“Mom, I have some not-good news,” my 35-year-old daughter told me. Jeanie was 10 weeks pregnant and had just received results from a routine prenatal blood screen. Her voice was flat, and my stomach dropped.
My daughter had been excitedly waiting to learn the baby’s sex from this test. Instead, Jeanie was told that her fetus “might” be as higher risk for chromosomal abnormalities.
The test was inconclusive. Jeanie was assured there were several common reasons for such a result. Women who were overweight, had gotten pregnant through IVF (in vitro fertilization) or were carrying multiples often had inconclusive results on this screen. But my daughter met none of these criteria.
Jeanie had follow-up genetic testing. Meanwhile, the original test was repeated, and this time came back clear. The baby is due later this year.
The prenatal screening that threw us into a panic didn’t exist when I gave birth to my daughter back in 1985. Jeanie’s follow-up genetic testing also revealed that she’s a carrier for some obscure disease that I’d never heard of. What’s more, based on ethnicity, that particular gene likely came from me. That test, too, didn’t exist back in the day.
First-time boomer grandmothers-to-be — beware. Or at least be aware. What to expect when your kid is expecting is a lot more testing and a lot more information about the fetus. That knowledge is a double-edged sword. Doctors know more, but they can’t necessarily do more. Angst for moms and grandparents-to-be is higher than ever.
“Genetics is probably the biggest explosion,” says Laura Riley, M.D., obstetrician and gynecologist-in-chief at New York-Presbyterian/Weill Cornell Medical Center and chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine. “Women are now faced with things they were not faced with before. With carrier screening, the panel now has 560 things; literally a year ago it was 280 things. It definitely creates more anxiety.”
Thirty years ago, genetic carrier screening could pick up only cystic fibrosis and sickle cell disease. Down syndrome could be identified later, through amniocentesis.
Riley says she tells patients that everyone has something, and it generally doesn’t matter unless the husband has the same thing. In fact, after my daughter’s screening, her husband needed to go through his own round of genetic testing to determine if he was a carrier. (He wasn’t.)
Compounding the worry about genetic abnormalities is the fact that women are beginning their families later than ever before. Generally, older women are at greater risk for fertility problems, miscarriage and chromosomal abnormalities. The average age of a first-time mother in this country is 26, up from 21 in 1972. But ages vary by demographics and income. Analyzing National Center for Health Statistics, Caitlin Myers, a professor of economics at Middlebury College, found that first-time mothers in big cities and on the coasts tend to be older, while in rural areas, the Great Plains and the South, they tend to be younger. The two areas with the highest average age are San Francisco and Manhattan, where first-time moms average ages 32 and 31, respectively. Riley, who practices in New York City, says most of her patients are in their 40s.
Boomer moms may remember sonograms as fuzzy, gray images that you could barely make out. I recently saw a sonogram of all four chambers of my grandchild-to-be’s heart — in Technicolor! The technology has improved exponentially. Again, a mixed bag — thrilling when all is well, but these amazing views can also detect more problems in the developing fetus.
Just because more issues can be identified doesn’t mean a healthy baby is guaranteed. “Parents and grandparents don’t understand why, after having all these fancy ultrasounds and a million and a half tests, the baby could not come out perfect,” Riley says. “And the problem is that all of those tests tell us certain pieces of information, but none of them tell us the functionality of those things.”
Then there’s the internet. Detailed information about pregnancy is no longer the sole province of obstetricians. Sites like babycenter.com and thebump.com provide detailed analysis of each stage of development, common pregnancy symptoms and more. At 16 weeks, the baby’s heart is pumping 25 quarts a day. At 27 weeks, the baby’s fused eyes start to open. At 32 weeks, the baby’s fingernails have grown in.
This may sound benign — yet, as with all things online, research can quickly take a bad turn. False information, self-diagnosis with “Dr. Google,” and the rabbit hole of chat rooms that regale readers with the pregnancy stories from hell up the anxiety ante even more.
Then there’s the accurate scary news, like racial inequities in maternal care. Black women are three to four times more likely to die in the U.S. during pregnancy and childbirth than white women, Riley says. She advises Black grandmas-to-be to empower themselves with information, and to be extra supportive to their daughters. Of course, most pregnancies do go well, and most moms and babies thrive. As a prospective grandparent, once that baby is born, you can relax. (Hah! Maybe in 18 years.) But guess what else has changed? Baby care.
Don’t put that baby on her stomach to sleep (increased risk of sudden infant death syndrome)! Don’t use talcum powder on his bottom (dangerous for the baby’s lungs)! No blanket, pillows or stuffed animals in the crib (smothering risk)!
One thing that hasn’t changed: grandparents’ unconditional, goofy, weepy and overwhelming love.
Jennifer Tapias Derch
