Season 1

Episode 9

 

 

Refusing My Ultrasounds

I have been thinking about ultrasounds (US) for awhile and was planning to write about it ever since realizing the obscene number of ultrasounds being offered to women during many parts of conceiving and pregnancy, particularly in Ontario. It began when I was referred to a fertility clinic at 36 years old trying to get pregnant. I went for diagnostics because we had no intention of doing any of the fertility treatments they would offer. However, I did take part in some aspects so that it could help with taking charge of my fertility. I began with cycle monitoring, which meant that on Day 3 of my menstrual cycle, I was to return for an US, which I did do, largely because I hadn’t yet thought about whether doing such an US had any negative consequences. I admit, it was exciting to know they saw 6 eggs in one ovary and 9 in the other. I felt proud. I was instructed to come back again on Day 10. When I was leaving the clinic it occurred to me that many of of the 20+ women in the waiting room were probably going for US and were at various stages in their fertility monitoring or treatments. It also occurred to me that I wasn’t prepared for this US. I hadn’t read the science about the safety of USs. Not too surprisingly to me, when I did review it I realized that US were not benign and indeed there was some evidence (particularly in the animal research) of potentially adverse effects. 
 
When I returned on Day 9, I refused the US. This surprised everyone involved including the technician — who was actually quite hostile with me — and the MD. I was looked at like I was crazy and told "they are perfectly safe”. While laying there refusing part of the diagnostic that day, I was made to feel like I was now a major inconvenience. I’m sure I was inconvenient. But I tried to explain that I had read the research and indeed, they were NOT "perfectly safe" nor completely benign, albeit the risks associated with US have been decreasing over the years as technology improved. Note: an important distinction should be made between medical US and "keepsake” US that people can get from private clinics. The US offered through medical diagnostics are typically much safer than those offered in these private clinics, largely because the heat used to derive the image is much greater with private clinics in order to achieve the very high-resolution 3D photo. Also, the training of technicians in a medical diagnostic clinic is typically 2 years for compared to a weekend course as minimum training for the private clinics. This skill of the technician is important for ensuring properly distributed movements (and heat) of the wand when gathering an image. This distribution over the fetus is necessarily ignored in private clinics in order to gather really crisp, high-resolution images for the keepsakes. 

All in all I ended up refusing several US during the course of my fertility diagnosis and eventual pregnancy. When I did get pregnant, I knew quite early. I went to see my doctor within a week of missing my period, which put me at 5 weeks pregnant. She suggested that I go for an US at 8 weeks in order to confirm a heart beat and for dating. The dating was not an issue for me. I knew exactly when I got pregnant, not that that mattered for any of my doctors or midwives who wanted their kind of data. But needing to confirm a heartbeat was interesting. I didn’t feel the need to confirm the heartbeat and wasn’t sure why anyone else did. If the heart was not beating, we would find out soon enough and yes, it would be disappointing. But it wouldn’t change much. 

So I refused that one. 

And I was offered one at 10 weeks too, which I also refused.
I got the 14 week one, because we wanted to do genetic screening. It did give peace of mind. And I got the 20 week anatomy US, which many people do even if they refuse all others.

Those were the only ones I did until I was 41 weeks pregnant. Then I got about 4 or 5 more because I was a week overdue and there were concerns that the baby was not moving. There was definitely a lot of fear around this time, which played into my acceptance of the US, for better or for worse. 
I think what concerns me the most is that US are being used so routinely now (especially in Ontario and I know this is not the case everywhere, like Nova Scotia where the first US is typically at 20 weeks unless there is a real reason to do any before). That discrepancy even across Canada is concerning. Why is Ontario doing so many and Nova Scotia not? This is concerning also because US are not benign, as several MDs and technicians have tried to tell me. It concerns me because some of consequences of US may not yet be known. What if we haven’t asked the right questions? What if we haven’t tested the true ways in which US are having a negative effect on babies? That’s entirely possible because that’s the nature of science. We rule out possibilities through good design methods and statistics. But if we don’t know the questions to ask — i.e., which consequences are potentially related — we may not find the answers. I also hate to bring this up but things like Autism, might be linked to US. In fact, there is at least one study that I read where that was the case, particularly for male children. In this particular study, males who also had a particular genetic variation and were exposed to first trimester US had evidence of two symptoms related to Autism-spectrum disorder: significant decrease in non-verbal IQ and increase in repetitive behaviours, compared to those without a autism-spectrum disorder diagnosis (1). In any case, I do think our casual use of US should be reflected upon and studied in order to inform ourselves of potential negative consequences of US. 

