LadyGang - Everything Every Pregnant Woman Should Know With The Expert Of All Experts!

Episode Date: June 10, 2026

What pregnancy tests do you actually need, and which ones could change everything? Dr. Amanda Horton, a double board-certified OB-GYN and Maternal-Fetal Medicine specialist with more than 23 years of experience caring for high-risk pregnancies, breaks down the screenings, ultrasounds, and genetic tests every expecting parent should know about. From IVF pregnancies and carrier screening to NIPT, anatomy scans, and the red flags doctors are looking for, Dr. Horton explains what these tests can reveal, what questions you should be asking, and why being your own advocate during pregnancy is so important.  Thank you for supporting our sponsors!BabyGang is presented by Better Help. Sign up and get 10% off at https://BetterHelp.com/BABYGANGSkylight Frames: Go to https://MySkylight.com/BABYGANG for $30 off your 15-inch Calendar.HERS: Ready to reach your goals? Visit https://forhers.com/babygang to get personalized, affordable care that gets you.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Based on Natural Resources Canada fuel consumption ratings, conditions apply. Visit HyundaiCanada.com or your local dealer for details. hello hello hello welcome to the baby gang i am your host becca tobin and thank you to our presenting sponsor better help i am really excited for this episode i had a wonderful conversation informative conversation with dr amanda horton i have followed her for a long time on instagram she just does this incredible job of really breaking down pregnancy screenings She's a maternal fetal medicine doctor. We'll get into what that means. But she is so I just think she does a wonderful job of really telling us and empowering us to have all the information to know what we have access to, what we can ask for, because it's not this universal thing where everyone goes to the doctor and is offered all the same testing and screening.

So you may be somebody who doesn't need to hear this. You're not pregnant. You've already had your babies. But if there's anyone in your life who is pregnant or is thinking about getting pregnant or if you're just curious, I am a very curious person when it comes to this topic. So I learned so, so much. It was so informative. And I'm just super excited for you to listen to this episode. And before we get into it, I want to tell you about how I personally struck gold. And by gold, I mean liquid gold, because there is a beautiful lady gang listener who I met at a live show a couple of years ago named Sarah. Sarah became a surrogate for two of my very close friends, and she just delivered their second baby or their third baby, the second one she carried in February. She had been pumping for them and sending it to them, you know, shipping it to them, which is what you do when you go through this with your surrogate. And some surrogates,

they don't pump at all. So it's very case by case, but she's a big producer and she wanted to continue on pumping, but our friends left the country and they're moving. So there was no way to get this breast milk to them. So because she wanted to continue pumping, I jumped in and I was like, well, let me take over the payments and let me have this liquid gold sent to me because Katie and I had already had a conversation, our beautiful surrogate, about how she didn't love pumping and we really weren't sure if we were even going to go down that road with her because it's just not something. It's so, you guys know, it's very case by case. Some women have no problem at all and they love it and some women are not big producers and yada, yada, yada, which is why it's

so separated from the surrogacy journey to the breast milk journey. I digress. I have so much breast milk. And I am so excited. And I am so grateful. It's in my freezer. And I just feel like, listen, if we had no breast milk whatsoever, we would be doing formula because Ford was a majority formula baby. We had a little bit of breast milk. Maybe it was like six weeks of it when Sierra was sending it to us. But whatever. Fed is best, guys. Fed is best. I just felt like this was a really kismet thing that happened for us. And I'm really grateful. And it's just such an expansion on It Takes a Village. And I'm just, wow, women are fucking awesome. Without further ado, Dr. Amanda Horton.

Dr. Amanda Horton is joining us today. She is a double board certified OBGYN and maternal fetal medicine specialist with more than 23 years of experience dedicated to providing compassionate evidence-based care for high-risk pregnancies. She partners closely with expectant parents to navigate complex medical conditions and pregnancy complications while helping families feel informed and empowered every step of the way. I have spent hours watching her on social media as she shares her expertise to extricate, decode, and demystify high-risk pregnancy topics. Please welcome Dr. Amanda Horton to the pod. Thank you for having me. Thanks for coming on. Selfishly, I just want you on because I've been navigating fertility journey, which feels like 500 years. It's been

about, well, it took four years to get my son here and now he's four. So we're going on eight years. Oh my goodness. Yeah. But you know what? It's worth it. It all ends up working out and I wouldn't have it any other way because I feel like this platform has really allowed me to share not only my own experience, but resources and access to people that otherwise you might not have depending on where you live and who your provider is. To kick us off, because I'm sure most people are like myself and they don't know the difference between an OB-GYN and an MFM. So who do you see? What kinds of patients and why are you different? Yeah. So maternal fetal medicine physicians are all OB-GYNs. OB-GYN residency is four years.

