Obstetricians, a quick question about pregnancy

[MrsCoolCat]

Hi. I started a new job and my health insurance starts on August 5th. I have an appt scheduled and I will be 14 wks and 4 days pregnant according to my calculations. I actually already take prenatal vitamins, folic acid, calcium and fish oil. I also have minimal morning sickness, zero vomiting and have maintained my exercise with adjustments for my elevated heart rate (bc of underfill & the blood pumping, lung circulation thing). Very thankful about that one.

I mentioned it would be my first appt, that I'd be 14 wks and feel fine; the scheduler didn't tell me to come in any earlier. Obviously if I was vomiting and had a hard first tri I'd go in earlier. Any thoughts or comments bc one pregnant friend said they can't perform certain tests after 12 wks? Is that true? Technology has come a long way for me to believe that entirely. Thank you in advance!

I should prob add that I checked out fine last July when I told my PCP that we were going to try to get pregnant. The cardiologist said I was fine. My BMI is normal. I'm 32 yrs old. First pregnancy. My blood pressure and cholesterol are both fine. I don't take any medications (I stopped allergy meds when I found out I was pregnant). I do have a low pulse from the readings at those machines but I think it's bc I work out. It was like a 58 or 59. I also have 3 pregnancy books. One for the overall what happens week by week, what to eat & how to exercise. 😊

[Gin1984]

You are fine. 

[lbmustache]

x2 you are fine... and congrats!

[Captain FIRE]

my first appointment was near the end of 9 weeks, my second will be at 14 weeks.  The first appointment was mostly getting a history, genetic counseling, and doing a short exam.  I did the urine sample/blood draw together with some genetic testing (waiting on most of those results) about 1-2 weeks later, because I needed to be at least 10 weeks for one of them.  Unless you are spotting, cramping or having other major issues/history of miscarriages, I wouldn't think it would matter that much.  Just make sure you're taking the vitamins and eating healthy (or at least: no alcohol, no smoking, no unpasteurized cheese, mostly avoiding mercury & listeria foods, no ibuprofen or the like - Tylenol ok, etc.)  btw, apparently morning sickness is actually taken as a positive marker for healthy pregnancy, go figure

[naners]

If you want to have screening for Down Syndrome (nuchal translucency screen), they need to do that between 11 and 14 weeks because of the fetus' anatomy. The thing they're looking for just isn't there after that point. It also screens for heart defects and some other congenital disorders.

[MrsCoolCat]

Thank you, everyone! Yes, I read that ppl with morning sickness are less likely to miscarry but that ppl that don't get it, like me, shouldn't get worried either. Go figure. Also, the cheese thing has been the only thing that's bothering me. I eat things with cheese. Like Publix subs. How do I and sometimes even they know whether or not it's pasteurized?! I will ask the Dr. when I see her, but also read the baby is so small at this point anyways... I don't smoke & barely drank before. Tho I already stopped raw sushi & medium rare meat which those two are like worse than giving up alcohol for me lol!

[MrsCoolCat]

If you want to have screening for Down Syndrome (nuchal translucency screen), they need to do that between 11 and 14 weeks because of the fetus' anatomy. The thing they're looking for just isn't there after that point. It also screens for heart defects and some other congenital disorders.

My friend mentioned Downs Syndrome being the one they can't test for after 12 wks. Do they not have or take any other tests that can check for that? Ty. It doesn't run in either of our families & I'm 32.

[Kitsune]

If you want to have screening for Down Syndrome (nuchal translucency screen), they need to do that between 11 and 14 weeks because of the fetus' anatomy. The thing they're looking for just isn't there after that point. It also screens for heart defects and some other congenital disorders.

My friend mentioned Downs Syndrome being the one they can't test for after 12 wks. Do they not have or take any other tests that can check for that? Ty. It doesn't run in either of our families & I'm 32.

They do, but they're higher risk for miscarriage, from what I know.

Also (and I am NOT saying this to start a debate about abortion in this thread and will not get into that discussion), should this apply to your situation: if a positive screening for Downs would cause you to reconsider the pregnancy, there is benefit to having that done before the end of the first trimester. If it wouldn't change your mind either way, not so much, you're fine.

[MrsCoolCat]

If you want to have screening for Down Syndrome (nuchal translucency screen), they need to do that between 11 and 14 weeks because of the fetus' anatomy. The thing they're looking for just isn't there after that point. It also screens for heart defects and some other congenital disorders.

My friend mentioned Downs Syndrome being the one they can't test for after 12 wks. Do they not have or take any other tests that can check for that? Ty. It doesn't run in either of our families & I'm 32.

They do, but they're higher risk for miscarriage, from what I know.

