After Roe v. Wade, more patients rely on early prenatal testing as states tighten abortion laws
Washington: Since Roe v. Wade was overturned, many health care providers say a growing number of patients are deciding the fate of their pregnancies based on whatever information they can gather before state abortion bans go into effect. are doing.
But early ultrasounds tell much less about the condition of the fetus than later ultrasounds. And genetic testing can be wrong.
When you find out there’s a serious problem with your fetus, “you’re in crisis mode,” said doula Sabrina Fletcher. “You’re not thinking about the legal repercussions and (state) cutoff dates, and yet we’re forced to.”
About half of the states ban or restrict abortion after a certain point in pregnancy.
That leaves millions of women in about 14 states with no option to get follow-up diagnostic tests in time so they can get an abortion if they want, a paper published last March in the Journal of Obstetrics & Gynecology found Was. Even many states have long established abortion limits for mid-pregnancy ultrasound.
“More people are already trying to fit these things into laws that I think have no place in the practice of medicine,” said Dr. Clayton Alphonso, an obstetrician and gynecologist at Duke University. ” Carolina.
Doctors said that when done at the right time, prenatal testing can identify problems and help parents decide whether to have an abortion or continue the pregnancy and the baby’s health after delivery. Have to be prepared for complex needs.
One of the most common tests is the 20-week ultrasound. It looks for signs of congenital problems by examining the heart, brain, spine, limbs and other body parts of the fetus. It can detect brain, spine and heart abnormalities and signs of chromosomal problems such as Down syndrome. Follow-up testing may be needed to make a diagnosis.
Ultrasounds earlier in the first trimester, for example, are not standard practice because it is too early to see many of the fetus’s organs and limbs in detail, says the American College of Obstetricians and Gynecologists.
Dr. Cara Heuser, who practices maternal-fetal medicine in Utah, said it’s impossible to detect problems like serious heart defects until midway through pregnancy because the fetus is so small. Still, he said, more patients are having ultrasounds at 10 to 13 weeks to get access to an abortion if they want.
Experts say there are no data on how many people opt for early ultrasounds or make choices based on them. But some health care providers say they’ve seen an increase in requests for scans, including Missouri genetic counselor Chelsea Wagner. She consults patients across the country via telehealth.
But he said doctors can’t tell patients “‘everything looks good’ or give them a clean bill of health from an ultrasound at 10 weeks.”
Doctors cannot make a firm diagnosis even with genetic testing, which is done at or after 10 weeks of pregnancy. These screenings are designed to detect abnormalities in fetal DNA by looking at small, free-floating fragments circulating in the pregnant woman’s blood.
They screen for chromosomal disorders such as trisomy 13 and 18, which often end in miscarriage or stillbirth, Down syndrome, and extra or missing copies of sex chromosomes.
The accuracy of these tests varies according to the disorder, but none are considered diagnostic.
Natera, one of a handful of U.S. companies that perform such genetic testing, said in an email that prenatal testing results are reported as either “high risk” or “low risk” and patients are assigned a “high Confirmatory testing should be done if “risk” is found. Risk” results.
Some may be very accurate, but false positives are possible, doctors said. In 2022, the Food and Drug Administration issued a warning about screening, reminding patients and doctors that the results needed further confirmation.
The agency is set to release a new regulatory framework in April that will require prenatal screenings and thousands of other laboratory tests to undergo FDA review.
Health care providers said that in states with strict abortion laws, there is greater urgency because of the timing of clinical trials.
CVS, or chorionic villus sampling, is performed at 10 to 13 weeks of gestation. Preliminary results take a few days to arrive and more detailed results take about two weeks. Amniocentesis is usually performed at 15 to 20 weeks, with the same amount of time for results.
For example, if a state has a 12-week abortion ban, “some people may have to take action on screening,” Alfonso said.
Wagner said she has had to counsel patients who can’t afford to travel out of state for an abortion while they wait for a clinical trial. “They are forced to use information to make choices they never thought they would have to make,” he said.
Some states restrict abortions so early that women will not have a chance to get any prenatal testing before the cutoff.
That was the case for 26-year-old Hannah in Tennessee, where abortion is strictly banned. In late November, at about 18 weeks, an ultrasound revealed she had amniotic band sequence, when very thin pieces of amniotic membrane attach to the fetus. In Hannah’s case, the bands were attached to several parts of her baby’s body and exposed several parts of her body.
After calling clinics in Ohio and Illinois to terminate the pregnancy, she finally found a clinic in Illinois, four and a half hours away, and had the procedure in early December at 19 weeks gestation. The results of the amniocentesis – which was done to find the cause of the problem – came the day after her miscarriage and other results soon after.
Hanna, who did not want her last name used for fear of backlash, said it’s “terrible” to think about state deadlines and having to travel long distances when dealing with something like this. But he’s grateful he had enough information to be confident in his decision.
“I know some women aren’t so lucky,” Hannah said. He named his son Velen.
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Unger reported from Louisville, Kentucky.
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