“Dr. Fox Responds to the NY Times Article on Genetic Testing”

Link to article: New York Times article: “When They Warn of Rare Disorders, These Prenatal Tests Are Usually Wrong.”

Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
All right, everyone. I’m gonna be rolling solo for this podcast today. And the reason I decided to do this is there was an article that came out in “The New York Times” on New Year’s, on January 1st, 2022. It was written by Sarah Kliff and Aatish Bhatia, I apologize if I mispronounced either name. And it was titled “When They Warned of Rare Disorders, These Prenatal Tests Are Usually Wrong.” And basically, this article caused a lot of stir surrounding prenatal screening and testing. And I know that I’ve been getting a lot of questions about it from my own patients and from family and friends. And I thought it’d be helpful to use this podcast to give my take on the topic. Think of it maybe like a rebuttal to the article. And maybe to clear up some, what I think, are a few misconceptions regarding the article and regarding prenatal screening and testing in general.
So, in terms of some background on the article, if you haven’t read it, you can google it and, you know, find it, read it, if you’d like. The article is well-written and it seems to be researched well. I don’t know the authors or their knowledge of the topic, so, again, I’m not criticizing the authors at all, I just wanna be clear about that. And the article focuses on really the patient experience of receiving a wrong result on a genetic test. And I’m gonna go into what that means, “a wrong result.”
I’m actually gonna read the first few paragraphs of the article. Okay. So, this is from the article. “After a year of fertility treatments, Yael Geller was thrilled when she found out she was pregnant in November 2020. Following a normal ultrasound, she was confident enough to tell her 3-year-old son his ‘brother or sister’ was in her belly. But a few weeks later, as she was driving her son home from school, her doctor’s office called. A prenatal blood test indicated her fetus might be missing part of a chromosome, which could lead to serious ailments and mental illness. Sitting on the couch that evening with her husband, she cried as she explained they might be facing a decision on terminating the pregnancy. He sat quietly with the news. ‘How is this happening to me?’ Ms. Geller, 32, recalled thinking.” “The next day, doctors used a long, painful needle to retrieve a small piece of her placenta. It was tested and showed the initial result was wrong. She now has a 6-month-old, Emmanuel, who shows no signs of the condition he screened positive for.” “Ms. Geller had been misled by a wondrous promise that Silicon Valley technology has made to expectant mothers, that a few vials of their blood, drawn in the first trimester, can allow companies to detect serious developmental problems in the DNA of the fetus with remarkable accuracy.” “In just over a decade, the tests have gone from laboratory experiments to an industry that serves more than a third of the pregnant women in America, luring major companies…” and so forth.
So, the authors then go on to describe the newer technology that’s used for prenatal testing for Down syndrome and the expansion of testing for other more rare conditions. The authors then state, quote, “the grave predictions made by those newer tests are usually wrong, an examination by ‘The New York Times’ has found,” end quote. They discuss how, when the test says the baby has one of these, the, quote, “positive results are incorrect more than 90% of the time,” end quote. And then they talk about how the companies describe the products as reliable and accurate and that the companies are being misleading.
There’s a lot to unpack here with this article. But in case you don’t wanna listen to this entire podcast, here’s my short take. It is true that, when one of these tests comes back as abnormal, most of the time the baby is fine. But that’s not the problem. The problem is when the patient or the doctor don’t know that going into the test, and then they misinterpret the results. When the tests are used correctly by providers who know what they’re intended to do and communicate that correctly to their patients, these tests can be very helpful.
All right, now we’re gonna go into the long answer. We’ve done several full-length podcasts on this on [inaudible 00:04:42] screening and genetic testing in general, so, feel free to listen to those. But basically, I wanna start with a history of how we got to this place. And basically, this started with a desire to diagnose or to let women who are pregnant know whether their babies who they are carrying do or don’t have Down syndrome. This was really the first condition that we were testing for. And Down syndrome is a condition where in every cell in the body, instead of having 46 chromosomes, there’s 47 chromosomes. The extra chromosome is the 21st chromosome. So, instead of having two 21st chromosomes, you would have 3. So, it’s also called “trisomy 21,” meaning 3 copies of the 21st. There are other genetic conditions where you have extra or missing chromosomes, what we call aneuploidy. For example, there’s trisomy 18, which is 3 copies of the 18th chromosome. Trisomy 13, which is 3 copies of the 13th chromosome. And then there are some sex conditions like with the XY chromosome, which is the 23rd pair.
