AIBU to worry about my sister’s pregnancy risks at 46?

[Nordicdaydream]

My sister is pregnant (24 weeks). She is 46 and conceived naturally. She’s had quite a few miscarriages in the past and has one son already who is 6.
I am concerned at the risks once she gets further along. They are monitoring her with growth scans and she’s had a regular appointments but they offered her the glucose test for gestational diabetes and she’s refused it. She also refused the NIPT Down syndrome test.

I suppose I’ve been researching and worried for both her and the baby as I know things are more likely to be complicated at this age.

Has anyone else had a natural pregnancy around this age? And were there complications?

I had my last baby at 43. I had a C section but that was due to issues from a previous birth, not my age.
Friend had her one and only baby at 46 all was well. Several of my great and great great grandmothers had a last baby at 45/46.
The risks are higher but most women will still have a healthy pregnancy if it proceeds. Miscarriage risk is higher.
The stats are meaningless on an individual level though, as it’s either going to be fine, or things might go wrong, which is true for every pregnancy. Of course you will be a bit more worried but hopefully all will be well. A close friend of mine was born when her Mum was 47, in 1962, so no monitoring.

My gran had my mum naturally at 49. All good.

Friend at 50.
First baby.
Was monitored alot.
Had a natural birth mother and baby did well.

Little girl is now 7.

I was pregnant at age 46 and had gestational diabetes. Was so shocked at the time as I felt fine. I was monitored closely and also self-monitored (fingerprick test to check glucose levels) and managed to control it through diet. Once i'd given birth (induction on the due date) I was fine plus the baby was fine too. I don't know why your sister wouldn't get the test - it involved drinking lucozade (which I hate) and waiting around the hospital a few hours but that's all.and safer for the baby to be monitored.

That is good. Just be there for her. I'm sure she will be fine.

I don’t know any 46 year olds but I know a handful of 43 / 44 year old women that have conceived naturally and had problem free pregnancies.

They have made it look a doddle to be honest.

I'd rather do something unpleasant like drinking a disgustingly sweet drink than risk my health or my baby's health. Wouldn't you?

I knew someone who had a healthy baby at 46 with no detriment to her health either. She was very happy as far as I could tell. Fingers crossed that all goes well.

I'm pregnant with my 4th child at 42, I'll be 43 by the time I give birth. I've had 3 other uneventful pregnancies and so far this is exactly the same (I'm also 24 weeks). I am midwife led and have also been offered growth scans and a GTT due to my age, I'm actually low risk though. I paid for a private NIPT very early on, but this is the only baby I have done this with as our other children it wouldnt have made any difference if anything came up high risk. If a high risk result wouldn't lead her to having a diagnostic test and potentially having a termination if anything came back well a NIPT would be an expensive unnecessary test (I paid £400 for mine). If you are generally healthy, normal weight there's no reason why you can't carry a baby to term at 46, your chances of an early miscarriage are very high due to chromosomal abnormalities, but she's 24 weeks now and will have had an anomaly scan which would pick anything major up such as heart defects, issues with brain development or issues with growth etc which would point towards chromosomal abnormalities or any major syndromes, not everything shows on a scan but the main ones a basic NIPT would screen for would have markers on a scan at 20 weeks.

I really think your worry is misplaced, she's pregnant and has a continuing pregnancy, there really isn't any point in wasting your energy on worrying.

The biggest issue at that age is getting pregnant in the first place and not miscarrying in the first 12 weeks, she’s got past those hurdles this time miraculously so just be pleased for her. Abnormalities is the next biggest potential issue but I take it she’s had her scans and they’ve not picked up anything obvious. Past that I wouldn’t be overly concerned about the slight increased risks of GDM etc. I take it she’s hasn’t tested positive for glucose in her urine, not measuring excessively big etc or may consider the testing for GDM if she did get any of those signs? As for the screening for downs etc, it’s something women have to think about carefully as an amnio/CVS is the only thing that would give her a definitive result but does carry a risk of miscarriage so she perhaps doesn’t want to go down that road

My grandmother, my auntie and my sister all had babies in their mid-40s. all went fine. she’s got to 24 weeks so hopefully all will go well for her too.

What difference would it make if she didn’t want to abort the baby?

