Thursday 23 October 2014

Real Life: Older mums' bum deal

Cutting edge: Professor Fergal Malone in Dublin's Rotunda Hospital

Irish mothers, especially older ones, are losing out because there is no national screening programme in place. In fact, prenatal tests still seem to carry some sort of stigma

THE average age at which women have their first child is now over 30 and increasingly mums are waiting until their late 30s to start a family.

As well as decreasing fertility, older mums also face concerns about genetic and chromosomal disorders. The Government has not kept pace with this trend and does not provide a prenatal screening programme.

The HSE confirmed there is no national policy on a population basis, with screening only being offered by doctors on an individual patient basis where there are risk factors.

There are three main screening tests for genetic and chromosomal disorders. These include early stage tests like the scan and blood test at 11 to 12 weeks and chorionic villus sampling (CVS), involving placental tissue sampling.

Later stage tests include amniocentesis, usually carried out at 14 to 16 weeks, during which small amounts of amniotic fluid are extracted from the womb. Both amniocentesis and CVS carry a small risk of miscarriage.

It can be difficult to access screening tests in Ireland and negative attitudes to screening also exist in the medical profession.

It was revealed in a study headed up by Professor Fergal Malone of Dublin's Rotunda Hospital that 70pc of Irish GPs and 38pc of consultants believe there are ethical issues for patients undergoing prenatal screening and diagnosis of genetic and chromosomal disorders.

The report also found that only one-third of GPs and a quarter of consultants could easily access prenatal screening for high-risk patients and they found only limited access for other patients.

"I was working in the United States for 14 years. My special area of interest is obstetric ultrasound, prenatal diagnosis, and maternal-foetal medicine," explains Prof Malone.

"It was a surprise to find that there was no sort of coherent service available for Irish women when I came back to Ireland."

Prof Malone found that some doctors were cutting edge but a lot of medics weren't aware of the range of tests available to pregnant women.

"There were a couple of doctors who believed that Irish women were somehow different. They felt it is all very nice having this service in New York or London but Irish patients wouldn't want it."

Rather than depend on anecdotal evidence, Prof Malone decided to carry out an Irish study on attitudes to screening babies before birth.

He set up the OSCAR clinic (One Stop Clinic for Assessment of Risk for foetal abnormalities) in the Rotunda Hospital in 2005.

Prof Malone explains that the tests are best carried out between 11 and 12 weeks into the pregnancy. At 18 to 20 weeks, the nuchal fold scan is very ineffective.

The tests are not restricted to older mums as genetic and chromosomal disorders can occur in pregnancies of any age, with two-thirds of Down syndrome babies being born to mothers under the age of 35.

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