And, so, that was the desire, how do we find out which women are carrying babies with these conditions. And the only way…this is way back when the only way we could figure it out and the only way to know for sure, which is still true, is to do an invasive test, like an amniocentesis or a chorionic villus sampling or CVS…which is, I assume, the procedure they talked about in the article because that’s the long needle going into the placenta. Again, we did a podcast on amnio and CVS, you can look on that or listen to that directly to, you know, hear all about it. But basically, that’s the only way to know for sure.
So, the question is, all right, who should get an amnio or CVS? Should it be every pregnant woman? Should it be no pregnant women? Or should it be some pregnant women? And at the time, there was a thought that we shouldn’t do it for everyone because it’s painful, there’s a risk of miscarriage, maybe there’s like money costs associated with it so that doesn’t make sense. But if we do it for nobody, then no one’s gonna be able to find out this information.
And, so, the concept of screening was then invented. Not invented in general but invented for this. And for screening, the point of it is to take a whole group of women who are pregnant and make a decision about which ones we should do an amniocentesis or CVS on and which ones we shouldn’t. And this was based on the risk. Meaning someone who’s at a higher risk of having a baby with Down syndrome, we’re gonna do the amniocentesis for her, or CVS. And someone who’s at a much lower risk, we’re not going to.
Now, as an aside, this really is not about us, doctors, deciding for the women but really them deciding whether they want it or not. But sort of I’m gonna couch it in someone who’s high-risk, it’s gonna get done. And someone’s lower, it’s not gonna get done. Though it’s, obviously, always the choice of the woman whether to do it or not or whether to be involved in this process at all, meaning she may not want any screening or testing. We’ll talk about that.
But basically, how do we triage, so to speak? And then the first screen that we had was simply the age of the mother. It’s been known for a very long time that, as women get older, the risk of one of these conditions, what we call aneuploidy, an extra missing chromosome happening, goes up. And, so, what originally happened is we drew a line in the sand and said, “Okay, anybody who’s 35-years and older should get an amniocentesis because the likelihood of them having a baby with Down syndrome or one of these other conditions are higher. And anyone who’s 34-years, 11-months, 31-days or younger should not have one.”
And the reason that was used as the screening is because that’s all we had. All we knew is that, as the mother gets older, the risk goes up. And, so, age 35 was used, and that’s where this term “advanced maternal age” came from, and so forth.
Now, to be fair, that’s pretty crude, right, in saying that, you know, there’s a cut off. Meaning there’s no real difference between someone who’s 34 and 35 or between 35 and 36 but that’s sort of the first screen that was invented to sort of draw that line in the sand to decide who’s at a higher risk and should get an amniocentesis.
Now, also to be clear, the women who are over 35, the majority of them did not have a baby with Down syndrome. And by “majority,” 99%, 98%, whatever it is, the vast majority did not have a baby with Down syndrome. And, so, using age as a screen, you would also conclude age as a screen is wrong 98% of the time. Just taking it back to how this article sort of couches it.
After age, there were more tests that were developed to help screen a little bit more accurately. There were blood serum tests, like serum hormone tests. Then an ultrasound tests, like the nuchal translucency, and that’s still done a lot nowadays. And using the age of the mother plus some blood tests plus an ultrasound we were able to screen a little bit better to sort of separate who was higher-risk and who was lower-risk.
When we were using these tests to help differentiate who is at an increased risk and who is not at an increased risk, there was a similar issue with people misinterpreting what a positive screen meant. Meaning you would get back a report that used the data from the age, the ultrasound, and the blood test, and the report would say “normal” or “abnormal.” And “abnormal” did not mean your baby has Down syndrome, it just means you are now at an increased risk compared to before. So, maybe that risk was 1%, maybe it was 2%, maybe it was 5%, maybe it was 10%. Whatever it was it was sort of above a certain number and, therefore, you have screened into the group that should probably get a CVS or amniocentesis to know for sure. But again, people misinterpreted it at the time and they would say, “Oh, the doctor told me my baby had Down syndrome. And then, when I did a CVS or amnio, they were wrong.”
