An increasing number of mothers-to-be are requesting early ultrasounds and genetic tests to help them make informed decisions regarding their pregnancies as more states enact strict abortion laws.
Prenatal genetic screening and other diagnostic tests are frequently used to screen for abnormalities and health risks to a fetus and help doctors and patients plan for the safest pregnancy and delivery.
They also provide information to women that may influence whether they wish to terminate a pregnancy.
Many of these tests cannot be done until a woman is at least 10 weeks into her pregnancy. However, more than a dozen states have laws in place that completely prohibit abortions or restrict them to before six weeks, meaning by the time a person receives prenatal testing results, it is often too late to terminate a pregnancy.
Prenatal genetic screening and other diagnostic tests are frequently used to screen for abnormalities and health risks to a fetus
There are multiple prenatal tests a woman can undergo to get health information about her baby.
Some screenings include an amniocentesis, done between 16 and 20 weeks of pregnancy to test fluid surrounding the fetus for certain health conditions, chorionic villis sampling, done between 10 and 13 weeks to test a piece of the placenta for genetic disorders, and noninvasive prenatal testing, a blood test performed at 10 weeks to analyze the fetal DNA present in a mother’s blood.
These tests screen for conditions including down syndrome and spina bifida, as well as more severe and fatal abnormalities like Edwards disease and Tay-Sachs disease.
Some women may choose to terminate their pregnancies if prenatal testing reveals the fetus has a life-threatening birth defect that may result in death shortly after delivery or if the pregnancy is not viable.
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommend that reproductive healthcare professionals offer prenatal screenings to every pregnant patient.
Researchers in a 2023 study in the journal Obstetrics and Gynecology said: ‘Although many factors influence a patient’s decision to have an abortion, fetal genetic abnormalities are a common reason, particularly for terminations after the first trimester.’
Citing a systematic review in 2012, the researchers also said that when faced with a down syndrome diagnosis, up to 67 percent of patients in the United States chose to terminate their pregnancies.
The study noted the data has remained consistent.
Sabrina Fletcher, a doula who has counseled pregnant patients in these situations, told the Associated Press when women find out their fetus has a serious health problem, ‘you’re in crisis mode.’
She added: ‘You’re not thinking about legal repercussions and [state] cutoff dates, and yet we’re forced to.’
Following the Supreme Court’s overturning of Roe vs. Wade in June 2022, 14 states have a ban on abortion at every stage of pregnancy – meaning diagnostic testing of a fetus cannot be done before gestational age–based cutoffs.
While there are no definitive statistics on how many women are asking for early tests, anecdotally, healthcare providers say they’ve noticed an uptick.
However, experts are worried women are rushing to make decisions about whether to continue or terminate their pregnancies based on whatever information they can get before a state abortion ban kicks in.
But early tests aren’t always 100 percent correct and may give only limited information.
Ultrasounds early in a pregnancy reveal far less about a fetus than scans done at later weeks and genetic screenings may be inaccurate.
Dr Clayton Alfonso, an OB-GYN at Duke University, told AP: ‘More people are trying to find these things out earlier to try to fit within the confines of laws that in my mind don’t have a place in medical practice.’
The types of tests and ultrasounds a pregnant woman receives – and when she receives them – can vary based on an individual’s health and risk factors, as well as equipment and tests available to a medical clinic.
While some women may get an ultrasound in their first 12 weeks of pregnancy, to estimate a due or check for multiple fetuses, it’s not standard because it is too early to see limbs and organs in detail, ACOG said.
It is also hard to find major birth defects before the 20-week midpoint of gestation.
A common prenatal test at 20 weeks – after the abortion cut-off in more than a dozen states – is an ultrasound commonly referred to as an anatomy scan.
This scan checks the fetal heart, brain, spine and limbs to look for congenital problems and can detect problems and abnormalities that may lead to more testing and a possible diagnosis.
But since Roe vs Wade was overturned, OB-GYN Dr Cara Heuser from Utah – where abortion is allowed until 18 weeks – said more patients are having ultrasounds at 10 to 13 weeks in order to have time to get an abortion if needed.
However, Missouri genetic counselor Chelsea Wagner said early scans don’t provide a complete picture of a pregnancy and doctors cannot give a definitive diagnosis from scans or other screening tests that early in a pregnancy.
She said: ‘You can’t give somebody an “everything looks good” or clean bill of health off of an ultrasound at 10 weeks.’
Additionally, when it comes to genetic testing, the accuracy of the tests vary by disorder, but no test is considered definitively diagnostic and false positive are possible.
And in 2022, the Food and Drug Administration issued a warning about certain screenings, reminding patients and doctors that results need further confirmation.