Early Pregnancy Laboratory Tests
Several blood tests are generally recommended in early pregnancy. Some of these are required by law. Some of them screen for conditions that could cause problems during the pregnancy or with the baby. And some of them provide information that may help you make decisions during your pregnancy.
A urine culture and prenatal panel are generally suggested at your first or second visit and are best done before about 16 weeks of pregnancy.
Urine culture. Approximately 5% of women will have large amounts of bacteria in their urine that don't cause uncomfortable symptoms. Normally this is not a problem, but pregnant women who have this situation have a 40% chance of developing a kidney infection. Kidney infections are never fun, but during pregnancy they can be quite dangerous. Research shows that if these silent infections are treated early, the chances of developing a kidney infection is greatly reduced to about 3%.
The prenatal panel includes several different tests:
Blood type and Rh factor. This tells you which type of proteins are on your red blood cells. Because your baby has different genetics, it may have a different blood type. Sometimes a little blood from the baby can get into your system and cause your body to make antibodies against the baby's red blood cells. One of these can be prevented with a medication and others may cause a significant but treatable severe jaundice in the baby once it is born. Knowing this beforehand will allow prevention or early treatment that will prevent serious problems.
Antibody screen. This is a test that checks to see if the mom's immune system has reacted to a foreign blood type. This particular test only checks for antibodies that can cause a mother's system to destroy a baby's blood. The Rh factor is the most well known of these, but there are several others that can do similar damage. If this is positive, the actual number of antibodies will be measured. Although this situation is quite rare, it can be very serious and newer treatments are available that can enable a baby to survive.
Complete Blood Count. This test measures the size, shape and color of your blood cells. It will tell us if you have anemia and what kind of anemia. That helps us know the best way to treat it. It will tell us if you have a normal amount of platelets which are essential in helping your blood to clot normally. It also tells us about the numbers and kinds of white blood cells that you have.
Syphilis Screening (RPR). This test is required by law. Syphilis is a sexually transmitted infection that can cause serious problems in a baby. Treatment drastically improves outcomes for the baby.
Hepatitis B. This test is required by law. Hepatitis is a blood borne and sexually transmitted infection that affects the liver. This sometimes does not cause obvious disease in the mother but can still be passed on to the baby. There are medications that can be given to the baby at birth that can prevent infection.
Rubella or German Measles Immunity. This test is required by law and tests to see if childhood vaccinations are still working. Most people who have been vaccinated are still immune into adulthood but since the virus can cause such serious damage to a developing fetus, it is considered a public health measure to test all women just to make sure. If you are not immune, vaccination is recommended after the baby is born.
Other tests you may want to consider.
HIV Screening. Because HIV transmission from mother to child can be largely prevented, the major obstetric organizations recommend that every pregnant woman is screened for this disease. This screening is evidence-based.
Gonorrhea and Chlamydia Screening. These are sexually transmitted infections that may not cause symptoms in the mother but can cause serious infections both in baby and mother after the birth. Because of this, they are routinely offered in a medical setting. Yearly screening is recommended for women younger than 25 and all women who are at increased risk of contracting a sexually transmitted disease. The samples are collected from the cervix using a speculum or can be collected from a urine sample. This screening is evidence-based.
Pap Smear. Pap smears are the current best way to screen for cervical cancer. While not part of routine pregnancy testing, if you are due for a pap smear it can be done during pregnancy. The current guidelines say to start pap tests at age 21 and continue every 3 years until age 30. Starting at age thirty, co-testing is recommended with both a pap test and and HPV test every 5 years until age 65. Women with a history of abnormal tests or certain risk factors should follow different recommendations. Many women will get a pap test at their six-week postpartum visit. This screening is evidence-based.
Thyroid Testing. Since most women do not get regular health screenings outside of pregnancy, many providers recommend having your thyroid tested. Appropriately balanced thyroid levels are essential to a developing baby and slightly low levels may not be readily detected without testing. Severely low or high levels will cause noticeable symptoms. Based on your physical exam or history, we may specifically recommend a thyroid test. Routine screening is not evidence-based.
Diabetes Testing. If you are significantly overweight, are over 35, have parents or siblings who have Type 2 diabetes or have previously been diagnosed with Gestational Diabetes, you might want to consider diabetes testing earlier than usual in pregnancy. This is specifically to detect Type 2 Diabetes that existed before the pregnancy. The early stages of this disease often have no symptoms and earlier treatment may lead to healthier outcomes for both mother and baby. Screening based on these risk factors is evidence-based.
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