And it’s possible that the patient misinterpreted what the doctor said. It’s possible the doctor misinterpreted the test and told it to the patient wrong. But either way, that’s not what the test was meant to do. It was not meant to say which baby has Down syndrome or any other aneuploidy, it was meant to say who’s at a higher risk and who’s not at a higher risk.
Then along came cell-free fetal DNA, which is the game changer. And this is sort of the test that this article is talking about. The concept of cell-free fetal DNA is that, if we draw blood from the mother, in her blood, there is free-floating pieces of DNA in there. The majority of it is her DNA and a minority of it called 5%, 6%, 10%, somewhere in that range, is actually DNA that comes from the baby. Technically, it comes from the placenta, not from the baby but the placenta DNA and the baby’s DNA are basically the same. And then, using different complicated technologies, the lab can sort of differentiate the mother’s DNA from the baby’s DNA and then test the DNA directly to say does the baby have aneuploidy, an extra missing chromosome.
The one that people understand the best is can they determine if the baby’s a boy or a girl, right, XY or XX. And it’s pretty straightforward. People get that, if we look in the mother’s blood, and in the DNA floating we find a lot of Y chromosome floating around there, well, that’s not her, she’s carrying a boy. And if we find no Y chromosome floating around there, she’s having a girl. But the same is true regarding the 21st chromosome. And, so, we could test for Down syndrome.
And the reason cell-free fetal DNA became a game changer is because, unlike using age and the serum hormones and the nuchal, this was very very highly predictive. Meaning a normal test on the cell-free DNA, major risk of having a baby with one of these conditions is extremely low. And having an abnormal test made it extremely high. Now, it was not and is not 100% but it was high. You know, in some situations, it was about 50%, above 70%, above 90%, meaning really really high and much higher than we ever got with the previous screens.
But it’s still a screen. Same concept. If someone has the cell-free fetal DNA and it says “you’re at a high risk for trisomy 13, trisomy 18, Down syndrome,” which is trisomy 21, or “Turner syndrome,” which is a sex chromosome with 1 X chromosome and not another one, the correct interpretation is not “my baby has this,” the correct interpretation is, “Oh, I’m at an increased risk. If I wanna know for sure, I have to do an amniocentesis or a CVS.” For a negative test, meaning a normal test, the same is true. It doesn’t mean 100% “my baby doesn’t have it,” it just means a very very very low risk.
And, so, that’s how the test is used now. What the article is talking about is the technology for this test has increased and expanded. So, not only can it be used to test for an extra or missing chromosome, it can now start looking for things called “microdeletions” and “microinsertions,” an extra or missing small piece of DNA within one chromosome. Meaning the count of chromosomes is normal, still 46 chromosomes, but there are some conditions where a tiny bit of DNA is missing or a tiny bit of DNA is added and this cell-free DNA test can be used to look for these disorders.
Now, before this, there was no other way to screen for these other than doing an amniocentesis or CVS and saying, “All right, let’s actually look at the chromosomes and see if this little piece of DNA is missing.” And there are conditions, most of them you’ve never heard of them. Right? These are rare conditions, let’s say it’s about 100 of them. All of them combined, the likelihood of it happening is 1%, give or take. So, you’re talking each one of them is a ballpark 1 in 1,000, 1 in 10,000, it doesn’t happen that frequently. So, [inaudible 00:14:39] conditions people might have never heard of. You know, there’s something called Williams syndrome, there’s something called Prader-Willi, there’s something called Angelman. These are syndromes that maybe you’ve heard of someone who’s had it, but generally not. But again, before cell-free fetal DNA, the only way to know anything about these conditions is to do an amniocentesis or CVS.
So, the concept is these labs started using the cell-free DNA technology to start screening, screening, not testing, for these conditions. And what they do is the same concept. You get back a report and they’ll tell you whether you’re at an increased risk or decreased risk for this.
Now, when you get back the results for this, if it’s abnormal, again, it does not mean your baby has one of these conditions, it just means you’re at an increased risk for having these conditions. And exactly what that risk is depends on the specific tests, but they tend to range approximately in the 5% to 10% range. Meaning, instead of it being 1 in 1,000, it’s now like 5% to 10%. Which is, you know, 1 in 10, 1 in 20, so, it’s much much higher. But again, that means that 90% to 95% of the time it’s not true, your baby does not have one of these conditions.