So we go to medical school, then we do a four-year residency. And then some of us choose to further specialize in an area of women's health. And I chose to do an additional three-year fellowship after my four-year residency in maternal-female medicine, which is also called perinatology. So we take care of individuals pre-pregnancy. So for planning for pregnancy, preconception care, individuals who have chronic medical conditions that want some advice and help navigating how their medical condition might impact pregnancy and how pregnancy might impact their condition if it's really risky to get

pregnant and pregnancy is not health neutral. And then during pregnancy, we see individuals to manage those chronic medical conditions as well as provide expert care in ultrasound, prenatal diagnosis. We see patients in the office, so outpatient and then inpatient in the hospital. And then afterwards, if you had a pregnancy complication and you want to know, you know, you want to debrief about it, placental pathology, you had a complication and are planning for a future pregnancy and want to know what things might be managed differently and what the chances of this happening again or other things that this might impact as you want to build and grow a family. And I will say the word journey is really loaded and I feel like it's a – I don't know. Sometimes you talk about a journey and I don't ever know that it feels like there's a destination that you're trying to get to. It feels to me like it's an experience. It is an experience. It's a transformative one.

It sure is. And I actually interviewed the owners of the agency that helped me find my wonderful surrogate for my son. And we were saying like, journey just doesn't feel right. And one of them said, no, it's a hike. Yes. Yes. It's a hike. It's a hike. It is. It is a hike. Sometimes it's beautiful and it's rigorous and intense. And sometimes there are parts that are not on the map that you think, this isn't the way I was supposed to be going. So true. And I'm really trying to make this so that it's very simple for people to understand and also for women to know, do they need you? So are they told by their doctors? What is the process of that? Because it is all very confusing even after this many years of

navigating it. Yes. And most people have never heard of me or my specialty. Or if they have, they think, oh yeah, our neighbor's son was born with this complex birth defect and they had to go see a maternal fetal medicine specialist. So I see a lot of people very, very anxious about coming to see me because they think something must be wrong. Their provider hasn't disclosed something and they're waiting for the other shoe to drop and get bad news. And so we see patients in all different kind of points in time or different touch points. I work a lot with the fertility community and see a lot of patients who may be undergoing IUI or IVF. And management of an IVF pregnancy is a little different than a pregnancy that's conceived spontaneously. And so it's a

good opportunity for us to review, here's our, you know, what we expect. And, you know, the punchline is, is in general, people who have IVF pregnancies have really healthy pregnancies and have healthy babies, but they're managed a little differently because the chance for some things to happen may be a little higher. And so navigating that and understanding, I need to have this done, or I need this type of ultrasound instead of that type of ultrasound. And I'm going to have this growth ultrasound because there's the potential for this to happen. I think it provides a lot of empowerment on your journey that someone unexpected, the

route's never linear, and it can feel really confusing why somebody is recommending that you have these things without having this kind of inherent baseline knowledge that it has the potential to be a little different. And because of that, we want to do all of our checks and balances and out of an abundance of caution, have you come see a specialist to get certain things kind of checked off the list to make sure everything is going as well as we expect it to. Who knew? It was just so complicated. Thank God for you. But I really wish it was like what we thought when we were in high school, just have sex, you'll have a baby. I know. We spent so much of our time preventing pregnancy.

And then when we want it to happen, whether that's, you know, we feel like we've reached the pinnacle of our career, we've met someone, or maybe we haven't. We decide we want to be a single parent by choice. We recognize we don't always have all that time that we thought we did to be a parent. And that can be devastating. You know, it's like, why did I waste all that money on those birth control pills? So true. Why did I go through the painful IUD process? Oh, my God.

