Your Pregnancy After 35 : Tests for You and Your Baby (part 7) - Tests for Blood-Sugar Levels, Nuchal Translucency Screening , Fetal MRI , Instant Risk Assessment

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Tests for Blood-Sugar Levels

Many doctors test every pregnant woman for diabetes, usually around the end of the second trimester. Testing is particularly important if you have a family history of diabetes. Blood tests used to diagnose diabetes are a fasting blood-sugar and glucose-tolerance test (GTT).

For a fasting blood-sugar test, you eat your normal meal the evening before the test. In the morning, before eating anything, you go to the lab and have a blood test done. A normal result indicates diabetes is unlikely. An abnormal result (a high level of sugar in the blood) needs further study.

Further study involves the glucose-tolerance test (GTT). You must fast after dinner the night before this test. In the morning at the lab, you are given a solution with a measured amount of sugar in it to drink. It is similar to a bottle of soda pop but doesn’t taste as good. After you drink the solution, blood is drawn at predetermined intervals, usually at 30 minutes, 1 hour and 2 hours and sometimes even 3 hours. Drawing the blood at intervals gives an indication of how your body handles sugar. If you need treatment, your healthcare provider can devise a plan for you.

Nuchal Translucency Screening

Nuchal translucency screening is a test to help healthcare providers and pregnant women find out if a fetus has Down syndrome. Results are available in the first trimester.

A detailed ultrasound allows the doctor to measure the space behind baby’s neck. When combined with blood tests, the results of these two tests (ultra-sound and blood test) can be used to predict a woman’s risk of having a baby with Down syndrome.

Because results are available early, a couple may make earlier decisions regarding the pregnancy, if they choose to do so. When this test is done between 10 and 16 weeks of pregnancy, it accurately detects Down syndrome more than 95% of the time. In fact, it is the single-most powerful screening tool for Down syndrome. One study showed that doing this test in women with a higher risk of having a baby with Down syndrome increased the rate of detection of Down syndrome from 60 to 80%.

Fetal MRI

Ultrasound is the standard test used to diagnose birth defects and other fetal anomalies. It is usually the first test used, but there are some limitations to ultrasound evaluation. If a pregnancy involves an obese mother-to-be, decreased fluid around the baby (oligohydramnios) or an abnormal fetal position, ultrasound may not reveal problems. In addition, its optimal use is in midpregnancy, so earlier or later use of the test may not be as helpful.

Another test in use has fewer limitations—fetal MRI. Fetal MRI (magnetic resonance imaging) provides excellent tissue contrast and is not limited by maternal obesity or fetal position. This test is most helpful when findings from ultrasound are unclear or cannot be seen clearly.

Unlike X-ray and CT scans, MRI does not use ionizing radiation. Several studies have demonstrated the safety of MRI on human embryos and fetuses. To be cautious, MRI is still not advised during the first trimester. The test is used to identify conjoined twins, a diaphragmatic hernia, oligohydramnios, various large tumors, diagnosing fetuses with brain abnormalities and masses in the neck.

It’s important to note ultrasound is more widely available and less expensive than MRI. Ultrasound is still the first choice for diagnosing fetal problems. However, MRI can be helpful in special situations, as mentioned above.

Instant Risk Assessment (IRA)

A screening test for Down syndrome, called IRA (Instant Risk Assessment), offers women faster results at an earlier stage in pregnancy and has a 91% accuracy rate. IRA has two parts, a blood test and an ultrasound. Women receive a collection kit from a provider or hospital.

The mother-to-be pricks her finger and marks a card in the kit with her blood, which is sent to an IRA lab for analysis. It is tested for levels of HCG (human chorionic gonadotropin) and a substance called pregnancy-associated plasma protein A. Both are produced by the placenta and help maintain the uterine lining, but elevated levels have been associated with Down syndrome.

The second part of the test, the ultrasound, is a nuchal translucency exam, in which an ultrasound measures the space on the back of the baby’s neck. The more space in this area, the higher the chance that baby has Down syndrome. Your doctor can schedule the ultrasound.

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