Also (and I am NOT saying this to start a debate about abortion in this thread and will not get into that discussion), should this apply to your situation: if a positive screening for Downs would cause you to reconsider the pregnancy, there is benefit to having that done before the end of the first trimester. If it wouldn't change your mind either way, not so much, you're fine.

Ok, thank you. Very informative. I will ask the scheduler to confirm with the Dr. that I can still take that test or if there are any issues or alternatives that are safe, etc. Thank you.

[slappy]

I believe there is a blood test for Down Syndrome as well as other issues, but my understanding is that insurance won't cover it if you are under a certain age. If you were concerned, you could probably request the blood test and pay out of pocket for it. I have no idea how much it costs, but I know that it can also test for gender.

[MrsCoolCat]

I believe there is a blood test for Down Syndrome as well as other issues, but my understanding is that insurance won't cover it if you are under a certain age. If you were concerned, you could probably request the blood test and pay out of pocket for it. I have no idea how much it costs, but I know that it can also test for gender.

Sounds like a plan since I already skipped this month's visit bc of insurance I might as well just pay for that one. Thank you, all, very informative remarks! So appreciated. 😊

[KS]

I believe there is a blood test for Down Syndrome as well as other issues, but my understanding is that insurance won't cover it if you are under a certain age. If you were concerned, you could probably request the blood test and pay out of pocket for it. I have no idea how much it costs, but I know that it can also test for gender.

Sounds like a plan since I already skipped this month's visit bc of insurance I might as well just pay for that one. Thank you, all, very informative remarks! So appreciated. 😊

There are I believe at least 3, maybe 4 options for the blood DNA test to check for chromosomal disorders. They can be taken anytime after 10 weeks I think. This is the one my doc preferred, due to all the high-quality validation data the company has published relative to the others (although maybe now some of the others have more data published as well): http://www.ariosadx.com/expecting-parents/  They go out of their way to specify it is not 100% diagnostic, but it at least helps flag whether or not you likely need to get an amnio for proper diagnosis. (And at least in my case, it was more accurate than the California state-provided NT screen/blood protein measurements.) I'm not sure who covered mine as I never got a bill but did see the charge on my insurance summary (insurance did not pay) and I believe it was just under $3k, just FYI. But there is info in the FAQs about cost and ways they can work with you to minimize it, if insurance does not cover.

[MrsCoolCat]

...and I believe it was just under $3k, just FYI. But there is info in the FAQs about cost and ways they can work with you to minimize it, if insurance does not cover.

Wow, thanks for the estimate bc I was def not expecting that! That sucks bc my max OOP is lower than $3k, but it doesn't really matter if it's not covered!

[forummm]

The ultrasound tests are much, much cheaper than most DNA tests. And the DNA tests are good for some things and not great for others. Expecting Better by Emily Oster has a section on testing pros and cons based on the research. We got ultrasounds and some very limited blood tests.

[Captain FIRE]

They can't do an amnio for down syndrome?  (I know that carries some risk, but I thought that would still be an option.)

So because I am 35+ (advanced maternal age), I was offered two options for early testing of trisomy 13, 18 and 21 - a test done via an early ultrasound, or a blood test.  (Note that trisomy 13 and 18 are the really bad ones, not 21 which is Down syndrome.  My recollection is that 50-90% of all babies born with it die w/in the first week according to the literature and the vast majority die w/in the first year.)  Mothers under 35 are just offered the ultrasound I believe.  If they screen positive, then they are given the blood test.  The blood test was far more accurate (but gives no ultrasound picture) so we opted for it.  Learned later that we'd be told the gender through it.  The blood test I was told couldn't be done until week 10 (and possibly if done early might be a little less accurate and give a false positive), but they made no mention of a time limit on it.  It's a new test of the mother's blood, as opposed to the old tests trying to test the baby's dna through amnio.  They also said you can tell some markers through ultrasounds too.

[naners]

Yes you can get amnio but it carries a risk of miscarriage, which the ultrasound and blood tests do not. Agreed with the person who said that if the results of the test would influence your decision about continuing the pregnancy, then better to know earlier rather than later.

You know, one possibility is to go to Planned Parenthood for a first visit, then an OB once your insurance kicks in. Pretty sure PP offers prenatal care and it would probably be a lot less expensive than an out of pocket visit to an OB.

[MrsPete]

My friend mentioned Downs Syndrome being the one they can't test for after 12 wks. Do they not have or take any other tests that can check for that? Ty. It doesn't run in either of our families & I'm 32.

