Genetic Counselors: How They Can Help You Conceive with Confidence

Before you try to get pregnant, it's a good idea to have a medical checkup to make sure you're in the best possible health. For some people, it's a good idea to have a genetic checkup as well, with a prenatal genetic counselor. But how do you know if you're one of those people, and what steps should you take if you are? We asked Donna F. Wallerstein, a certified genetic counselor at the University of Medicine and Dentistry of New Jersey's Center for Genomic Medicine in Newark, who has been involved in prenatal genetic counseling for 21 years.

Who Should See a Prenatal Genetic Counselor?

"Most people are referred to a prenatal genetic counselor by their obstetrician during a pregnancy or by their infertility specialist when they are having difficulty either maintaining a pregnancy or becoming pregnant," says Wallerstein. "Rarely do people seek out a prenatal genetic counselor on their own." She says a couple might be referred to a counselor for any of the following reasons:

• Advanced maternal age. Women over the age of 35 have a higher likelihood of having a child with a chromosome abnormality than younger women. "They are usually offered a variety of options for testing during a pregnancy, either to refine their individual risk or to make a definitive diagnosis in a fetus," Wallerstein says.
• Abnormal results from standard prenatal laboratory tests. For example, women are often tested to see if they are carriers for cystic fibrosis. A woman who is found to be a carrier will usually be referred to a genetic counselor.
• Concerns about their family history. People who have a family member with some type of physical or mental handicap might consult with a counselor to learn whether there's a risk that they might have a similarly affected child.
• Difficulty with pregnancy, such as repeated miscarriages. Both women and men who have primary or secondary infertility may be sent to a prenatal genetic counselor, especially if other infertility studies have not found a cause for the problem.
• Chronic health concerns, such as diabetes or epilepsy. Some of these conditions can increase the risk of birth defects, either because of the underlying condition itself or the medications needed to control the condition, Wallerstein says.
• Concerns about exposures to potentially harmful substances. A woman who took medication or was exposed to x-rays before she realized she was pregnant might want to check with a counselor. A few alcoholic drinks probably would have little effect, but excessive drinking well into the first trimester might be cause for concern.