I refused the downs screening and a glucose tolerance test in my pregnancies. I didn’t care if my child had downs, so it was pointless to me. i refused GTT because I had HG very badly and fasting for that long whilst also having 3 small children was more than i could face. my doctor agreed with me that we could moniter things in other ways. All was fine.

My husband who is now 58 was conceived when his mum was 49 and was born and has obviously grown up with no problems 🥰

No point worrying. My sis did same. All well

I had DS2 at 45 after several early miscarriages and a ruptured tube due to ectopic pregnancy. The pregnancy was uneventful, apart from nausea that lasted throughout and severe acid reflux. Pretty standard for some regardless of age, even if hugely uncomfortable. The birth was quick and straightforward (same as DS1) and all was fine. Complications are statistically more common but absolutely not inevitable. I understand why you would worry, but it won’t change the outcome.

You're not filling your body with sugar. I had to drink a tiny bottle of liquid that apparently contained the same amount of sugar as a large apple, just very concentrated so it's easier to get down. You do the fasting overnight & have the test in the morning so you only need to skip breakfast. The worst of it is sitting around for 2 hours waiting to see how you've processed the sugar.

GD is bloody dangerous and as a previous poster said, can lead to lifelong type 1 diabetes. I've never heard of anyone vomiting and crapping themselves but even that would be a better alternative. You're the one talking shite on this I'm afraid.

My aunt had a stillbirth due to undiagnosed gestational diabetes, before the testing was available. She also had major complications during delivery of the baby due to his very large size, also caused by the diabetes.

Has she explained why she doesn’t want the test? If it’s logistics or it not being very ‘nice’ she might be persuaded with an offer of support to attend?

My worry would be that she’s being influenced by social media where there are a small but vocal group encouraging women to decline most medical care, without really explaining the risks.
I don’t think medics are great at explaining the risks and benefits either, admittedly, leaving women in an impossible position unable to make a truly informed choice!

It's more important that she has the glucose tolerance test, but there's a strong argument that it's better to be prepared if your baby has Downs - a significant percentage of babies with Trisomy 21 need multiple surgeries in their first year, and after that early intervention in the form of physiotherapy, occupational therapy and speech therapy significantly increases the chances of a high quality of life.
Heart defects and other congenial anomaly will hopefully be spotted by ultrasound, assuming she's not declining that too, so it's personal choice whether to test specifically, but you wouldn't want a home birth (which she won't get at 46 anyway) or a midwife led unit to deliver a baby with Downs because of the very high chance (not inevitable, but high chance) they'll need neonatal ICU.

No. I would rather (and have) monitored my blood sugar levels at home over a week or two when it was clinically indicated to be necessary. This gives a much better picture of what’s actually going on and avoids the logistical and physical difficulties of the GTT.

There is no way to say this without causing irreparable damage.
However you dress it up, this would be saying to your sister that she must have an invasive test and abort a child who had Down's syndrome because you don't want to be stuck looking after them if she died!
This would not be a conversation you could come back from so I'd seriously advise not thinking along those lines at all. Every decision we make has the potential to affect our families lives but we have to live in the assumption that things largely turn out okay.

I’m near 45 and 38 weeks pregnant doing marvellous so far fingers crossed so I don’t think you need to be so worried unless there’s a specific reason to

She probably declined the test as she wouldn't get rid of it if it came back high risk of downs syndrome. That's completely her choice and a perfectly valid one. Your sister is a fully grown woman and can make her own decisions. If she had a baby fairly healthily at 40, I don't see why she wouldn't at 46 if she in good health already?

I know people who have had straightforward pregnancies and healthy babies at 45,46. There is no point being tested for Down syndrome if she knows she will continue with the pregnancy. She’s entitled to accept or decline care, not a great deal you can do.

I get the point of being prepared for a child who may have issues but my reply was in the context of you indicating that she needed to know if she was carrying a baby with downs just in case she couldn’t make the necessary’ provisions in case anything ever happened to her. If theoretically she was carrying a baby with down’s and she couldn’t guarantee someone who could step in her place, what exactly were you indicating she should do then?
As for a home birth, no woman is declined a homebirth (unless no staff to cover the service) but are advised if it would be outside of medical guidance, which at 46 it would be.
Of course the whole point of screening, GTTs, scans etc is to optimise outcomes but it is still the woman’s choice and has to be respected and she may have her own logically sound reasons for that. Just like it is when an adult decides care at any other time or indeed when a women decides on an abortion