Here is some evidence suggestive of at least some negative effects:

  • Infants in the intensive-ultrasound arm were more likely to have birth weights in the lower quartiles, but this was not reflected in adult eye development. There was no statistically significant difference between the two groups with regard to ocular biometric or visual outcomes, except for slightly higher intraocular pressure identified in individuals exposed to multipleultrasound scans (P = 0.034). US done at 16-18 weeks gestation (2).
  • In this review (3), some major concerns are raised including a particular susceptibility to the heat of US in early gestation (10-12 weeks) because of organ development at this time. This might be particularly problematic for endovaginal US.
  • Mice exposed to diagnostic ultrasound in utero are less social and more active in social situations relative to controls (4).
  • There is, however, evidence that US have no effect in overall school performance in teenager who were subjected to routine US in the second trimester (5), no detrimental effects on children’s physical or cognitive development (6), no evidence of increased risk of childhood cancer with in utero exposure to US (7), and no effects of multiple US 18-weeks onward compared to a single 18-week US in children (ages 1, 2, 3, 5, & 8 years old) on standard tests of childhood speech, language, behaviour, and neurological development. There is also evidence that routine US are associated with a reduction in labour inductions for 'post term' pregnancy because of more accurate dating (8)... so not all bad!

References:

  • Jane Webb S1,2, Garrison MM1,2, Bernier R2, McClintic AM2, King BH1, Mourad PD2. (2016). Severity of ASD symptoms and their correlation with the presence of copy number variation and exposure to first trimester ultrasound. Autism Res. 2016 Sep 1. doi: 10.1002/aur.1690. (https://www.ncbi.nlm.nih.gov/pubmed/27582229).
  • Forward H1, Yazar S, Hewitt AW, Khan J, Mountain JA, Pesudovs K, McKnight CM, Tan AX, Pennell CE, Mackey DA, Newnham JP (2014). Multiple prenatal ultrasound scans and ocular development: 20-year follow-up of a randomized controlled trial. Ultrasound Obstet Gynecol. 44(2):166-70. doi: 10.1002/uog.13399. http://www.ncbi.nlm.nih.gov/pubmed/24789332
  • Abramowicz JS1. (2013).  Benefits and risks of ultrasound in pregnancy. Semin Perinatol. 37(5):295-300. doi: 10.1053/j.semperi.2013.06.004. http://www.ncbi.nlm.nih.gov/pubmed/24176149
  • McClintic AM1, King BH, Webb SJ, Mourad PD. (2014). Mice exposed to diagnostic ultrasound in utero are less social and more active in social situations relative to controls. Autism Res.7(3):295-304. doi: 10.1002/aur.1349. Epub 2013 Nov 18. http://www.ncbi.nlm.nih.gov/pubmed/24249575
  • Stålberg K1, Axelsson O, Haglund B, Hultman CM, Lambe M, Kieler H. (2009). Prenatal ultrasound exposure and children's school performance at age 15-16: follow-up of a randomized controlled trial. Ultrasound Obstet Gynecol. 34(3):297-303. doi: 10.1002/uog.7332. http://www.ncbi.nlm.nih.gov/pubmed/19705400
  • Whitworth M1, Bricker L, Neilson JP, Dowswell T. (2010).  Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 4:CD007058. doi: 10.1002/14651858.CD007058.pub2. http://www.ncbi.nlm.nih.gov/pubmed/20393955
  • Rajaraman P1, Simpson J, Neta G, Berrington de Gonzalez A, Ansell P, Linet MS, Ron E, Roman E. (2011). Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case-control study. BMJ. 342:d472. doi: 10.1136/bmj.d472.http://www.ncbi.nlm.nih.gov/pubmed/21310791 
  • Whitworth M1, Bricker L, Neilson JP, Dowswell T. (2010).  Ultrasound for fetal assessment in early pregnancy. Cochrane Database Syst Rev. 4:CD007058. doi: 10.1002/14651858.CD007058.pub2. http://www.ncbi.nlm.nih.gov/pubmed/20393955

 

 
 

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