I was warned, but I almost passed out. I have a pretty high pain tolerance too. Okay. So you see it all. Pretty much you are the one who sees it all. What preconception tests or evaluations do you recommend for individuals or couples planning to try and conceive? And what are the essentials in your mind? And what's the optional tests, I guess? Sure. Yeah. So there's a lot in the pre-pregnancy space. And I think it's always really important as well, in addition to having your OBGYN or your fertility specialist, to also have a primary care doctor, which in general, many of us, when we are feeling well, don't feel the need to have to see a primary care doctor to get your cholesterol checked or to make sure your thyroid gland is

working or that you're up to date on all of the health maintenance things you need. But if you're preparing or planning to have a baby, it's always a great idea to do a quick preconception check-in with your OB-GYN. And that's the person that I would typically start with. You can always request to be referred to a maternal fetal medicine specialist or ask if your rheumatologist or cardiologist might be better equipped to handle specific labs. But kind of first and foremost would be carrier screening. So carrier screening is a big thing that I spend a lot of time talking about.

That's also quite confusing when we start talking about genetic testing or screening. Are we talking about testing the parents? Are we talking about testing the pregnancy? And are we getting absolute information that's 100% accurate? Or are we getting risk-based information, which is, well, this chance is very low, but it's still not 100% accurate. So carrier screening helps us to figure out whether or not you as the pregnant individual or partner of the pregnant individual, the co-contributor, have a gene with a change or a variant that you could pass on to your child. And oftentimes I hear, well, I don't need that done because we have no family history of that.

And that is the exact reason why we want you to do carrier screening, because these conditions are usually autosomal recessive. So if we go back to seventh grade middle school, when we talk about Punnett squares and figuring out whether things are dominant or recessive, carrier screening by and large is screening for autosomal recessive disorders. So you carry a copy of a gene that has a difference. You have another copy that is normal and doesn't have that difference. And so that copy doesn't impact you. But if you pass on that recessive trait and your partner is also a carrier of that recessive

trait, then you have a one in four chance or 25% chance for every single pregnancy to have a child that might be impacted with that condition. And some are things like cystic fibrosis, which many people have heard of, but a number of these are very, very rare and can have devastating consequences where they are associated with in utero problems, or they're associated with lifelong health concerns, or they may be associated with a very, very short lifespan. And a child may die days to weeks to months after birth. And when you pee on that stick, get that positive pregnancy test, go into your fertility lab and get your positive beta, that's not what you're thinking about having a child that may not survive or having a child

with a shortened lifespan or a chronic medical condition that you could have known about had you chosen to do this test before you got pregnant. Can you do carrier screening when you are pregnant? Yes, you can. It takes a few weeks for that test to come back. And most of the time the testing is done by the pregnant individual. So the likelihood of having a child with this condition is based on your partner status as well. So you would be what we call a carrier couple. And so by the time you do the test and get into an obese appointment and then find out maybe you're a carrier for X condition, and then your partner gets screened and then you find out, oh, he's also a carrier. And now it's, oh, I have this 25% chance. Well, what are our

options? Options would be you could do a chorionic villus sampling, which is where we sample the placenta for information, genetic information, or you can do an amniocentesis, but then you have to send that information off. And so by the time parents might find out they have an affected child, they may be close to halfway through their pregnancy. And that's another weight and another load of stress and information that you could have had the potential to learn earlier. And maybe you had made different decisions. Right. Yeah. It was really interesting. I had no idea about this carrier screening. I don't think my parents did it. I think it's probably something, a newer technology or advancement. And I do remember I tested positive for cystic fibrosis

as a carrier. And my husband thankfully did not, but I did understand that if he had, we would have gone the IVF route. We probably would have never even tried to get pregnant naturally and gone IVF and tested embryos. I'm very grateful that that was given to me. And I know so many women my age who have never been offered this test at all. Yes. They've never heard of it or it was a, you know, you get into your new OB visit and it's a pamphlet and a packet that they expect you to read about. And by the time you get to it, you know, or, or there's misinformation out there. Oh, that's not anything you need to worry about because you don't have a family history of that. Yeah. It's pretty crazy. And I was a carrier for a lot of things, like a

