Estimated read time: 4-5 minutes
This archived news story is available only for your personal, non-commercial use. Information in the story may be outdated or superseded by additional information. Reading or replaying the story in its archived form does not constitute a republication of the story.
WASHINGTON — Since Roe v. Wade was overturned, many health care providers say an increasing number of patients are deciding the fate of their pregnancies based on information they can gather before the state bans kick in. But early ultrasounds show far less about the condition of a fetus than later ones. And genetic screenings may be inaccurate.
When you find out your fetus has a serious problem, "you're in crisis mode," said Sabrina Fletcher, a doula who has helped women in this predicament. "You're not thinking about legal repercussions and (state) cutoff dates, and yet we're forced to."
About half of states ban abortion or restrict it after a certain point in pregnancy. In Utah, it's generally illegal after the 18-week mark.
'Within the confines of laws'
This leaves millions of women in roughly 14 states with no option to get follow-up diagnostic tests in time to feasibly have an abortion there if they wanted, a paper published last March in the journal Obstetrics and Gynecology found. Even more states have abortion cutoffs too early for mid-pregnancy ultrasounds.
"More people are trying to find these things out earlier to try to fit within the confines of laws that in my mind don't have a place in medical practice," said Alfonso, an OB-GYN at Duke University.
When done at the right time, doctors said prenatal testing can identify problems and help parents decide whether to continue a pregnancy or prepare for a baby's complex needs after delivery.
They are forced to use the information they have to make choices they never thought they'd have to make.
–Chelsea Wagner, genetic counselor
One of the most common tests is the 20-week ultrasound, sometimes called an "anatomy scan." It checks on the fetal heart, brain, spine, limbs and other parts of the body, looking for signs of congenital problems. It can detect things like brain, spine and heart abnormalities and signs of chromosomal problems such as Down syndrome.
The type of ultrasounds patients receive — and when in pregnancy they have one done — can vary depending on the risk level of the patient, as well as the equipment and policies of each practice. For example, some women may have a first-trimester ultrasound to estimate a due date or check for multiple fetuses. But it's not standard practice because it is too early to see many of the fetus' limbs and organs in detail, the American College of Obstetricians and Gynecologists says.
It's impossible to spot problems like serious heart defects much before mid-pregnancy because the fetus is so small, Heuser said. Nonetheless, she said, more patients are having ultrasounds at 10 to 13 weeks to get access to abortion if needed.
Missouri genetic counselor Chelsea Wagner counsels patients from around the nation through telehealth, frequently discussing the results of ultrasounds and genetic tests.
Wagner said these early ultrasounds can't provide the assurance patients are looking for because "you can't give somebody an 'everything looks good' or a clean bill of health off of an ultrasound at 10 weeks."
Doctors also can't make a firm diagnosis from a genetic screening, which is done at 10 weeks gestation or later.
'High risk'
These screenings, 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 screen for 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 by disorder, but none is considered diagnostic.
Natera, one of only a handful of U.S. companies that makes such genetic tests, said that prenatal test results are reported as either "high risk" or "low risk" and that patients should seek confirmatory testing if they get a "high risk" result.
In 2022, the Food and Drug Administration issued a warning about the screenings, reminding patients and doctors that results need further confirmation.
Even before Roe was overturned, pregnant patients have sometimes been confused by what prenatal testing does – or doesn'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 go over the limitations of such screens and emphasize the results they receive are not diagnoses.
'Pain and misery'
Alfonso and Wagner said they advise getting diagnostic tests, too. In addition to amniocentesis, which removes and tests a small sample of cells from amniotic fluid, these also include chorionic villus sampling, which tests a small piece of tissue from the placenta. Both carry a small risk of miscarriage.
But lately, Wagner said, there's "more urgency to patients' decisions" in many states, as it can take a week or two to get the results of genetic screenings.
"They are forced to use the information they have to make choices they never thought they'd have to make," she said, adding some states restrict abortion so early that women would not have the chance to get any prenatal testing done before the cutoff.
