When Is Genetic Counseling Recommended for Pregnancy?

Genetic counseling is often recommended when there is a higher likelihood that a genetic condition could affect you, your pregnancy, your baby, or when test results are complex or unexpected. 

If genetic counseling is “recommended”, it means your healthcare team believes genetic counseling may provide helpful information and support, but it is still your choice whether to attend. Recommendations may differ slightly based on local guidelines and available services.

Common reasons your provider might recommend genetic counseling include:

• Your medical or pregnancy history
• Family history
• Your age or other pregnancy factors
• Abnormal or unclear testing results
• Ultrasound findings
• Medications, environmental exposure, or infection concerns
• You are planning a future pregnancy

Your Medical or Pregnancy History

Your personal health history may also lead to a recommendation for genetic counseling. Reasons may include:

• You already know you are a carrier of a genetic condition
• You have a known genetic diagnosis
• You have a medical condition that might have a genetic component
• You have a history of multiple miscarriages or stillbirths

A genetic counselor can help connect your medical history with what is known about genetics. They can review how your condition or carrier status may affect pregnancy, what testing options exist, and how results might guide care.

Family History

Genetic counseling is often recommended when there is a known or suspected genetic condition in your family or your partner’s family. Examples include:

• A known single‑gene condition (such as cystic fibrosis or sickle cell disease)
• A relative with a chromosomal condition (such as Down syndrome)
• Multiple relatives with similar birth differences or developmental delays
• A history of unexplained early deaths or certain childhood conditions

In these cases, a genetic counselor can review your family history in detail and estimate the likelihood that you or your baby could have, or inherit, a similar condition. They may discuss carrier screening, prenatal diagnostic testing, or other evaluations that could clarify your risks.

Age and Other Pregnancy Factors

Genetic counseling is commonly recommended when a pregnant individual will be 35 years old or more at the time of delivery. This is because the likelihood of certain chromosomal conditions, such as Down syndrome, increases with age. 

Many pregnancies in this age group are completely healthy, but genetic counseling can help explain age‑related risks and available testing options.

Other pregnancy‑related factors that may lead you to a genetic counselor include:

• A previous child or pregnancy with a chromosomal or genetic condition
• A previous pregnancy with certain birth differences
• Concerns raised in fertility or assisted reproduction settings

In these situations, genetic counseling supports informed decisions about screening, diagnostic testing, and pregnancy management.

Abnormal or unclear testing results

One of the most common reasons for referral is a “positive” or high-risk prenatal screening result. This may come from serum screening, cell‑free DNA screening (NIPT), or other prenatal screening tests. Because screening tests estimate likelihood and do not diagnose a condition, follow‑up genetic counseling is important.

Genetic counseling is also recommended when screening results are inconclusive or when the laboratory cannot provide a result (sometimes called a “no‑call”). A counselor can explain why the result may be unclear, what it does and does not show, and what options may be reasonable next steps. This can help you decide how much additional information you would like.

Ultrasound findings

Prenatal ultrasound sometimes shows findings that could be related to a genetic condition. Examples include certain differences in the heart, brain, kidneys, or patterns of multiple structural changes. When this happens, genetic counseling is frequently recommended.

In these cases, the genetic counselor works closely with the ultrasound or maternal‑fetal medicine team to review what was seen and what it might mean. Some findings carry a higher likelihood of a chromosomal or genetic condition, while others may have a lower likelihood of being part of a genetic syndrome. Genetic counseling can help clarify these possibilities and outline options for further testing or imaging.

Medications, environmental exposures, or infection concerns

If you have taken certain medications, used illicit substances, or been exposed to chemicals, radiation, or infections that might affect a baby’s development, genetic counseling may be recommended. Examples include some anti‑seizure medicines, retinols, significant alcohol use, or infections such as Zika or rubella. Not every exposure causes problems, but some may increase the likelihood for certain birth differences or developmental issues.

A genetic counselor can review what is known about specific exposures, including how timing and dose may affect risk. They may discuss targeted ultrasound or referrals to other specialists to monitor the pregnancy. 

Planning a future pregnancy

Genetic counseling may also be recommended before pregnancy for some individuals and couples. Preconception counseling may be suggested if:

• You know you are a carrier of a genetic condition
• There is a strong family history of a genetic condition
• You belong to a group where certain genetic conditions are more common
• You plan to use assisted reproductive technologies such as IVF

Preconception genetic counseling allows more time to consider carrier screening, options for testing embryos, and other reproductive choices, such as using donor sperm or donor eggs. Having this information ahead of time can make decisions in a future pregnancy feel less rushed.

Personal preference and other reasons

Even if you do not meet any specific criteria, you can still ask for genetic counseling if you have questions or concerns. Some people seek genetic counseling because they feel anxious about testing decisions, want more detailed explanations, or have questions about genetic test reports.

Genetic counseling can also be helpful after pregnancy loss, especially if there are questions about whether a genetic factor played a role. In every case, genetic counseling focuses on providing information and support, not on telling you what you must do. If you think genetic counseling might help you, it is reasonable to ask your healthcare provider for a referral.

Unity offers access to a team of board-certified genetic counselors who can help individuals understand their options, understand their screening results, and discuss next steps. Appointments can be scheduled through the patient portal, on the Unity website, or by contacting Client Services directly.