How Roe v Wade reversal is changing pre-natal care: Growing number of pregnant women in Red states are getting genetic tests and early ultrasounds to detect birth defects and beat strict abortion bans

An increasing number of expectant mothers are requesting early ultrasounds and genetic testing to help them make informed decisions about their pregnancies, as more states pass strict abortion laws.

Prenatal genetic screening and other diagnostic tests are often used to detect abnormalities and health risks to a fetus and help doctors and patients plan the safest pregnancy and delivery.

They also provide women with information that may influence whether they want to terminate a pregnancy.

Many of these tests cannot be performed until a woman is at least ten weeks pregnant. However, more than a dozen states have passed laws banning abortions entirely or limiting them to before six weeks. This means that by the time a person receives prenatal test results, it is often too late to terminate a pregnancy.

There are several prenatal tests a woman can undergo to obtain health information about her baby.

Some screenings include amniocentesis, performed between 16 and 20 weeks of pregnancy to test the fluid around the fetus for certain health problems, chorionic villus sampling, performed between 10 and 13 weeks to test a piece of the placenta for genetic disorders, and non- invasive prenatal testing, a blood test done at 10 weeks to analyze the fetal DNA in a mother’s blood.

These tests screen for conditions such as Down syndrome and spina bifida, as well as more serious and fatal abnormalities such as Edwards disease and Tay-Sachs disease.

Some women may choose to terminate their pregnancy if prenatal testing shows that the fetus has a life-threatening birth defect that could lead to 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 health care professionals offer prenatal screenings to every pregnant patient.

Researchers in a 2023 study the journal Obstetrics and Gynecology states: ‘Although many factors influence a patient’s decision to have an abortion, fetal genetic abnormalities are a common reason, especially in abortions after the first trimester.’

Citing a 2012 systematic review, the researchers also said that up to 67 percent of patients in the United States, when confronted with a diagnosis of Down syndrome, chose to terminate their pregnancies.

The research shows that the data has remained consistent.

Sabrina Fletcher, a doula who has guided 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 don’t think about legal consequences and deadlines, and yet we are forced to do this.’

After the overturning of the case of Roe vs. Wade by the Supreme Court in June 2022, 14 states have bans on abortion at any stage of pregnancy – meaning diagnostic testing of a fetus cannot be performed before gestational age-based cutoffs.

While there are no definitive statistics on how many women are requesting early testing, health care providers anecdotally say they have noticed an increase.

However, experts are concerned that women are rushing to make decisions about whether to continue their pregnancies based on the information they can get before an abortion ban takes effect.

But early tests are not always 100 percent correct and may provide only limited information.

Ultrasounds early in pregnancy reveal much less about a fetus than scans done in later weeks, and genetic screenings can be inaccurate.

Dr. Clayton Alfonso, a gynecologist at Duke University, told AP, “More people are trying to discover these things earlier to try to fit within the confines of laws that I don’t think have a place in medical practice.”

The types of tests and ultrasounds a pregnant woman gets — and when she gets them — can vary based on an individual’s health and risk factors, as well as the equipment and tests available at a medical clinic.

Although some women may get an ultrasound in the first 12 weeks of pregnancy to estimate the due date or to monitor multiple fetuses, this is not standard because it is too early to see limbs and organs in detail, according to ACOG.

It is also difficult to detect major birth defects before mid-pregnancy, after 20 weeks.

A common prenatal test at 20 weeks — following the end of abortion in more than a dozen states — is an ultrasound commonly called an anatomical scan.

This scan checks the fetus’s heart, brain, spine, and limbs to look for congenital problems and can identify problems and abnormalities that may lead to more testing and a possible diagnosis.

But since Roe vs. Wade was overturned, gynecologist Dr. Cara Heuser of Utah — where abortion is allowed up to 18 weeks — said more patients are getting ultrasounds at 10 to 13 weeks so they have time to have an abortion if that is necessary.

However, Missouri genetic counselor Chelsea Wagner said early scans don’t provide a complete picture of a pregnancy and doctors can’t make a definitive diagnosis based on scans or other screening tests this early in a pregnancy.

She said: ‘You can’t give someone an ‘everything looks fine’ or a clean bill of health based on an ultrasound scan at ten weeks.’

Additionally, when it comes to genetic testing, the accuracy of the tests varies by condition, but no test is considered definitively diagnostic and false positives are possible.

And in 2022, the Food and Drug Administration warned against certain screenings, reminding patients and doctors that the results need further confirmation.