WASHINGTON– In Utah, more and more Dr. Cara Heuser’s maternal-fetal medicine patients are requesting early ultrasounds, hoping to detect serious problems in time to choose whether to continue the pregnancy or abort.
In North Carolina, more obstetrics patients of Dr. Clayton Alfonso and his colleagues are relying on early genetic testing that does not provide a firm diagnosis.
The reason? New state restrictions on abortion mean the clock is ticking.
Since Roe v. was overturned. Wade, 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 bans take effect. But early ultrasounds show much less about the condition of the fetus than later ones. And genetic tests can be inaccurate.
When you discover your fetus has a serious problem, “you’re in crisis mode,” said Sabrina Fletcher, a doula who has helped women in this situation. “You’re not thinking about legal repercussions or (state) deadlines, and yet we’re forced to do it.”
About half of states ban abortion or restrict it 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 about 14 states with no option to get follow-up diagnostic testing in time to have an abortion there if they wish, an article published last March in the journal Obstetrics and Gynecology found. Even more states impose too-early abortion limits for mid-pregnancy ultrasounds.
“More and more people are trying to find out these things earlier to try to fit within the confines of laws that, in my opinion, have no place in medical practice,” said Alfonso, an obstetrician and gynecologist at Duke University.
When done at the right time, doctors said prenatal tests can identify problems and help parents decide whether to continue the pregnancy or prepare for the baby’s complex needs after birth.
One of the most common tests is the 20-week ultrasound, sometimes called an “anatomy scan.” Examines 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, spine, and heart abnormalities and signs of chromosomal problems like Down syndrome. Follow-up tests may be needed to make a diagnosis.
The type of ultrasounds patients receive, and when they receive one during pregnancy, can vary depending on the patient’s risk level, as well as the equipment and policies each practice has. For example, some women may undergo a first trimester ultrasound to estimate their due date or check for multiple fetuses. But it’s not standard practice because it’s too early to see many of the fetus’s limbs and organs in detail, says the American College of Obstetricians and Gynecologists.
It’s impossible to detect problems like serious heart defects much earlier than halfway through pregnancy because the fetus is so small, Heuser said. However, he said, more patients are undergoing ultrasounds between weeks 10 and 13 to have access to abortion if necessary.
Experts say there are no statistics on exactly how many people opt for early ultrasounds or make decisions based on them. But some health care providers say they’ve noticed an increase in requests for scans, including Missouri genetic counselor Chelsea Wagner. She counsels patients across the country via telehealth, and frequently reviews ultrasound and genetic testing results.
Wagner said these early ultrasounds can’t provide the reassurance patients are looking for because “you can’t give someone an ‘everything looks good’ or a clean bill of health with a 10-week ultrasound.”
Doctors also can’t make a firm diagnosis from genetic testing, which is done at 10 weeks gestation or later.
These tests, also called “non-invasive prenatal tests,” are designed to detect abnormalities in fetal DNA by looking at small, free-floating fragments circulating in a pregnant woman’s blood.
They look at 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 depending on the disorder, but none are considered diagnostic.
Natera, one of the few U.S. companies that makes these types of genetic tests, said in an email that prenatal test results are reported as “high risk” or “low risk” and that patients should seek genetic testing. confirmation if they obtain a “high risk”. result “risk”.
Some can be quite accurate, doctors said, but false positives are possible. In 2022, the Food and Drug Administration issued a warning about screening tests, reminding patients and doctors that results need further confirmation.
“While non-invasive prenatal screening genetic tests are widely used today, these tests have not been reviewed by the FDA and claims may be made about their performance and use that are not based on sound science,” he 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 would require prenatal screenings and thousands of other lab tests to undergo FDA review.
Even before Roe was overturned, pregnant patients were sometimes confused by what prenatal tests reveal (or don’t reveal) about the pregnancy or fetus, said bioethicist Megan Allyse, whose research focuses on emerging technologies around women’s reproductive health. She said it’s important for doctors to review the limitations of such tests and emphasize that the results they receive are not diagnostic.
Alfonso and Wagner said they recommend getting diagnostic tests as well. In addition to amniocentesis, which removes and analyzes a small sample of cells from the amniotic fluid, it also includes CVS, or chorionic villus sampling, which analyzes a small piece of tissue from the placenta. Both carry a small risk of miscarriage.
But lately, Wagner said, there is “more urgency in patient decisions” in many states.
This is due to the specifics of the time of testing. It may take one to two weeks to get the results of genetic testing. CVS is offered between weeks 10 and 13 of gestation, with initial results taking a few days and more detailed results around two weeks. Amniocentesis is usually performed between 15 and 20 weeks, with similar times to obtain results.
If a state bans abortion at 12 weeks, for example, “some people may have to act based on a test,” Alfonso said.
Wagner said she has had to counsel patients who couldn’t afford to travel out of state for an abortion if they waited for diagnostic testing.
“They are forced to use the information they have to make decisions they never thought they would have to make,” he said.
Some states restrict abortion so early that women would not have the opportunity to have any prenatal tests before the deadline.
That was the case for Hannah, 26, in Tennessee, where abortion is strictly prohibited. An ultrasound performed in late November, at approximately 18 weeks’ gestation, revealed that she had a sequence of amniotic banding, which is when very thin pieces of the amniotic membrane adhere to the fetus, sometimes resulting in amputation of the fetus and other problems. In Hannah’s case, the bands were attached to many of her baby’s body parts and opened up multiple areas of her body.
She called clinics in Ohio and Illinois looking for a place to terminate the pregnancy, while her genetic counselor’s office called about six facilities. She finally found a clinic 4 1/2 hours away in Illinois and underwent the procedure in early December, when she was 19 weeks pregnant. A series of results from the amniocentesis, which she had performed to look for the cause of the problem, came back the day after her abortion, and other results later.
Hannah, who did not want her last name used for fear of backlash, said it is “horrible” to have to think about state schedules and travel long distances out of state when it comes to something like this. But she is grateful to have received a firm diagnosis on the ultrasound 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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