Learn about the importance of folate and Vitamin D during pregnancy, and potential complications during the first trimester here, or clicking on the image.
Other types of tests offered during your pregnancy are summarized below.
A. Viability scan, before 11 weeks
B. Nuchal translucency first trimester screen 11-14 weeks
C. Fetal anatomy scan 18-22 weeks
D. 3rd trimester growth scan
Blood Pressure Checks
Having regular checkups with blood pressure checks is one of the simplest but most important 'tests' you should do during your pregnancy. Checking your blood pressure regularly is especially important after 24 weeks.
If your reading is higher than normal, in many cases your next blood pressure reading will be normal. Even if it isn't, many pregnant women with high blood pressure deliver perfectly healthy babies, although it does require careful monitoring.
Be sure to let your practitioner know if you're concerned about any unusual symptoms, especially sudden weight gain or severe swelling, which could be signs of preeclampsia or more serious conditions
Testing and Screening may be slightly different between countries.
These tests are done at your first visit and include having a blood draw and giving a urine sample.
From the MAMA Academy
The MAMA Academy was started by Heidi Eldridge, who lost her baby to stillbirth. Read her story here.
This is a specific test to check for diabetes. Also called the OGTT (oral glucose tolerance test), this involves drinking a sugary drink and having blood tests. The OGTT is done when you're between 24 and 28 weeks pregnant. If you've had gestational diabetes before, you'll be offered:
Reasons to have a GTT include:
Full Blood Count
Check for anemia. Hb – your haemoglobin (Hb) level is affected by your iron levels. In pregnancy it is normal to appear slightly anaemic. This is due to extra fluid present in the blood so the blood dilutes itself slightly. This corrects itself after pregnancy. Any Hb level below 10.5 should be treated with a low level of iron treatment and monitored.
Blood Group – to make sure no antibodies have developed during the pregnancy
These are taken if you have high blood pressure, protein in your urine or both. They are checking your iron level, and kidney and liver function. (visit our High Blood Pressure page for more information)
Your Urea and creatinine levels should be below the normal range for a non-pregnant person. This is again due to the extra fluid in the blood and due to dilution.
The only change here is that your ALP will be raised. ALP is a hormone released by the liver and your bones. It is also released by the placenta which is why it is normally raised in pregnancy and nothing to be concerned about.
Consider getting a vitamin D blood test from your provider or a home vitamin D test. Authorities in vitamin D and pregnancy actually suggest 3 levels during the pregnancy.
Vitamin D has now been shown to reduce the risk of a variety of pregnancy related complications, many of which can be traced to placental function.
At the time of a 12 week (11 to 13+6) weeks) nuchal translucency (NT) ultrasound scan (offered to all pregnant women), you will also be offered a blood test measuring human chorionic gonadotropin (HCG), which tends to be increased in affected fetuses, and plasma associated protein A (PAPPA) which tends to be decreased in affected fetuses with Down syndrome. This test is offered as standard through the NHS. It can detect approximately 85% of major chromosome abnormalities like fetal Down syndrome, but there is also at least a 5-7% chance of a false positive result, in which case genetic amniocentesis or CVS might be suggested.
NIPT (non invasive prenatal testing) is a specialized genetic test of the fetal DNA, usually taken at 10-13 week range. These tests directly analyze fetal DNA fragments circulating in the maternal circulation. They are highly accurate for detecting fetal trisomy 21 (Down Syndrome) and other major chromosome abnormalities. The advantage is both the higher detection rate (99.5%) and the very low false positive rate (less than 0.5%). However, NIPT tests and cost vary with the extent of testing. They are offered to some selected high risk patients in the NHS.
There are 3 types of NIPT tests
In addition to major chromosome abnormalities, a number of inheritable conditions with much smaller chromosome abnormalities may affect the baby. These are not detected with typical chromosome screening, but can be suspected based on carrier screening of the mother. These are typically x linked conditions or autosomal recessive conditions, so the mother may carry the gene even when she is perfectly normal. Because this is carrier screening of the mother, these tests can be performed any time, even before pregnancy. The most important of these conditions which parents might consider screening for include
More extensive panels can screen for over 100 conditions, many of them metabolic conditions which are otherwise not found until after birth when the baby begins feeding.
Carrier screening is routinely offered in the U.S., but is not routinely offered in the U.K.
ACOG (American College of Obstetricians and Gynecologists) has updated two committee opinions on carrier screening. Committee Opinion 691 reviews the recommendations based on disorders. Committee Opinion 690 addresses the issues related to use of screening strategies such as expanded gene panel testing.
Changes to look for compared to previous guidance include the following:
In contrast, the NHS has no position on carrier screening for all patients. Instead, they suggest talking to your GP is there is a history in your family.
Speak to your GP if you're planning a pregnancy and:
From the Fetal Medicine Centre
In humans, there are 23 types of chromosomes and most people have a pair of each one of these chromosomes (therefore a total of 46 chromosomes). In trisomy, there are three rather than two of a particular chromosome (total of 47 chromosomes). The most common trisomies are those of chromosomes 21, 18 and 13.
A video from Illumina - one of the laboratories which performs NIPT testing- to explain the science behind it.
Amniocentesis is a very specialized test, usually performed a a genetic test. It is considered the most accurate method of testing fetal chromosomes (and sometimes other things) but carries a small risk of losing the pregnancy.
Choronic Villus sampling is an alternative specialized genetic test, similar to amnioctensis, but it can be performed earlier. Instead of sampling the fluid around the baby, CVS samples the placenta (which forms from the same DNA that makes the baby)
At about 20 weeks, you should have an ultrasound scan which will look at baby 'head to toe' and confirm everything is developing normally.
This is also the time to look at the cervix which acts like a 'plug' to hold the pregnancy in the uterus (womb). More on preterm births and prevention here.
The third trimester is the best time to confirm that baby is growing normally and appears healthy. This may not be offered to all patients in the NHS. Review the GAP protocol criteria below to see if you have a risk factor and should request a scan.
More on potential complications of third trimester pregnancy here.
Placental position is determined by ultrasound. The placenta is most often in the front (anterior) or back (posterior) of the uterus, but also may be on the sides or at the top.
It is common for a placenta to appear in a low position early in pregnancy, at the time of the fetal anatomy scan. Low is considered to be within 2 centimeters of the cervical opening.
If the placenta is more than 2 cm away on any ultrasound measurement, there is no placenta previa. If within 2 cm, you should be followed. Most low lying placentas seen at 20 weeks will resolve by 30 weeks.
If the placenta is still low at 28 weeks-30, the next ultrasound is usually performed about 32-35 weeks. If it's still low or covering the cervix near the time of delivery, then you are likely to give birth by cesarean delivery, usually between 37 and 38 weeks. The timing of delivery is moved earlier based on the vaginal bleeding: how much and how recent. .
There are a number of potential nonstructural or minor markers which may be seen at the time of the fetal anatomic scan around 20 weeks. These findings may sometimes indicate an underlying chromosome abnormality, like Down syndrome or other fetal abnormality, but are most often seen as a normal variant. As an isolated finding, these findings usually do not significantly change the risk. For additional reassurance, you might choose an NIPT test to confirm the chromosomes are normal.
Amniocentesis and CVS from RCOG (pdf)Download
Carrier Screening brochure (pdf)Download
Fragile X Syndrome -Carrier screening (pdf)Download
Spinal Muscular Atrophy (SMA) - carrier screening (pdf)Download
cystic fibrosis carrier screening (pdf)Download