It also happens to be that the technology is now developing, or developed, that they can test not just for what we call microdeletions but they can test for actual single-gene mutations. These are conditions caused by single genes that, until now, we really couldn’t screen for them at all, again, until amniocentesis or CVS. But again, these actually seem to be even more accurate, that, if it’s abnormal, it’s much higher than 5% to 10%. The concept is these are all screens. They’re not meant to be diagnostic to tell you an answer, they’re meant to screen to see who might want to do an amniocentesis or CVS to find out for sure.
So, taking all this, when I meet with patients, I give them three options. I say, “Option number one is,” and this is in no order, “let’s do nothing.” Right? You don’t wanna do any screening for any genetic conditions for whatever reason, either you have no intention of terminating a pregnancy and, therefore, you don’t wanna know because it’ll just cause you stress potentially, or you’re just highly confident that everything’s gonna be okay. You’re young, you’re healthy, there’s no family risk, you don’t wanna sort of deal with the stress of screening and maybe getting an abnormal result and then doing amnio or CVS. Fine, then you do nothing.
On the other end, “I wanna do everything. I wanna do an amnio or CVS. I wanna test for everything we can. Let’s test for aneuploidy, let’s test for these microdeletions, let’s test for anything that runs in my family. Let’s test for everything we can so I can know 100% either way.” Again, that involves a needle getting stuck in your belly and it’s, you know, painful, potentially, and there’s some risk.
And the third option is sort of, what I call, “the middle option,” which is to do a screening test, whether the blood test, the ultrasound, a combination, and let that guide your decision. If it comes back, quote unquote, normal, again, it doesn’t mean there’s 0% chance of anything but it’s very very low and you’re gonna say, “All right, I’m done. I’m now moving to the do nothing more category. And if it comes back abnormal, it does not diagnose my baby with anything, it just means we’re gonna move to the other side and do an invasive test.” And, so, when you do the screening test, it’s gonna either lead to no more testing or an invasive testing. But the screening test itself is not a diagnostic test, it’s merely a screen.
Okay. So, knowing all that I think the big issue with this article is that the authors, when they’re describing it, they’re describing these as tests. But in fact, they’re not tests, they’re screens. There’s a very big difference. A test is meant to give you an answer. Whereas a screen is meant to select people from a larger group to get tested.
So, let’s talk a little bit more about the screening versus testing. I’m gonna use a crude example. But it’s not medical, so it’s something that I think you’ll all understand and know a lot about, airport security screening. All right, we all hate airport security screening, but follow along. So, the point of the screen…and let’s just talk about the walking through the metal detector. Forget about screening your bags, that’s a whole different story. So, the point of walking through the metal detector is to keep someone from boarding the plane with a weapon on them. Now, obviously, that’s a pretty rare occurrence. But we’ve sort of agreed, as a society, that it’s worth having everyone walk through a metal detector before they get on a plane to prevent that rare occurrence. Now, we might disagree the best way to do it and exactly how sensitive these metal detectors should be and whether it’s really necessary in every circumstance, but I think most people are comfortable with the concept of, before you get on a plane, walk through a metal detector.
All right. So, when you walk through a metal detector, if it doesn’t beep, you’re done. You’ve passed, you go through, they’re never gonna have you walk through a metal detector again before you get on the plane. Now, if it does beep, all right, they say, “All right, have you taken off your belt? Is there any metal in your pockets? You do that and you try again.” And if it still beeps, they go to Phase 2, which is they make you stand there with your arms out, they do the wand thing. Maybe they pat you down. And assuming everything’s normal, you go along.
So, the question is, if the second screen is getting wanded and patted down and that’s really the better way to go, why don’t they just do it for everybody? Why do we deal with the metal detector? Well, obviously, if they had to wand and pat down every single person, number one, it would take a very very long time, you would need many many more TSA agents, and it would annoy a tremendous amount of people that get patted down and wanded every time they go through an airport. So, we use a metal detector as a screen. And it works. The vast majority of people go through the metal detector, they pass, and they’re done. A few people get beeped, they go through again, they get beeped again, and so they get wanded and patted down.
Now, if I told you that, when the machine beeps, it’s wrong 99% of the time. Meaning 99% of the time when we wand and pat people down, we don’t find any weapons, would you say it’s a bad screen? No, of course not. Because, when the machine beeps, they don’t call you a terrorist and say you have a weapon and put you in prison. They say, “Oh, it beeped. Let’s just make sure it’s nothing important and let’s just,” you know, “wand you and pat you down to make sure there’s nothing there.” And we don’t say that it’s therefore a bad screen. But that’s what the article does.
