is recommended that she go to a pre-pregnancy checkup first so the doctor can be aware of any concerns early on. “It’s very important to diagnose women prior to pregnancy,” says Dr. George Taliadouros, founder and director of the Delaware Valley Institute of Fertility & Genetics (DVIF&G) in Marlton. “All these changes happen in nine months. If someone has a condition, the clock is ticking.”

The risks involved
Whether she’s diabetic or carrying multiples, the mom-to-be should try to be in the best possible health to keep from having serious issues before, during and after pregnancy.

Taliadouros, considered an expert in reproductive medicine, stresses it’s important for a woman to take care of her body before she even becomes pregnant. Everyone has a past and it may affect them more than they realize. Everything starts from conception, he says, so a woman should ensure it begins in a safe environment. “Anyone who wants to be pregnant should be healthy,” he says. “It’s like she’s programming a computer with a life expectancy of 90-plus years.”

When difficulties in getting pregnant to begin with arise, places like DVIF&G offer treatment options for both men and women, from nutritional counseling to IVF. Age is also a very important factor because as a woman gets older, her eggs lose their health. “Age alone is a barometer. Fertility wanes for older women,” explains Berger. Our bodies change as we age, and there is a higher risk for developmental conditions such as Down syndrome.

There are always potential complications during any pregnancy, but when a patient is categorized as high risk, the complications can become even more serious. Women who carry multiples are at a higher risk of going into premature labor. Other complications that can arise are possible congenital anomalies and heart defects. Technology today provides many advancements in prenatal testing that are available for high-risk moms, including chromosomal testing. There are also tests that are now provided at a younger gestational age where doctors can find any possible complications early on in the pregnancy, allowing parents to decide how they will move forward.

Advancements in testing
Tests are recommended by doctors to ensure the baby is healthy and to keep parents up to date on the process. Within the first trimester, there is a sequential screening, which tests for chromosome issues such as Down syndrome, Trisomy 13 and Trisomy 18. It is recommended for all pregnant women and is at least 94 percent accurate. There are other tests that are available as well, depending on the conditions of the pregnancy.

“Extra testing has to be tailored,” says Dr. Byron Hapner, an obstetrician at Inspira Medical Center – Woodbury. “We tailor the management based on the condition.”

In addition to the standard blood work and ultrasounds women usually have, some specialists may recommend having more in-depth tests done, such as amniocentesis or Chorionic Villus Sampling (CVS). These tests are usually provided around 11 to 13 weeks of pregnancy and prove to be 100 percent accurate in determining issues such as Tay-Sachs disease or hemophilia. CVS is usually done when either the mother or the father has a genetic disorder that runs in the family, but women over the age of 35 may have the test done as well. CVS is done by inserting a flexible tube through either the cervix or abdomen into the placenta. An ultrasound is also provided to guide the catheter or needle in order to collect the sample.

Amniocentesis is a prenatal test where a small amount of amniotic fluid is taken from the sac, which surrounds the fetus. A needle is placed through the uterus and into the abdomen in order to find any chromosomal abnormalities. Aside from birth defects, amniocentesis can also be used to look for neural tube defects, such as spina bifida. Though these tests are accurate, parents should be aware there is a low risk of miscarriage.

Additional prenatal tests are out there and the Harmony Prenatal DNA test and Panarama prenatal screening test are just some of the more advanced screenings. They are provided in the first trimester at 10 weeks or less and are considered non-invasive. Blood is taken from the mother to measure the fetal DNA in order to find any genetic disorders. Though these tests are not currently designed for all pregnant women, they seem to be headed in that direction. “Research is being done so it can be approved for everyone,” Hapner says.

With all of the advancements in technology, parents have many avenues they can now utilize in order to have a safe and healthy pregnancy. In the end, it’s always important for parents and doctors to come together and have an open dialogue as well. “Sometimes you can’t prevent everything,” Berger says, but then he stresses: “We are all looking for the same thing—a safe and healthy mom and baby.”

Delaware Valley Institute of Fertility and Genetics
6000 Sagemore Drive
(856) 988-0072

Inspira Medical Center – Woodbury
509 N. Broad St.
1 (800) INSPIRA

Our Lady of Lourdes Medical Center
1600 Haddon Ave.
(856) 757-3500

Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 5, Issue 4 (June, 2014).
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