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May 29, 2019

First Trimester Pregnancy – The Dual Marker Test, Ultrasounds and Blood Screening

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Maternal health during pregnancy is vital to the health of the baby, and there seems to be an endless sea of tests to be undertaken during any pregnancy. If you are an older mother, particularly a first time mother over the age of 35, have any pre-existing health concerns, or have any known health or genetic issues that run in the family, you will likely find that you get poked and prodded by expert maternity healthcare specialists more often that you could ever have imagined.  

There are regular urine tests looking for protein markers and signs of the ever common urinary tract infection, blood tests that monitor your iron levels, the hideous glucose test that generally induces nausea, takes hours, but can tell if you are going to be at risk of developing gestational diabetes, and there is also the double marker test in pregnancy which can alert you early on to whether you run the risk of having a baby with serious chromosomal abnormalities – if you get the right dual marker test you can also be screened for pre-eclampsia.

First Trimester Testing

Generally, the very first test a pregnant woman undertakes is her pregnancy test, but once that comes back positive there is a barrage of tests – all to ensure the health of both mother and baby.

Ultrasound Scans and Testing

In the first trimester (from the first day of your last period through to 12 weeks after this), you will normally have a ‘dating’ scan. This is an ultrasound to confirm how pregnant you are and to give you an estimated delivery date.  This will also tell you how many babies you have growing in your uterus and confirm the position of the baby and placenta. This is not done before 6 weeks, as the fetus is too small to see. https://www.healthnavigator.org.nz/health-a-z/u/ultrasound-pregnancy/
From around 11 weeks you will be able to have a Nuchal Translucency scan (often the two scans done at the same time, but you can have a dating scan earlier). In this scan, the sonographer will measure the fluid-filled space at the back of the baby’s neck, although they will not usually interpret the results for you. The nuchal translucency scan is done as a way of checking the likelihood of the baby having a chromosomal abnormality. These can range from a more common Down syndrome which has a high survival rate, to trisomy 13 or 18 which has a very high mortality rate (and will often be an indicator for likely miscarriage).
You won’t be able to find out the sex of your baby until an anatomy scan in your second trimester (normally after 18 weeks). This will also be able to tell you, and your doctor, if there are any concerns about the way the baby’s organs and body are developing. Because this is technically about the baby’s anatomy, you may need to specifically ask your sonographer to check what the sex is (although it is not at all uncommon for baby’s to position themselves in a way that hides their genitals, denying parents an early indicator).  
An ultrasound is considered to be non-evasive (you have hopefully warm, gel placed on your belly, and the wand is run over your belly creating an x-ray like image from ultrasound waves bouncing back to the wand), and there have been no known negative effects on baby or mother, however it is still should not be used by anyone untrained, and having more than needed is not recommended.

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Blood Testing

You are unlikely to need to confirm your pregnancy with a blood test, but this can be done as part of your routine first trimester blood workup. However, your first routine blood test will confirm your blood type and Rh factor. This is important because if your blood type is Rh negative and the father of the baby has an Rh-positive blood type, your body may develop a condition in this pregnancy or future pregnancies where the mother's body sees the baby as a foreign body to be fought off (see here for more information).
You will also be tested for anemia, as low red blood count is not uncommon in pregnancy, and amongst the serious health concerns can also increase first trimester fatigue and nausea symptoms. A standard blood test will also scan for hepatitis B, syphilis and HIV, as these are all transferable to the baby.
Another testing you may consider can include your immunity to rubella and chickenpox, cystic fibrosis, thyroid conditions, fragile X syndrome, hepatitis C, and a range of other conditions. However, most people will only include these for testing if there is a confirmed risk through exposure or family history.

Dual Marker Testing

This is technically a blood test, however, the results of the double market test (or double marker + PLGF) will often be used in conjunction with the first trimester ultrasound where the mother gets her Nuchal Translucency scan to make any recommendations.
The Dual marker test is looking for the presence and levels of the hormones Beta Human Chorionic Gonadotropin (Beta hCG) and Pregnancy Associated Plasma Protein (PAPP-A) in the mother's blood (research is available here).
If the results of these test indicate that there is a high risk of the baby having a chromosomal abnormality then the mother can weigh up the risks of getting a diagnostic test. Normally these are either the amniocentesis or chorionic villus sampling, both of which are more invasive than the blood test and to create a level of risk to the baby and the pregnancy.
Additional testing that includes detection of the PLGS is helpful in detecting the risk of pre-eclampsia in the first trimester.  Although there is no cure for pre-eclampsia, early detection can mean that healthcare professionals can assess the risk levels and provide a cause of action that can help keep both mother and baby as safe as possible throughout the pregnancy. This may be as simple as recommending that you sleep only on your left side, or may require medication, bedrest or even hospitalization.
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