Essentially, when you do this blood test, this cell-free fetal DNA, and it comes back abnormal, if you say, “All right, that person’s a terrorist,” right, “it’s abnormal, you’re done, it’s wrong,” you know, “it’s bad,” then yes, it’s gonna be wrong 90% to 95% of the time. But if you say, “No, no, no, the screen came back abnormal, you have a 5% to 10% risk we should do more testing,” you know, “wand you and pat you down, we should do more testing like an amnio or CVS to make sure it’s not there.” That makes a lot of sense.
So, here’s another example from the pregnancy world. We screen for gestational diabetes in every pregnancy. And most people in the U.S. do a two-step screening process. The first thing we do is we have someone come into the lab, have a drink of sugar, and, an hour later, we draw their blood. And about one in five people test abnormal and four in five people pass.
Now, the one in five people who test abnormal, it’s just a screen. They don’t have gestational diabetes after that test. They go on to a much longer and more annoying test, which takes half a day 3 hours, they have to come in fasting and they do that test. And when that second test happens, about 80% of people pass and 20% of people fail. And we’re all good with this, that makes a lot of sense. We don’t wanna make every pregnant person take that 3-hour half-day fasting test because it’s horribly annoying and it would be very disturbing to a lot of people to have to just do that. So we do a screen, 4 out of 5 people, 80% of people pass and they’re done, and 1 in 5 are told, “Hey, your screen’s abnormal. You’ve gotta move on to the next step.” We don’t have an expose on this saying, “Oh, that screen is wrong 80% of the time,” because we don’t tell them they have diabetes from the first screen, we just tell them their screen came back positive and now they have to move on to Phase 2.
And, so, it’s the same concept with the non-invasive screening. It’s not a test. We need to be very clear not to conflate the terms “test” and “screen.” In the article, they keep referring to it as a test when, in fact, it’s a screen. It’s not meant to diagnose anything, it’s meant to tell a person if their risk of one of these conditions is still 1 in 1,000 or less or if now it’s closer to 5% or 10%. It’s the same math we used to use for Down syndrome screening when we just did the ultrasound and the serum blood test, it’s not conceptually different. But if we don’t understand that and we don’t understand the point of it, it absolutely can be very anxiety-provoking.
One of the problems is, yes, I agree, I think a lot of the companies do misstate some of their data. And I don’t think they’re saying things that are untrue, I think that they’re basically talking about accuracy, which is different from positive predictive value. Meaning, if I say a test is 95% accurate, what does that mean 95% accurate? What it means is, if they have 1,000 tests run, right, 950 of them are gonna be correct and 50 of them are gonna be incorrect. That means 95% accurate. But that’s not really relevant. What people are looking for with these tests is not the accuracy, it’s the positive predictive value. Which is basically, if I get an abnormal test, what is the chance my baby has the condition? It’s not the accuracy, it’s not 95%, it’s a positive predictive value, which is about 5% to 10%.
And, so, I don’t think that the people who are selling these like the sales reps are intentionally misleading. I think that this is very complicated statistically and they’re told, you know, “Hey, this test is 95% accurate,” and, so, they’re gonna say, “this is a great test, it’s 95%.” The companies know that the positive predictive value is 5% to 10%, at least the people who work in the lab and the companies know that. And in fact, they’re very clear like in their literature that it’s not diagnostic, it’s a screen, “You should confirm over to CVS or amnio.” But that gets lost, for sure, either in the translation from the lab to their sales people or from the sales people to the doctors or from the doctors to the patients.
And, so, I do think, sort of coming back and summing it up, I do think the article did a really good job of bringing a problem to the forefront. And the problem is that there’s a lot of people who don’t understand these tests, what we’re doing, why we’re doing them, what it means when it’s normal, what it means when it screens abnormal. And when I say “a lot of people,” I’m not talking about the listeners here, I’m not talking about patients, even though that might be true, I’m talking about doctors. I think there’s a lot of providers, doctors, midwives, nurses, whoever, people who order these tests who don’t really get it.
