Dr. Cara Heuser’s patients in Utah are increasingly seeking early ultrasounds for maternal-fetal medicine, in the hopes of identifying any potential issues early on and making decisions about continuing the pregnancy or considering abortion.

More obstetrics patients in North Carolina, including those under the care of Dr. Clayton Alfonso and his colleagues, are increasingly utilizing early genetic screenings that may not yield a definitive diagnosis.

Why? The passing of new abortion laws in the state has set a time limit.

After the decision to overturn Roe v. Wade, numerous healthcare professionals report a growing trend of patients making decisions about their pregnancies based on the information available before state bans are implemented. However, early ultrasounds provide much less information about the health of the fetus compared to later ones, and genetic screenings may not always be reliable.

Upon discovering a severe issue with their unborn child, individuals often enter a state of crisis, according to Sabrina Fletcher, a doula who has supported women in similar situations. In this state, they are not focused on potential legal consequences or the restrictions imposed by state cutoff dates, yet they are still required to consider them.

Approximately 50% of states prohibit or limit abortion after a specific stage in pregnancy. In Utah, it is usually against the law after reaching 18 weeks, while in North Carolina, it is banned after 12 weeks.

A recent study found that due to strict abortion laws in approximately 14 states, countless women are unable to obtain necessary follow-up diagnostic tests in a timely manner, making it nearly impossible for them to have an abortion if they choose. Additionally, many states have abortion restrictions that do not allow for mid-pregnancy ultrasounds.

According to Alfonso, an OB-GYN at Duke University, there is a growing trend of individuals seeking information earlier in order to adhere to regulations that he believes are not applicable in the medical field.

According to doctors, timely prenatal testing can detect issues and assist parents in determining whether to proceed with a pregnancy or prepare for the potential challenges of caring for their baby after birth.

The 20-week ultrasound, also known as the “anatomy scan,” is a frequently used test that examines the fetal heart, brain, spine, limbs, and other body parts for any indications of congenital issues. It can identify abnormalities in the brain, spine, and heart, as well as signs of chromosomal disorders like Down syndrome. Further testing may be necessary for a definitive diagnosis.

The type and timing of ultrasounds performed on patients can differ depending on their risk level, the equipment and policies of the practice. For instance, some women may undergo a first-trimester ultrasound to determine their due date or check for multiple fetuses. However, this is not a standard procedure as it is too early to see the fetus’ limbs and organs in detail, as stated by the American College of Obstetricians and Gynecologists.

According to Heuser, it is not possible to detect serious heart defects in the fetus before mid-pregnancy due to its small size. However, she noted that more patients are now opting for ultrasounds between 10 to 13 weeks in order to have the option of abortion if necessary.

According to specialists, there is a lack of data regarding the number of individuals who choose to have early ultrasounds or make decisions based on them. However, some healthcare professionals have observed an increase in requests for these scans, such as Missouri genetic counselor Chelsea Wagner. Through telehealth, she advises patients from different parts of the country and often discusses ultrasound and genetic test results with them.

According to Wagner, early ultrasounds cannot give patients the reassurance they seek. This is because an ultrasound at 10 weeks cannot definitively confirm that everything is fine or give a clean bill of health.

It is not possible for doctors to definitively diagnose a condition through genetic screening that is conducted at 10 weeks of pregnancy or later.

These examinations, also known as “non-invasive prenatal exams,” are created to identify irregularities in fetal genetic material by examining small, unattached pieces present in a pregnant woman’s bloodstream.

They perform tests to detect chromosomal abnormalities such as trisomy 13 and 18, which frequently result in miscarriage or stillbirth, as well as Down syndrome and additional or missing sex chromosomes.

The precision of these examinations differs depending on the condition, but none are considered to be diagnostic.

Natera, a limited number of companies in the United States produces these types of genetic exams. In a message, they stated that the outcomes of prenatal testing are categorized as either “high risk” or “low risk.” If a patient receives a “high risk” result, Natera advises seeking further testing for confirmation.

According to doctors, some results may be highly precise, but there is a chance of incorrect positive results. In 2022, the Food and Drug Administration cautioned about the screenings and advised patients and doctors to verify the results.

According to a statement from Jeff Shuren, the director of the FDA’s Center for Devices and Radiological Health, although genetic non-invasive prenatal screening tests are commonly used, they have not been evaluated by the FDA and may be making unsubstantiated claims about their effectiveness and appropriate use.

In April, the agency plans to introduce a new set of regulations that would mandate FDA approval for prenatal screenings and numerous other laboratory tests.

According to bioethicist Megan Allyse, pregnant patients have often been unsure about the information provided by prenatal testing, both before and after the overturning of Roe. Allyse, an expert in women’s reproductive health technology, emphasizes the need for doctors to explain the limitations of these tests and remind patients that they do not provide diagnoses.

According to Alfonso and Wagner, it is recommended to undergo diagnostic tests. These tests include amniocentesis, which involves the removal and testing of a small sample of cells from the amniotic fluid, as well as CVS, or chorionic villus sampling, which tests a small piece of tissue from the placenta. Both tests have a slight risk of miscarriage.

Recently, Wagner noted that patients in several states are feeling a greater sense of urgency when making decisions.

The reason for this is due to the timing of the tests. It may take 1-2 weeks to receive the genetic screening results. CVS is available between 10-13 weeks of pregnancy, with initial results available in a few days and more detailed results in approximately two weeks. Amniocentesis is typically performed between 15-20 weeks, with similar timing for receiving results.

According to Alfonso, in states where there is a 12-week ban on abortion, individuals may be required to undergo a screening before taking any action.

Wagner mentioned that she has advised patients who were unable to financially travel to another state for an abortion if they postponed receiving diagnostic tests.

She stated that they are obligated to utilize the knowledge they possess in order to make decisions that they never anticipated having to make.

Certain states have laws that limit abortion to such an early stage that pregnant women are unable to undergo prenatal testing before the deadline.

Hannah, a 26-year-old resident of Tennessee where abortion is heavily restricted, experienced a similar situation. An ultrasound conducted in late November, when she was approximately 18 weeks pregnant, showed that she had amniotic band sequence. This condition occurs when thin strips of the amniotic membrane become attached to the developing fetus, potentially resulting in fetal amputation and other complications. In Hannah’s case, the bands were attached to several parts of her male fetus’s body and caused damage to multiple areas.

The woman contacted medical facilities in Ohio and Illinois to find a location for an abortion. Her genetic counselor’s office also reached out to approximately six facilities. Eventually, she located a clinic in Illinois that was a 4 ½ hour drive away and underwent the procedure in early December when she was 19 weeks pregnant. The results of the amniocentesis, which was performed to determine the cause of the issue, came back the day after her abortion, with further results following later on.

Hannah, who prefers to remain anonymous due to potential backlash, expressed her displeasure with having to consider state deadlines and travel far from home in dealing with this situation. However, she is thankful for the clear diagnosis from the ultrasound and the sufficient information that allowed her to make a confident decision to prevent her baby from experiencing pain and suffering.

Hannah acknowledged that not all women have the same good fortune. She chose to name her son Waylen.

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From Louisville, Kentucky, Ungar made a report.

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The Howard Hughes Medical Institute’s Science and Educational Media Group provides support for the Associated Press Health and Science Department. The AP is solely responsible for all of its content.