WASHINGTON (AP) — In Utah, more of Dr. Cara Heuser’s maternal-fetal medicine patients are requesting early ultrasounds, hoping to detect serious problems in time to decide whether to continue the pregnancy or have an abortion.
In North Carolina, more and more obstetric patients are trusting Dr. Clayton Alfonso and colleagues on early genetic screenings that do not yield a definitive diagnosis.
The reason? New state abortion restrictions mean the clock is ticking.
Since Roe v. Wade was overturnedMany health care providers say an increasing number of patients are deciding the fate of their pregnancies based on the information they can gather before state bans take effect. But early ultrasounds reveal much less about a fetus’s condition than later ultrasounds. And genetic screens can be inaccurate.
When you find out your fetus has a serious problem, “you’re in crisis mode,” says Sabrina Fletcher, a doula who has helped women in this predicament. “You don’t think about legal repercussions and (state) cutoff dates, and yet we’re forced to do that.”
About half of states ban or restrict abortion after a certain point in pregnancy. In Utah it is generally illegal after 18 weeks; in North Carolina, after 12 weeks.
This leaves millions of women in roughly 14 states without the option to get follow-up diagnostic tests in time to potentially have an abortion there if they wanted to. a newspaper published last March in the journal Obstetrics and Gynecology. Even more states are cutting off abortion too early for ultrasounds during pregnancy.
“More people are trying to discover these things earlier to try to fit within the confines of laws that, in my opinion, have no place in medical practice,” says Alfonso, a gynecologist at Duke University.
CHECK FOR PRENATAL PROBLEMS
When done at the right time, doctors say prenatal testing can identify problems and help parents decide whether to continue the pregnancy or prepare for a baby’s complex needs after delivery.
One of the most common tests is the 20-week ultrasound, also called an ‘anatomy scan’. It checks the heart, brain, spine, limbs and other parts of the fetus’s body, looking for signs of congenital problems. It can detect things like brain, spinal and heart abnormalities and signs of chromosomal problems like Down syndrome. Follow-up testing may be necessary to make a diagnosis.
The types of ultrasounds patients receive – and when to have one during pregnancy – can vary depending on the patient’s risk level, as well as the equipment and policies each practice has in place. For example, some women may have a first-trimester ultrasound to estimate a due date or to check for multiple fetuses. But it’s not standard practice because it’s too early to see many limbs and organs of the fetus in detail, says the American College of Obstetricians and Gynecologists.
It’s impossible to spot problems like serious heart defects before mid-pregnancy because the fetus is so small, Heuser said. Nevertheless, she said, more and more patients are getting ultrasounds at 10 to 13 weeks to access abortion if necessary.
Experts say there are no statistics on exactly how many people opt for early ultrasounds or make choices based on them. But some health care providers say they have noticed an increase in requests for the scans, including Missouri genetic counselor Chelsea Wagner. She sees patients from across the country via telehealth, regularly discussing the results of ultrasounds and genetic tests.
Wagner said these early ultrasounds can’t provide the certainty patients are looking for because “you can’t give someone an ‘all looks good’ or a clean bill of health after an ultrasound at 10 weeks.”
Doctors also cannot make a definitive diagnosis based on a genetic screening, which is carried out after a pregnancy of ten weeks or later.
Also called “non-invasive prenatal tests,” these screenings are designed to detect abnormalities in fetal DNA by looking at small, free-floating fragments circulating in a pregnant woman’s blood.
They screen for chromosomal abnormalities 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 by condition, but none are considered diagnostic.
Natera, one of the few U.S. companies that make such genetic tests, said in an email that prenatal test results are reported as “high risk” or “low risk” and that patients should seek confirmatory testing if they receive a “high risk” . risk” outcome.
Some may be quite accurate, doctors said, but false positives are possible. In 2022, the Food and Drug Administration issued a warning about the screenings, reminding patients and doctors that the results need further confirmation.
“Although genetic noninvasive prenatal screening tests are widely used today, these tests have not been evaluated by the FDA and may make claims about their performance and use that are not based on sound science,” said Jeff Shuren, director of the FDA . Center for Devices and Radiological Health, wrote in a statement.
The agency is poised to release a new regulatory framework in April that will require prenatal screenings and thousands of other laboratory tests to be reviewed by the FDA.
A ‘TERRIBLE’ DECISION TO MAKE
Even before Roe was overturned, pregnant patients were sometimes confused by what prenatal tests did or did not reveal about the pregnancy or fetus, says bioethicist Megan Allise, whose research focuses on emerging technologies surrounding women’s reproductive health. She said it is important for doctors to understand the limitations of such screens and emphasize that the results they receive are not diagnoses.
Alfonso and Wagner said they recommend getting diagnostic tests as well. In addition to amniocentesis, in which a small sample of cells from the amniotic fluid is removed and tested, this also includes CVS, or chorionic villus sampling, in which a small sample of tissue from the placenta is tested. Both carry a small risk of miscarriage.
But lately, Wagner said, there has been “more urgency around patient decisions” in many states.
This is due to the specifics of the test timing. It may take a week or two for the results of genetic screenings to be available. CVS is offered at 10 to 13 weeks’ gestation, with initial results taking a few days and more detailed results around two weeks. Amniocentesis is typically done at 15 to 20 weeks, with similar timing for results.
For example, if a state has a 12-week abortion ban, “some people may need to take action based on a screening,” Alfonso said.
Wagner said she has had to counsel patients who couldn’t afford to travel out of state for an abortion as they waited for diagnostic tests.
“They are forced to use the information they have to make choices they never thought they would have to make,” she said.
Some states restrict abortion so early that women would not have the opportunity to have prenatal testing done before the cutoff date.
That was the case for 26-year-old Hannah in Tennessee, who had a… strict abortion ban. An ultrasound in late November, around the 18th week of pregnancy, revealed that she had an amniotic band sequence, which means that very thin pieces of amniotic fluid attach to the fetus, sometimes causing amputation of the fetus and other problems. In Hannah’s case, the straps were attached to many of her baby boy’s body parts and tore open several parts of his body.
She called clinics in Ohio and Illinois looking for a place to end the pregnancy, while her genetic counselor’s office called about six facilities. She eventually found a clinic 4.5 hours away in Illinois and had the procedure in early December, after 19 weeks of pregnancy. A set of results from the amniocentesis – which was done to determine the source of the problem – came back the day after her abortion, and other results afterward.
Hannah, who didn’t want her last name used for fear of backlash, said it’s “terrible” to have to think about state timelines and travel long distances out of state when dealing with something like this has. But she is grateful that the ultrasound gave her a clear diagnosis and enough information to feel confident in her decision, which she made so that her baby would not suffer “pain and misery.”
“I know some women aren’t so lucky,” Hannah said. She named her son Waylen.
Ungar reported from Louisville, Kentucky.
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