Ngozi Osuagwu , MD, FACOG is an OhioHealth physician on the medical staff of Grant Medical Center and Doctors Hospital. She is an attending obstetrician/gynecologist with Doctors Obstetrics and Gynecology, Inc. and the author of the book Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist. This is an excerpt from her book.

Dear Abigail,

You called to ask about what tests you are required to have as part of your prenatal care. There are several tests that your physician will order during your prenatal visits. The tests that the physician orders depend on how far along you are in pregnancy and any risk factors you might have based on your medical and family history.

Most pregnant women come to their physician during the first trimester. The doctor will give you a physical exam. During this exam, a pap smear and cultures for gonorrhea and Chlamydia will be obtained. The pap smear is a screening test for cervical cancer. If this test is abnormal, you will need further testing. If the gonorrhea or Chlamydia results are positive, you and your partner will need to be treated with antibiotics and then retested to confirm that the infection has been eliminated.

Your physician will also order several blood tests. The complete blood count (CBC) is a test to screen for anemia. Your blood will also be typed, and it will be screened for antibodies. Your blood will be screened for syphilis and hepatitis as well. A rubella test will be ordered, and lack of immunity will require you to be vaccinated after delivering the baby. HIV testing will also be offered, but your blood will be tested only with your permission. Knowledge of your status assists the doctor in determining the method of managing your care to decrease the chances of transmission to the child. A urine test to check for infection is also ordered.

Depending on your risk factors, you might be screened for cystic fibrosis and sickle cell disease. Other tests might be ordered depending on your ancestry. Since you are likely of Eastern European or Ashkenazi Jewish ancestry, it may be important to test for Tay-Sach’s disease. These screening tests are mostly elective and will only be done if you agree to have them done.

Between 15 and 19 weeks of pregnancy, you will be asked if you want to be screened for neural tube defects (problems with the spine of the baby) and Down’s syndrome . If you want to be screened, you will have an alpha fetal protein test. This test may be enhanced with further tests to make the screening more valuable. Between 24 and 28 weeks, you will be screened for diabetes with a 1-hour glucose challenge test. Depending on the result of the test, you may have to do the 3-hour glucose tolerance test to determine if you have gestational diabetes. This is diabetes that is diagnosed during pregnancy but usually resolves after pregnancy. Between 35 and 37 weeks of pregnancy, you will be screened for group B streptococcus infection. Cultures will be obtained from your vagina and rectum. If this test is positive, you will need antibiotics when you go into labor.

I cannot overemphasize the importance of early prenatal care . Am I correct in assuming that your not making an appointment has to do with insurance coverage? Is it that you do not have any insurance coverage at this time and you are waiting to be covered by your job? Are you concerned that your insurance will not cover you for the pregnancy because it will be deemed to be a pre-existing condition, and so not liable for coverage? Start taking vitamins immediately and make an appointment as early as you can.

Sincerely,
Ngozi Osuagwu , MD, FACOG, RYT