Safe & Dangerous Medical Testing During Pregnancy
Welcoming a new child into the world is one of the most extraordinary and exciting times in a parent's life. As the pregnancy develops, soon the curiosity about the gender and health of the baby begins to build, and the parents are given a host of options that could reveal “inside” information about their baby. The curiosity is normal; however, the recent changes in our modern approach to prenatal screening may not be. It is important to remember that just a few generations ago, many of the prenatal screens and tests offered today were not routine and only used in the rare occurrence or for research. As a mother myself, the two questions I propose are:
1. “What kind of information will a particular test provide me that would change the way I care for myself and my baby? And, will the benefit of that knowledge outweigh any risks affiliated with that test?”
2. Using this lens, let’s take a closer look at some of the types of routine prenatal testing commonly offered to a mother during her pregnancy.
Safe and routine testing:
Safe and routine testing that is typically performed by both midwives and doctors throughout the pregnancy often involve urine, blood, and physical measurements. A urine test is used to assess bladder or kidney infections, diabetes, dehydration, and pre-eclampsia by screening for high levels of sugars, proteins, ketones and bacteria. This is usually performed at regular visits throughout the pregnancy. Blood tests are helpful to see an overall nutritional panel of the mother including vitamin D levels, progesterone levels, as well as to assess blood type, glucose, iron and hemoglobin levels. If there is a concern, a blood test can also be used to test for a sexually transmitted disease. Blood tests may occur at the beginning, middle and towards the end of a pregnancy depending on the health factors being monitored by the practitioner. Physical measurements are also attained during regular visits to monitor a mother’s blood pressure, heart rate, weight gain as well as the measuring of the uterus growth and palpating the position of the baby. These are all very simple tests and measurements that give the provider a profound picture of the health of mom and baby without any risk to either. Action can be taken if these tests show something out of the ordinary range through healthy habits of diet and exercise.
In the last 50 years, the modern medical approach to prenatal care has adopted another type of “non-invasive” screening; commonly known as ultrasound. However, the debate is still out on whether an ultrasound is truly non-invasive to the child. The first use of a clinical ultrasound began in the 1950’s and did not become popular in the U.S. until the 1970’s. Presently, ultrasounds have become the standard of care for pregnancy with women receiving a minimum of one scan to an upwards of five scans throughout the three trimesters. A new trend is developing for 3-D scans and videos for “keepsake” moments of the little one in the womb. Here is what ACOG (American Congress of Obstetricians and Gynecologists) has to say about ultrasounds:
“ Although ultrasound imaging is generally considered safe when used prudently by appropriately trained health care providers, ultrasound energy has the potential to produce biological effects on the body. Ultrasound waves can heat the tissues slightly. In some cases, it can also produce small pockets of gas in body fluids or tissues (cavitation). The long-term consequences of these effects are still unknown. Because of the particular concern for effects on the fetus, organizations such as the American Institute of Ultrasound in Medicine have advocated prudent use of ultrasound imaging in pregnancy. Furthermore, the use of ultrasound solely for non-medical purposes such as obtaining fetal ‘keepsake’ videos has been discouraged.”
Every parent must decide what feels right for them when choosing to proceed with an ultrasound. The purpose of highlighting this is to inform parents that the use of multiple screenings especially early on during pregnancy and keepsake videos pose more risk than are warranted for their benefit. It is our personal belief that ultrasound should be used sparingly and only when there is a medical concern.
As developments in ultrasound screening began, another type of prenatal testing was emerging. This time for the purpose of detecting genetic and chromosomal disorders. Some of these screens are considered to be on the “non-invasive” spectrum while other genetic testing is clearly invasive and carry risks to both the mother and the child. Depending on the prenatal provider, parents may be offered some of these tests as routine care. However, the debate over their safety, accuracy and usefulness is highly controversial. For the most part, the more non-invasive a test, the less accurate; likewise, the more invasive a test is, the greater the accuracy. It's important to remember that receiving this kind of genetic information during this delicate time can be emotionally disruptive for a mother especially given the potential for inaccurate information.
The more non-invasive testing can include the NT Screening (Nuchal Translucency) that observes the development of the nuchal fold via ultrasound in the first trimester or the Triple/Quad Test that checks the amounts of specific substances in the mother’s blood. Both tests are looking for signs or symptoms associated with higher probability the child in the womb may have a chromosomal abnormality. It is important to realize that results merely provide the baby's statistical likelihood of having a problem and have been associated with false positives. In other words, these tests DO NOT diagnose a problem; they can only signal the need for further testing. It is here the parent may end up in a dilemma. The non-invasive testing sounded simple, but now the pressure could mount to choose invasive techniques for more information.
Invasive techniques for genetic testing do have higher rates of accuracy; however, they also come with higher risks. The two most commonly used methods are Chorionic Villus Sampling (CVS) and Amniocentesis. Both are guided by ultrasound to take either a sample of the placenta (CVS) or the amniotic fluid (Amniocentesis) to obtain genetic information that would determine a possible chromosomal abnormality in the baby. The risks of these types of testing include amniotic fluid leakage, the introduction of infection to the mother or the child, needle injury to the baby, and worst case the loss of the child through miscarriage.
According to ACOG, the loss rate of the child is considered “low” ranging in about 1 miscarriage in 300 to 500 procedures.
It is hard to read statistics and label them as "low," knowing that each statistic was a real person, a real life. Again, the hard questions need to be asked: how will the knowledge received from this test benefit my baby and me and is it worth the risk?” It is our view, God did not create a “window” into the womb, and it should be respected as sacred. It is only in the last 50 years we have created this man-made window, and the question remains if it has brought more health or more hurt, physically and emotionally.
Every parent has to make these decisions based on their personal convictions on what is best for the health of the mother and child. Most importantly, we believe the trend for more testing will only continue, and as parents, it is imperative to stay informed. We encourage you to challenge the norms of our modernized culture by asking questions, doing your research and seeking the Lord for His desire related to your pregnancy and unborn child. Our Creator is the safest place to run when we face these decisions, especially regarding the body He intimately designed.
For more information about safe & dangerous medical testing during pregnancy, read Ina May's Guide to Childbirth
For You formed my inward parts; You covered me in my mother’s womb. I will praise You, for I am fearfully and wonderfully made. Psalm 139: 13-14