Downs doesn't run in families.  Aside from maternal age, it is completely random.  When I had the test of which you speak -- the AFP, Alpha Fetal Protein test -- it said my baby almost certainly had Downs.  (I was 26, and no one in our family has ever had it.)  My daughter didn't have it either.  Friends started coming out of the woodwork telling me the same story:  That test has a tremendously high false positive rate.  However, it did lead to some very nervous weeks and an appointment with a genetic specialist ... in the process, I became quite knowledgeable on the subject.

Regardless of that test, go to the doctor.  The prenatal tests for the baby aren't the only thing they can look out for.  For example, Gestational Diabetes is quite common, and without a test you have no way to know.  If you have any Rh factor problems, the doctor could take care of that. 

If money's a problem, go to your county health department.  The care is impersonal but better than no care. 

[MrsCoolCat]

I didn't know that about Downs Syndrome. I don't know much about it. It's just a common test that was brought up. Thank you for the advice.

[ShoulderThingThatGoesUp]

Maternity21 costs like $200 if your insurance won't pay and has much, much lower false positives (thinking there's a problem when there isn't) than the sequential screen.

[onlykelsey]

They can't do an amnio for down syndrome?  (I know that carries some risk, but I thought that would still be an option.)

So because I am 35+ (advanced maternal age), I was offered two options for early testing of trisomy 13, 18 and 21 - a test done via an early ultrasound, or a blood test.  (Note that trisomy 13 and 18 are the really bad ones, not 21 which is Down syndrome.  My recollection is that 50-90% of all babies born with it die w/in the first week according to the literature and the vast majority die w/in the first year.)  Mothers under 35 are just offered the ultrasound I believe.  If they screen positive, then they are given the blood test.  The blood test was far more accurate (but gives no ultrasound picture) so we opted for it.  Learned later that we'd be told the gender through it.  The blood test I was told couldn't be done until week 10 (and possibly if done early might be a little less accurate and give a false positive), but they made no mention of a time limit on it.  It's a new test of the mother's blood, as opposed to the old tests trying to test the baby's dna through amnio.  They also said you can tell some markers through ultrasounds too.

I'm pregnant now and 30 (but was 29 through my first trimester).  Around 12 weeks they did a blood test for Trisomy 13, 18 and 21, and just yesterday (15 weeks) they did a blood test for spina bifida.  I'm not sure why they were done in that order.  It's possible they get more accurate over time, and you just can't do them too early...

Downs doesn't run in families.  Aside from maternal age, it is completely random. 

Just a minor correction (not a doctor, but my husband has two folks in his family with Down's, so we just went through this): apparently most Down's is NOT genetic, but I understand that translocation Down's syndrome (not what affects the majority of babies with Down's) actually is genetic.  People don't know that they carry a translocated chromosome 21 because it was a balanced translocation, but their child is more likely to inherit an unbalanced translocation on that chromosome. https://ghr.nlm.nih.gov/condition/down-syndrome#inheritance  So, family history may be relevant, if you know which type has appeared in your family.

[MrsPB]

Late to the party here but thought I'd share my experience. The first trimester screening test, is a check for markets of genetic abnormalities but produces only a result that is a chance of it, such as 1 in 200. They test two proteins. I had this test done and had extremely bad results but quickly learned that it is not just a marker for genetic issues like Downs, it can also indicate a problem with the placenta function. This was the case with me. We didn't know that at the time so I got the expensive blood test done (NIPT) and it came back extremely low risk of genetic disorder (not 100% accurate like the amnio but risk free for baby and pretty darn close to accurate). So doctors correctly suspected a placental issue and immediately classed me as high risk at 12 weeks and I had some dr's orders to follow such as avoiding exercise and taking aspirin to help blood flow to the baby. Obviously don't do this unless advised! The point of my reply is that until this happened to me, I thought the first tri and second tri blood screens were just for genetic issues but they are not, they can indicate other issues that may require treatment or high risk monitoring as in my case. With my first child, I was under 35 and declined the tests, but as I was over 35, just, with my second, I took them and then learned of the issue. Baby was ok, very small due to placenta not working well but was able to get close monitoring and make decisions based on that as to when to safely deliver. Sorry for long reply, just wanted to put the extra info out there as there are so many misconceptions about the screening tests.

[MrsPB]

Oh and I'm in Canada and there is no NIPT such as MaterniT21, offered here so I had to get it from the US in California and it cost around $800 CAN in 2015 but cost almost double that a month earlier! I understand it's dropped in price even more since then. And we did find out the gender at 12 weeks from that test too.

[ShoulderThingThatGoesUp]

My wife just got put on a tiny dose of aspirin because she's pregnant with twins and double placenta means higher risk of preeclampsia, they said. Pharmacy freaked out that they were giving aspirin and Diclegis (morning sickness medication) to the same person.

