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.

Too much sugar during pregnancy

We’ve long known that women with gestational diabetes put themselves and their babies at risk of several complications and lifelong problems, but a new study shows that women with glucose levels that are within the normal range, but on the high side, may also be at risk. About 4 percent of pregnant woman in the US—or 135,000—are diagnosed with gestational diabetes each year. The disorder allows excess glucose to cross the placenta, putting the baby at risk of being born too large (a risk for cesarean section), as well as for developing obesity and diabetes later in life. It can also increase a woman’s own risk of weight gain, diabetes, and cancer.
The new study, reported at last month’s meeting of the American Diabetes Association, tracked 25,000 pregnant women over seven years and found that the current threshold for “normal blood sugar” levels may be too high. When women had blood sugar values that were within the upper end of the normal range, there was an elevated risk of the problems I mentioned above that are typically associated with gestational diabetes. Stricter guidelines are clearly in order to lower risk to you and your baby.
I recommend that you err on the side of caution, and request a blood test for glucose, called HgA1C (also known as “glycosylated hemoglobin"), which provides an estimate of your average blood sugar. Typically, women are tested for blood sugar problems during the 28th week of their pregnancy—following a drink of an overly sweetened beverage called a glucose challenge. Don’t wait until 28 weeks, but request this inexpensive blood test when you’re having blood drawn for other prenatal tests—typically around the second prenatal visit. If the number is in the high end of the normal range or above normal, request a referral to a registered dietician so that you can learn ways of improving your diet to lower your risks to yourself and your baby.

Second Hand Smoke: Unhealthy for Pregnant Women

As rates of cognitive and behavioral problems in children continue to rise, there’s a growing body of evidence that environmental pollutants are a significant contributor to the troubling trend. A new study has strongly implicated second hand smoke. The study found that regular prenatal exposure to second hand smoke has been linked to attention deficits, aggressive behavior, acting out, and regular confrontation with rules in children—a group of problems collectively called externalizing behaviors. Infants born to women regularly exposed to tobacco also experience more colic and can be more difficult to soothe. Single episodes of smoke exposure are unlikely to have an effect.

It is firmly established that children born to women who smoked during their pregnancy have a higher risk of behavioral disorders. Studies have shown that daughters born to moms who smoked were nearly five times more likely to develop attention deficit hyperactivity disorder (ADHD) whereas sons were twice as likely as those born to nonsmokers. ADHD is a growing problem in the US, affecting an estimated 5% of children. Tobacco contains many toxins including lead and various chemicals that can act as anti-estrogens and affect fetal development including brain development.

This study provides all the evidence you should need to take steps to avoid second hand tobacco smoke. Make your house and car smoke-free and support businesses that are smoke-free or provide a non-smoking section. Tell smoking family and friends that you’re pregnant and you don’t want to put your baby at risk. Ask to get reassigned if to a nonsmoking area at work. And if you’re a smoker, talk to your doctor about what you can do to quit.