During a pregnancy, women are offered prenatal genetic screening and diagnostic testing to determine whether a fetus is healthy or has certain genetic disorders or anomalies.
This information can help patients and their doctors prepare for the pregnancy. But some opt out of such testing, believing that babies should be born regardless of potential abnormalities.
For those who do choose to undergo such testing, maternal-fetal medicine specialists and genetic counselors usually work closely with the pregnant person or couple to explain in detail what the results mean for a birth, for mother and child, if a genetic disorder or fetal anomaly is detected. These health care providers can also provide the pregnant person or couple with guidance on what options are available to them after a diagnosis, which can include aborting a pregnancy. That option, however, is limited or no longer available to women in many U.S. states.
Prenatal tests can’t diagnose a genetic condition before 6 weeks
Without the protection of Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide and was overturned in June, the procedure has become illegal or heavily restricted in at least 14 states. Six states — Mississippi, Missouri, Tennessee, North Dakota, South Dakota and Ohio — prohibit abortions when the fetus may have a genetic anomaly, and in five of those states, it’s now nearly impossible, because it is banned at about six weeks. This is so early in a pregnancy that many women at that point don’t even know they are carrying a child.
“A person's first [doctor’s] appointment in pregnancy doesn't usually happen until eight or 10 weeks, so never mind the rest of the story. That's when obstetric care begins,” said Philip D. Connors, lead genetic counselor at Boston Medical Center.
“Three [percent] to 4% of all pregnancies are going to be affected by some sort of complication related to a difference in fetal or embryonic development, a genetic condition. And essentially none of those can be screened for or diagnosed until after the gestational age limits that are being placed by some of these really discriminatory laws,” Connors added.
Dr. Tani Malhotra, a maternal-fetal medicine specialist in Cleveland, Ohio, a state where abortions are now illegal after six weeks and where there are no exceptions for cases of rape, incest or fatal fetal anomalies, said it is impossible to assess whether there are any issues with the fetus at such an early point in pregnancy.
“The size of the embryo at six weeks is somewhere between 6 to 7 millimeters. It's less than 1 centimeter, and that centimeter is like the size of my finger, right? So it's just impossible for us to be able to detect abnormal findings on an ultrasound at that point,” Malhotra said.
Katie Sagaser, director of genetic counseling at Juno Diagnostics, a women's health company, told Yahoo News: “There’s no genetic testing or screening … that can be done prior to six weeks.”
One method of testing — which she said has revolutionized “the landscape of prenatal chromosome screening” and is mostly used today — is a noninvasive prenatal screening technology known as NIPT or NIPS. This can detect genetic variations as early as nine weeks into pregnancy, using a blood sample from the mother. But the test, Sagaser said, can only indicate if there is a potential problem, and does not replace diagnostic testing, such as chorionic villus sampling (CVS) or amniocentesis, which study the cells from the fetus or placenta and can confirm a diagnosis.
The earliest a CVS diagnostic test can be performed is at the 10th week of pregnancy. Amniocentesis is usually conducted at between 15 and 20 weeks of pregnancy, but can technically be done up until a person gives birth, according to the American College of Obstetricians and Gynecologists.
Aborting a pregnancy because of genetic anomalies
As prenatal screening testing like NIPS has become more common, selective terminations involving genetic conditions have too. Some studies have shown that parents often decide to terminate a pregnancy, even after finding a mild form of a genetic condition, including Turner and Klinefelter syndromes.
Down syndrome is the most common chromosomal disorder in the U.S., and about 6,000 babies are born with it in the U.S. each year, according to the Centers for Disease Control and Prevention.
A published review of studies, which included 24 publications studying pregnancy terminations after a prenatal diagnosis of Down syndrome in the U.S., found that 67% of those pregnancies end in abortion.
Terminating a pregnancy after the 2nd trimester because of medical complications
It’s notable, however, that the majority of abortions in the U.S. (91%) occur at or before 13 weeks of gestation. Abortions late in pregnancy are rare, but Malhotra said some of the main reasons why they do happen include delays and other barriers in obtaining abortion care, or after discovering medical complications. Those complications often include the discovery of lethal fetal anomalies, which can be detected during a fetal anatomy scan that is usually performed at around 20 weeks of pregnancy. Terminations at this stage, Malhotra said, are difficult and traumatic, because these pregnancies are often desired.
“It's really tragic, as you're telling these patients who have been continuing their pregnancy. They're at 20 weeks. They're excited about the pregnancy. They're planning their baby showers. They come to that ultrasound hoping to be able to find out the sex of the baby … and you tell them this devastating news, that there is an abnormality that is either not compatible with life, or is going to have significant impact on the quality of life after birth,” the Ohio doctor said.
Malhotra told Yahoo News that Ohio’s new abortion law has made her job even tougher, because she also has to tell patients in these situations who wish to terminate the pregnancy that they cannot receive such care in their state.
“It is just horrible, because not only are you giving them this tragic, heartbreaking news, but you're stigmatizing their care, because you're saying, ‘Oh, this thing is illegal here, but you could go to another state.’ So they have to travel to another state to do something that's illegal, which is a part of medical care,” Malhotra said. “If they're not able to go out of the state, then we're asking them to take on risks associated with a pregnancy, which we know inherently, pregnancy is not risk-free.”
In addition, she explained, she needs to inform these patients that they must act rapidly. Abortions later in a pregnancy are more complex and also more expensive. Medication abortion, which can be taken at home, can only be safely used in the first 70 days, or 10 weeks of pregnancy. After that, women need a surgical abortion, which typically takes about two days and requires inpatient care. A patient who needs to go out of state to receive care must therefore also take into account additional costs related to travel and lodging.
Because of the abortion bans that have gone into effect in the Midwest, surrounding states where the procedure is protected have seen an increase in patients, Malhotra said. “They are really backed up,” currently complicating the scheduling of an abortion, she said.
Another important reason to act quickly in these situations, according to Malhotra, is because most states do not permit abortions after 24 weeks — when a fetus has reached viability and can survive outside the uterus. According to the Guttmacher Institute, a research group focused on reproductive health, 17 states impose a ban at viability.
Little research has been conducted on what happens to women who are unable to terminate a pregnancy because of a fetal genetic condition or anomaly. However, one study conducted by the University of California, San Francisco, that tracked 1,000 women unable to get an abortion because they had passed the gestational limits, found they were more likely to fall into poverty, as well as have “worse financial, health and family outcomes,” than those who had terminated their pregnancies.
Opponents of abortions conducted as a result of screening for disabilities believe that such procedures are unjust, because all human beings have inherent value from the moment of conception. Malhotra, on the other hand, told Yahoo News that she finds it “absolutely horrible” to put patients “in a position where they don’t have a choice anymore.”
There are multiple reasons women may choose to terminate a pregnancy because of a genetic condition or anomaly, ranging from the emotional and financial cost of raising a disabled child to the effect that this may have on the existing children in a family, as well as the feeling that it is cruel to give birth to a child who may need a lifetime of constant medical intervention.
Connors said that terminations due to genetic or fetal anomalies are comparatively rare, but are often emphasized unduly in conversations on abortion and abortion care. “It inadvertently leads to a narrative about what makes a good or a bad abortion,” he said.
Sagaser agreed, saying: “There's no benefit to us as a society to say, ‘Oh, there's this one population that really needs access to abortion care — more so than other people.'
“Everyone deserves to be able to make the choices that are right for them and their family in that unique situation,” she added.