Decision Digest
Prenatal Tests
If you're pregnant, you've probably already experienced some prenatal
tests. Many of them, like the urine tests, are recommended for
everyone. Others, such as amniocentesis, are far more specialized. Your
health care provider will tell you which prenatal tests he or she
recommends for you, but the final decision is really yours. Perhaps
you'll want to ask about additional test options, or maybe there are
some tests you'd rather not have at all. This Decision Digest will give
you some things to think about as you make these decisions throughout
your pregnancy.
Why?
- Prenatal tests are designed to provide you and your doctor with more information about your health and that of your baby.
- Most likely, the information will give you peace of mind and reassure you that your baby is doing fine.
- Sometimes the information can detect potential health problems and allow your doctor to prevent or treat them.
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Prenatal tests also help you make informed decisions about your
pregnancy, let you know what to expect along the way, and give you time
to prepare for various outcomes.
Why not?
- Some tests can be invasive, uncomfortable or even painful.
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Most tests pose at least some risk, however small, such as added stress
and anxiety for you, possible infection, or even, in rare cases,
miscarriage. Make sure you understand and accept the risks involved in
each test.
- There is always the
possibility of getting a false negative or false positive. You need to
know the likelihood of inaccurate results for each test that you
undergo and think about what it would mean to you if your test results
turned out to be incorrect.
- Any positive result from a screening test may result in riskier and more invasive tests to determine a diagnosis.
- Ask yourself what you will do with the results, considering each test in the context of your religious and personal beliefs.
Summary
It is usually best to follow your doctor's advice when it comes to
prenatal tests, but make sure you have all the necessary information
first. Take the time to talk to your doctor about all of your options,
and don't be afraid to ask questions. If you still have concerns,
discuss them with family members, friends, a support group, a spiritual
advisor and/or a genetic counselor.
Resources
- About.com, Prenatal Tests: Ultrasound, AFP, Amniocentesis, CVS, and more!, http://pregnancy.about.com/cs/prenataltests
- BabyCenter.com, Prenatal Tests: An Overview, www.babycenter.com/prenatal-tests
- KidsHealth.org, Prenatal Tests, www.kidshealth.org/parent/system/medical/prenatal_tests.html
- March of Dimes, Your First Tests, www.marchofdimes.com/pnhec/159_519.asp
- Mayo Clinic, Prenatal Testing: Who Should Consider It?, www.mayoclinic.com/health/prenatal-testing/PR00014
- WebMD.com, Prenatal Tests, www.webmd.com/content/article/51/40791.htm
Newborn screening tests
In Washington, state law requires that all babies be tested for 10
congenital disorders, such as PKU and sickle cell disease, before they
are discharged from the hospital. The American College of Medical
Genetics (ACMG), however, recommends screening newborns for at least 29
conditions. Advanced technology, called tandem mass spectrometry, now
allows some labs to screen for as many as 50 disorders. Should you get
expanded screening from a private lab for your newborn? Here are some
answers about newborn screening to help you decide.
Why?
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Both the American Academy of Pediatrics (AAP) and the March of Dimes
endorse the ACMG's recommendations to screen for 29 conditions -- 19 of
which your baby will not be tested for by Washington State.
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Babies with these conditions often appear healthy, but without early
diagnosis and treatment they can suffer serious and permanent health
complications, mental retardation, or even death.
-
If your baby has one of the disorders, expanded newborn screening will
help your baby's doctor identify it quickly so he or she can begin
treatment before it is too late.
- If the
results are negative, your family will have the peace of mind from
knowing that your baby has been screened for the conditions listed.
-
Testing involves a simple heel prick to get a few drops of blood, which
can be collected at the same time as the state-mandated sample.
Why not?
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All of the conditions are considered rare. The ACMG estimates that
about 1 in every 800 babies born in the U.S. has a potentially severe
or lethal condition for which screening and treatment is available.
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There is always a risk of getting a false positive, and according to
Beth A. Tarini, M.D., from the University of Washington, "the greater
the number of tests run on a single drop of blood, the greater the
likelihood of a false-positive result."
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Any positive screening results -- accurate or not -- will require
additional medical tests to determine a diagnosis and will certainly
increase your family's stress and anxiety levels.
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The cost of expanded newborn screening tests, available from private
labs, ranges from $25 to $89 per sample and may require additional
costs for expedited shipping.
Summary
There is a chance that expanded newborn screening could save your
baby's life, but getting those extra tests will cost you. If you have
any questions about newborn screening, talk to your baby's future
health care provider.
Resources
Laurie Thompson is freelance writer and mother of two in Bellevue.
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