In this episode, we are talking about prenatal tests. Your pregnancy journey starts with a positive pregnancy test. That is the first of many tests offered throughout your prenatal care. Some tests diagnose conditions you may have during pregnancy. Others look for genetic abnormalities in your baby. Some tests, like a Group B Strep test, may impact your birth. Tests are useful tools, but they can also create anxiety and stress during your pregnancy. Learn the basics of testing, so you have a better idea of how to make an informed choice when opting into any type of prenatal test.
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There are a lot of tests available to you when you are expecting, and it is easy to feel like you are continually waiting for results back to let you know your baby is healthy. The more you know, the less anxious you will be. Confusing tests and complex results can be overwhelming, and that can contribute to anxiety.
If you have any questions about a test or are nervous about the results, bring it up with your doctor or midwife. Hopefully, they can answer all of your questions and help put your mind at ease. Remember that the highest probability is that your baby is healthy. Worrying isn’t going to do you or your baby any good. Easier said than done, I know. What you can do is learn about what the different testing options are and make informed decisions. Getting educated will give you confidence in your choices of the tests you opt in to and how to understand results.
Screening Test vs. Diagnostic Test
It is crucial to understand the difference between a screening test and a diagnostic test. A screening test gives you the likelihood of a condition. You would need a diagnostic test to diagnose anything. For example, a screening test, like the cell-free DNA test, combines the results from the blood test with other factors, including your age, ethnicity, and family health history. The results of this screening test estimate the chances of your baby having an abnormality. A screening test does not diagnose a condition; it only signals that further testing is needed. It can be devastating to get screening results back, showing your baby is at a higher risk for anything. Please understand that you don’t know anything for sure until a diagnostic test is done.
Noninvasive vs. Invasive Tests
You can further classify tests as noninvasive or invasive. Noninvasive tests are those that do not have a risk for you or your baby. These typically use a urine or blood sample from you. If you have anxiety about needles, you may not consider a test drawing your blood to be noninvasive. Let your doctor or midwife know if having blood drawn makes you uneasy. You can ask for someone who has a lot of experience taking blood, so you do not have a first-day intern sticking you with a needle. Examples of noninvasive tests are urine samples, gestational diabetes tests, and cell-free DNA tests. Invasive tests come with some risks to you or your baby. An example of an invasive test is an amniocentesis which involves inserting a needle into your belly to take a sample of amniotic fluid.
Typically screening tests are noninvasive. If a noninvasive screening test indicates your baby is at high risk for a condition, your care provider may offer you an invasive diagnostic test. The invasive tests include a CVS, amniocentesis, and a cordocentesis. None of these tests would be given without a screening test first.
Know what your options are for testing. Your testing options may be limited by the tests accessible to your doctor or midwife. Testing options will depend on the country or state you live in and the agreements between the testing companies and your doctor’s office. If you want a test not typically offered by your care provider, you may be able to have them request it or take the test through a 3rd party lab.
For a gestational diabetes screening test you may have the option to monitor your blood glucose levels at home rather than take the one hour test in your doctor or midwife’s office. If you do not know what your options, you do not have any. You can always ask if there is an alternative.
Your informed consent should always be required for any test. You always have the option to opt-out of a test. True informed consent means that your doctor or midwife has explained it to you, answered any questions, and given you all of your options. Finally, the choice to take the test is ultimately up to you.
Plan Ahead so You Can Get Informed
Many expecting mothers walk into a prenatal appointment to learn that they are taking one of many tests. If you know your next appointment will include a first-trimester screen test you can inform yourself and prepare. The alternative is that you are put on the spot to opt into a test. It is a lot easier to make informed decisions when you are not pressured and have the time and the space to explore your options and think through what is best for you and your baby.
No test is always 100% accurate. The rate of inaccurate results, known as false-negative or false-positive results, varies from test to test. When you are talking about the accuracy of a test, especially in research, you hear the terms sensitivity specificity and positive predictive value. Sensitivity is the true positive rate if a person has the disease. How often the test will be correctly positive when the subject has the disease. Specificity is true negative if a person does not have the disease. How often the test will be correctly negative when the subject does not have the disease. Predictive value is the probability that the patient has the condition if they test positive.
Costs and Insurance Coverage
Find out if your health insurance covers a test. Your health insurance will likely cover a cell-free DNA test if you are over the age of 35. If you are under the age of 35, insurance may not pay for it. You can always request a specific test, but just because you can get access to it does not mean health insurance will cover it. If you have any questions about whether your insurance covers a test, ask your doctor or midwife. Better yet, verify with your insurance company.
Assessing How the Results Will Alter Your Prenatal Care
A consideration when evaluating whether to take a test is determining how it will alter your prenatal care. Some expecting parents will use test results to decide as to whether they want to continue the pregnancy. Some people who wouldn’t consider that to be an option may want to know about any abnormalities ahead of time so that they can plan for their baby’s care in advance. Knowing results from some tests may allow you to pursue potential interventions, like a fetal surgery for spina bifida. If a parent knows their child will be born with a disability, they can plan for a child with special needs, address anticipated lifestyle changes, and find support groups and resources.
On the other hand, there are many reasons why some couples would elect not to pursue testing or additional invasive testing if they are comfortable with the results no matter what the outcome is. If deciding on carrying their child to term is not an option, some parents may choose not to participate in any testing that has a risk. Part of evaluating whether to opt into a test is weighing the risks and benefits. If you do not see any benefit in the results you could decide an invasive test is not worth the risk.
Ask your doctor or midwife when results will be available and how you will you get them. Your care provider may not notify you of normal results. In many cases, your doctor or midwife will only contact you if the test has an abnormal result. Make sure you understand the results and what they mean for you or your baby. Some tests will give you a positive or negative; others will assign a range or risk factor. Trying to interpret results from a lab print out without your doctor can be challenging. If you are confused, ask your care provider to clearly explain a test or results.
Prenatal Tests and Telemedicine
As more appointments are moving from in-office to online, we may see some changes in the availability of testing. At the time of this article, COVID-19 is changing a lot of standard policies and procedures related to prenatal care. Expecting mothers are getting fewer ultrasounds and seeing their doctor or midwife less often than normal. You should have access to your care provider as a resource for questions, even if you cannot be in their office in person or call.
There are positives to visiting a lab instead of your doctor’s office. Labs typically have a phlebotomist on staff. This is someone specifically trained to draw blood, which means they are very efficient and hopefully painless. This could also potentially cut down on some of the processing time for your results by cutting out time for your sample to transfer from your doctor’s office to a lab.
Including Your Partner in Decision Making
Your partner can be a big help in navigating prenatal tests. Ultimately decisions of what tests to take are yours. You can and should consider your partner’s input, especially as it relates to your baby. Your partner can be a sounding board to talk through any questions or concerns. They can also be an advocate for you and help speak up with questions or concerns during a prenatal appointment.
Talking to Your Doctor or Midwife or a Genetics Counselor
Keep open communication about prenatal testing with your care provider. Talk about the risks and benefits before opting for a test. You may also want to meet with a genetic counselor who can help you navigate testing. A genetic counselor can help you understand the chances that your baby may be affected by a particular condition, how a condition would impact your baby’s life, and go into detail on possible treatment options.
Additional Episodes on Prenatal Tests
- Noninvasive Prenatal Tests
- Invasive Prenatal Tests
- Cell-Free DNA & NIPT
- Gestational Diabetes Testing (Glucose Challenge Screening and Glucose Tolerance Test)
- Exercising Before a Glucose Test
- Group B Strep
- Finding Out Your Baby’s Sex
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