First Trimester Screening in Pregnancy

Knowing you have a healthy baby as early in your pregnancy as possible can significantly ease your worries and stress. And, if there is a problem, it’s better learning this early on, no matter what you decide to do about it. In the past, women had to wait until the second trimester to have an amniocentesis to test for Down syndrome. But in recent years, first trimester screening involving a simple blood test of several hormones and a non-invasive ultrasound, has become available. The combination of these tests detects about 75 percent of fetal problems. When they’re followed by second trimester testing, the detection rate is above 95 percent.

Though the American College of Obstetricians and Gynecologists now recommends first trimester screening for all pregnant women, many doctors still don’t offer it to their patients. Since it is fairly new, some may not know about it and others may not be trained to do the ultrasound, but some don’t offer it for ideological reasons—they don’t want the patient to consider terminating the pregnancy. A new study of over 38,000 pregnant women determined that all women should undergo first trimester testing, and when the results suggest a woman is at high risk, she should then be offered a minor surgical procedure involving a needle biopsy of the placenta (chorionic villus sampling or CVS) for confirmation or reassurance. This combination of universal screening followed by the CVS in those with a positive test is called contingent sequential testing. All of this should be completed before the twelfth week of pregnancy as it is in other Western countries like England.

The problem is, only 10% of people have easy access to CVS, so some drive to other cities to get it or others wait until they can do an amnio. I urge patients to ask their doctors about first semester screening—the more women who ask, the more doctors will be pressured into offering this important screening and as the demand for CVS increases, it will become more readily available as well.

The China Syndrome: Not During Pregnancy

Made in China is taking on new meaning. First it was tainted pet food imported from China, then toxic fish—from China, and now Veggie Booty sprinkled with Salmonella-laced seasonings—again from China. In recent weeks, a number of foods, drugs, toys, and other products produced in China have been found to contain harmful toxins, and this, many experts think, is just the tip of the iceberg. China itself is closing manufacturing plants in an attempt to avert a backlash against Chinese products. Many Americans have been asking the question of where our food comes from, and how rigorously it is tested for contamination.

It’s estimated that at least 15% of your food comes from foreign countries; though at least 80% of seafood does. Some of these countries, as we now know, often look the other way when it comes to the use of toxic agents and pesticides. Because it’s nearly impossible for consumers to know where the food they buy in food markets comes from, the US Department of Agriculture has established rules that require fish and seafood to contain Country of Origin Labeling (COOL). The USDA expanded these rules in 2004 to cover beef, lamb, pork, peanuts, and fresh and frozen fruits and vegetables, but they have not yet taken effect because of repeated delays. The rules are up for public comment until September 30, 2007. You can send your comments by email: cool@usda.gov or fax: 202.720.1112. COOL rules will enhance accountability among foreign manufacturers and help consumers to make educated decisions about their purchases.

During pregnancy, you’re eating for two and have to be twice as careful about what you’re eating. There are several ways to protect yourself and your vulnerable baby from potentially contaminated food. First, try to purchase organic products when you can. Second, try to buy food produced from local farmer’s markets. Third, buy from countries with the safest profiles. In order of safety, the US, Canada and Europe are first; Mexico is below US standards, then Latin America, and at the bottom of the list is Asia. Fourth, eating a Flexitarian diet— reducing your consumption of meat, fish and chicken, while increasing your fresh fruits and vegetables can also help lower your exposure to toxins from animal products—no matter where they come from. Avoid processed and prepared foods and choose fresh foods instead.