[MrsCoolCat]

I had this test done and had extremely bad results but quickly learned that it is not just a marker for genetic issues like Downs, it can also indicate a problem with the placenta function. This was the case with me. We didn't know that at the time so I got the expensive blood test done (NIPT) and it came back extremely low risk of genetic disorder (not 100% accurate like the amnio but risk free for baby and pretty darn close to accurate). So doctors correctly suspected a placental issue and immediately classed me as high risk at 12 weeks and I had some dr's orders to follow such as avoiding exercise and taking aspirin to help blood flow to the baby. Obviously don't do this unless advised!

Hi. I hope you don't mind me asking but did you have any issues or health concerns prior to finding out about the placenta function/issue? I still exercise and have called this OB's office 3x with the 3rd time speaking to a nurse and specified that it was my first appointment at 14 weeks. They didn't show any concern or issues with me coming in at 14 weeks, so hopefully IF I have any issues it can still be addressed because as far as I am concerned with me knowing my body I am fine, healthy and don't overdue it at the gym. I am however, worried about Zika and expressed that to the nurse yesterday, too, but there's nothing really they can do because they don't test for it and I don't have Zika symptoms. It sucks to be this paranoid and hormonal, too, but at this point it's out of my control aside from staying in, long sleeve shirts, no standing water, etc etc. Thanks everyone for your replies!

[Mesmoiselle]

Here at my hospital, the lab work blood test is done in conjunction with an ultrasound between 11-13weeks and a few days to check for down etc. The two have to be done in conjunction together; otherwise, the information is meaningless past that point.

Knowing your child has Downs in advance is not just about abortion or not aborting. It becomes a high risk pregnancy and your baby may need access to a NICU after birth. Wouldn't it be wonderful to have that foreknowledge and not be bawling from anxiety as the baby is flown by helicopter elsewhere?


I'm personally not a worrier, I'm just giving an argument for screening that is more than just abortion connected. You can be absolutely willing to give birth to whatever blessing and the test be useful.
But anyway. Don't do an amnio. That is so unnecessary and dangerous.

[MrsPB]

I had this test done and had extremely bad results but quickly learned that it is not just a marker for genetic issues like Downs, it can also indicate a problem with the placenta function. This was the case with me. We didn't know that at the time so I got the expensive blood test done (NIPT) and it came back extremely low risk of genetic disorder (not 100% accurate like the amnio but risk free for baby and pretty darn close to accurate). So doctors correctly suspected a placental issue and immediately classed me as high risk at 12 weeks and I had some dr's orders to follow such as avoiding exercise and taking aspirin to help blood flow to the baby. Obviously don't do this unless advised!

Hi. I hope you don't mind me asking but did you have any issues or health concerns prior to finding out about the placenta function/issue? I still exercise and have called this OB's office 3x with the 3rd time speaking to a nurse and specified that it was my first appointment at 14 weeks. They didn't show any concern or issues with me coming in at 14 weeks, so hopefully IF I have any issues it can still be addressed because as far as I am concerned with me knowing my body I am fine, healthy and don't overdue it at the gym. I am however, worried about Zika and expressed that to the nurse yesterday, too, but there's nothing really they can do because they don't test for it and I don't have Zika symptoms. It sucks to be this paranoid and hormonal, too, but at this point it's out of my control aside from staying in, long sleeve shirts, no standing water, etc etc. Thanks everyone for your replies!

I don't mind at all. No, no issues prior that were known. First we knew was the results of the blood and ultrasound screening at 12 weeks. I know my body well, had a very easy first pregnancy, am very fit and healthy (personal trainer!). Obviously it's not super common to have this issue and there wasn't a lot they could really do so early on, except offer additional testing to find out if DS or placenta, and then I saw a high risk dr for the standard 20 week scan but it was much more detailed and I saw high risk team after that. Like the last poster said, knowing of possible complications can help you prepare and get extra care if needed. I had no idea before All this, that the results did anything other than screen for genetic disorders. Don't want to worry you or cause any stress but at same time, I think it's important to know what you are declining or accepting in testing. Also, there are false positive/negative results with these screens too so it's not always clear until later in pregnancy. Hope all is well, and congrats on the pregnancy.

[historienne]

Several of the companies that offer the NIPT tests for Downs (and other chromosomal disorders) used to have much cheaper rates if you are paying out of pocket.  Not sure if that is still the case, but you can call them and ask. 

Do you have a good reason to think you've been exposed to Zika, such as travel to an area where there have been cases?  If so, you actually can get tested for it (I did). 

[MrsCoolCat]

I don't believe I was exposed but there is paranoia and I do live in FL. I'll mention it again when I see the Dr.