07 Aug Health Tests For Mums-to-be
So you’re pregnant or thinking about becoming a mum. Here are 6 health tests you will need to take while expecting.
Pregnancy can seem more like a chore than a miracle with so many tests and scans, but these procedures have an important purpose, say Dr Manisha Fernando and Dr Katrina Reid.
Finding out you are expecting a baby is often exciting, and the journey to prepare for baby’s arrival can take families in all kinds of directions. It is important to visit your general practitioner (GP) early on so they can help ensure things run as smoothly as possible for you and your baby’s health.
This is part of your prenatal care, which is provided to a woman and her unborn baby during pregnancy. The prenatal-care team includes GPs, midwives and specialist obstetricians. Appointments with health-care staff can sometimes seem overwhelming, but they needn’t be. This article outlines and explains the tests offered to mums-to-be.
At the first prenatal appointment, the doctor or midwife speaks with you about your past medical history and any previous pregnancies. There is also a general examination including blood pressure and urine checks. Tests may be ordered during this appointment. Make sure your doctor explains them so you can understand their limitations and consequences. You may also choose to ask for copies of your pregnancy-care summary and test results for your own records.
The tests discussed here assume you are in good health and your pregnancy is not complicated. Further tests may be suggested depending on your health and medical issues.
Blood group and antibodies: If you have a negative blood type or already have blood-group antibodies, you will need further checks during your pregnancy.
Full blood count: This looks at blood cells and can provide information about anaemia and iron levels.
Rubella (German measles): Most Australian women have been vaccinated against rubella, but if an infection occurs during pregnancy it can cause problems, so we check for immunity. We can advise if you need a repeat immunisation after having your baby, but it is not given during pregnancy.
HIV, hepatitis B, hepatitis C and syphilis: These infections are not common in the Australian community, but we check for them in all women because if they are present they can affect the health of the mother and her unborn baby. If you unexpectedly test positive for any of these infections doctors can offer treatment to safeguard you and your unborn baby and make labour and delivery as safe as possible.
Vitamin D levels: Low vitamin D levels are becoming more common in Australia, and some women (depending on geography and ethnicity) are more at risk than others. You should have your vitamin D levels checked early in the pregnancy.
Diabetes tests: At around 26 to 28 weeks, you will be offered a blood test to check your risk of developing gestational diabetes. If your risk is high – based on this initial test, your ethnicity or your family history – you may be offered further testing.
Most women will have two ultrasound scans during pregnancy – an early one, which looks for the baby’s heartbeat and can tell us when the baby is due, and a late scan (also called a morphology scan) at around 18 to 20 weeks, which looks at the baby’s growth and anatomy and where the placenta is placed. If there are any concerns, additional scans may also be ordered.
A urine sample is usually taken at the first visit to check for urinary infection, which can be present in pregnancy without symptoms. A urine dipstick test may be conducted later to look for white blood cells, which could suggest urinary infection, reveal high levels of sugar (which can occur with gestational diabetes) and excess protein (which can be present in pre-eclampsia). This used to be done routinely at every prenatal visit, but is no longer deemed necessary.
If you are due for a pap smear, it can be done early in pregnancy, however you may choose to defer it until after your delivery.
You may be offered additional tests depending on your individual needs and background. These include: tests for a blood condition called thalassaemia, a genetic disease of the blood that may cause anaemia; blood tests for previous chicken-pox infection (if you haven’t had it previously you can be immunised against it, but not while you are pregnant); thyroid-function tests; vaginal swabs for Group B streptococcus in the birth canal; and full blood count or iron-deficiency tests in the third trimester.
Down Syndrome Tests
The GP or obstetrician will offer you the option of testing for Down syndrome and other chromosomal (genetic) abnormalities. These tests are not compulsory and must be discussed with a doctor or midwife before they are ordered. They involve blood tests (best done at week 10) and an ultrasound scan (best done in week 12 or 13). Together these tests are referred to as the combined first-trimester screening test. The timing of these tests is critical. If this window is missed you may be offered a blood test during your second trimester between weeks 15 and 17. These blood tests and ultrasound scans are known as screening tests and do not give absolute answers. Rather, they provide information about whether the foetus is at high or low risk of having these abnormalities. If the risk is high you will have the option of further tests to find out for sure. Tests that can tell us if the foetus definitely does or does not have Down syndrome (or other chromosomal abnormalities) are called amniocentesis and chorionic villus sampling (CVS). They are not done in the first instance as there is a very small risk they may cause a miscarriage. If you are over the age of 37 or have previously had a foetal abnormality, you may be offered an amniocentesis or CVS straight away instead of the screening tests.
When To See Your Doctor
Ideally a couple should see their GP before trying to conceive, so health issues that may affect conception or pregnancy can be looked at. This includes smoking and alcohol, general health, medication, vitamin supplements and vaccinations.
Dr Manisha Fernando and Dr Katrina Reid are GP mothers who write about prenatal health.
This article provides general health information and in no way constitutes medical advice. Ideas and information expressed may not be suitable for everyone. Readers wishing to obtain medical advice should contact their own doctor.
Words by Dr Manisha Fernando + Dr Katrina Reid / Photography by Valeria Boltneva