And any test, particularly about something so sensitive, you know, someone’s baby, the health of their child, in the wrong hands, they can be, quote unquote, weaponized to cause a lot of stress and anxiety. If I call someone up and say, “Hey, your test is abnormal, you have a really high risk of your baby having this condition,” oh my god, like that’s really really terrifying. Whereas, if I call, you know, before we do the test, and say, “Listen, we’re doing this test it’s a screen, you’re at very low risk from this sort of statistically. This will tell you if you’re still low-risk or, in fact, you’re a little bit higher-risk. But even if it’s a little bit higher risk, it just means we’re gonna do an invasive test, the CVS or amnio, to be sure but, most likely, it would be normal.” Now, again, it depends on the test for something like Down syndrome, if it comes back abnormal, it’s not 5% to 10%, it could be 50%, 90%, again, based on the circumstances. But for these in particular, it’s still gonna be relatively on the low side.
So, the people who order these tests need to know what they’re ordering and how to interpret them. And they need to tell people about them before they’re ordered what we’re doing and why we’re doing it. And some people might not want them, and that’s perfectly fine. And I think for, you know, our own patients and for listeners and others out there who might be getting this test, if you don’t think you’re getting that right explanation, that’s really important to find out what exactly does it mean to help reduce stress in case it comes back abnormal.
I think that, if the tests are used correctly, they do allow us to screen for conditions we were never able to screen for in the past. And the technology is only getting better, it’s not getting worse. So, we do have an option to do no testing and hope the baby is fine. And honestly, that’s usually gonna work out, most babies are fine. But a lot of people who are pregnant are not comfortable with that. You know, in my experience, there’s a lot of people who wanna know as much as they can.
And, so, coming back to it, the way we talk about this in pregnancy with testing is, again, there’s three options. You could do no screening, and that’s perfectly fine, a lot of people choose to do no screening. Statistically, it’s gonna work out most of the time, most babies are okay. Or some people don’t wanna go through the stress or they don’t wanna be put in a position where they’re thinking about terminating a pregnancy. Great, don’t do any screening, that’s perfectly fine. Other people know, from the very beginning, “I wanna do everything I can, every test that’s available.” And, so, those should probably just do a CVS or an amniocentesis and get all the information they can.
And then for everyone else it’s sort of the middle, “Hey, let’s do these screening tests, see where we stand.” Most of the time, everything’s gonna come back fine in the screens, which lowers your risk. Probably it’s about 1% or so of having any genetic condition. “I’m comfortable living with that and move on, no more testing.” Or if it comes back abnormal, “Based on what comes back abnormal, my risk is maybe 5%, 10%, 50%, 70%,” again, based on what comes back. “And then I can, again…” you don’t have to do an invasive test, like a CVS or an amnio, but most the time, if you’re doing the screen, it’s because you wanna decide whether to do that. You’ll do the invasive test, hopefully, get good news that, in fact, there’s no issue whatsoever. Or if you get bad news, at least you know. And then this is the reason you did it, you can decide what you wanna do moving forward. And I think, under that context, it really, overall, reduces anxiety.
So, again, I think that the article does bring up to the forefront a problem that exists. I don’t think it’s the problem that they state. I don’t think the problem is the test or the screen, as it should be called. I think the problem is the knowledge surrounding it. And I think that, when people are ordering it, if they know what they’re ordering and can convey that correctly and meaningfully to their patients, I think that it’s not gonna be the kind of problem that they’re describing, I think, in fact, it could be a very good thing and a very helpful thing.
So, what can everybody do out there? I think for people who are listening, who are going to order these tests, whether you’re a doctor, midwife, whoever, I think it’s really important to know what you’re ordering and to be able to convey that information to the patients correctly. And that your staff should convey it correctly and it should not be misinterpreted.
And I think for those of you out there who are gonna get the test done on you, be educated about it. Listen to this podcast. Look online. Whatever it is. Go to the company website, they’ll tell you the statistics about it, they don’t lie about their stats. It’s just sometimes it’s misleading. And if you get news from a blood test that says “your baby’s abnormal,” you should really question that. The blood test is a screen, it’s not a test, it does not make a diagnosis.
I hope this was helpful. Again, I don’t really do a lot of podcasts alone, it’s not my thing, I usually like to have a conversation. But I thought this was something really important and I wanted to do it sooner rather than later. So, I thought that maybe talking about this on my own, just how I think about this, how I think about the article…and, obviously, if you have any questions, you can email in or ask your own doctors or midwives. Have a wonderful day everyone.
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