lot. Yes. Well, I mean, the panels have come a long way, right? We used to screen for three or four things and now the panels are in the hundreds. And with the rules of math, the more things you test for, the more things you're likely to become positive for. And yeah, so if you do background math of take a Caucasian individual, they have a roughly one in 30 chance of being a cystic fibrosis carrier. And they partner with another Caucasian individual who also has a one in 30 chance of being a carrier. That would mean you have a one in roughly 3,600 chance of having a child with cystic fibrosis. There are 4 million births a year in the United States. That's a lot of children with cystic fibrosis. It's a lot. So interesting. Okay. Now, once someone does

become pregnant, this is my favorite thing you talk about on your Instagram, probably because I've been through it and probably because I know, I mean, a quarter of my friends have been through it where some sort of screening or something has raised a red flag. Okay. So what do you suggest people do once they're pregnant as far as that goes? And by trimester, if that's applicable, like at what point and what trimester? Yeah. So there's some standard labs that are recommended for every person who's pregnant in the first trimester. And those sorts of things are your blood type, HIV, hepatitis, screening for sexually transmitted infections. And those are typically standard. There are some that I think should be individualized. So for example, if you're a

vegetarian, it's a great idea to get a baseline B12 level, get a ferritin level because you're more prone to different types of anemias. Healthcare workers, individuals who have small children, daycare workers. I also recommend having a conversation with your OB about CMV screening or cytomegalovirus screening, which is one of the most common conditions that nobody ever knows about or talks about and can have devastating consequences to a pregnancy. So being screened for that early can help you identify whether or not you've ever been exposed to the virus or if you haven't and that your pregnancy may be at risk and you may be at risk for developing CMV, which you can then pass on to your child who has the potential to develop congenital CMV.

So if you do test positive for this, what do you do? Is there a solution before getting pregnant? So the good news is that if you test positive for CMV, that means you've already been exposed. And the likelihood of that virus reactivating isn't zero, but it's pretty low. The concern would be if you've never, ever had CMV before, and you then develop a primary infection, and then you pass that on to your baby. Wow. So in this case, we want you to have it. We want you to have it. Okay. We want you to be exposed. Yeah, we want you to be exposed. And then similarly, and I failed to mention this, in the pre-pregnancy labs, outside of carrier screening, also a really good idea to get checked for vaccines that you may have had as a child. So rubella, measles has

been in the news a lot lately, so you can check for measles as well as varicella, so chickenpox. These are also conditions that you can develop if you are non-immune or if you've not been vaccinated and have the potential to cause congenital rubella syndrome or congenital varicella syndrome, both rubella and for chickenpox. And so getting screened to see whether or not you're immune gives you an opportunity, if you're not, to get re-immunized or vaccinated. Those are both live vaccines, MMR, which is measles, mumps, and rubella, and then the varicella vaccine. So because there is a theoretical risk that if you were to get pregnant, you could get sick and then pass that on to your pregnancy, we recommend that you wait about 28 days from

the time of your vaccine till you conceive just to erase that potential possibility. That's a theoretical risk. There's only been one reported case I think of in the many years that we've been doing this, but still risk avoidant, just wait 28 days after you get your vaccines. Wow. So checking for vaccines is really important. And I like CMV, especially for those that have the potential to be exposed. CMV is transmitted through bodily fluids, so urine, feces, vaginal secretions, which

during birth, tears, it's in breast milk, lots of different ways that you can get it. Most people who develop a CMV infection, unfortunately, as an adult, often have no symptoms and don't know where they were exposed. So unfortunately, because in medicine, there are different sorts of rules and guidelines for what constitutes a good screening test. They don't recommend universal screening, but I think everybody's care should be individualized. And it's a great conversation to have about your personal exposures to make sure that you're doing everything that you can to ensure that you're as up-to-date and as knowledgeable on the things that can impact your pregnancy and your family. Yeah. Okay. So now say we're pregnant, okay? What do we ask for? What do we advocate for? I know that it is such a wide range of what is offered. So outside of carrier screening, which is a type of genetic screening, I think first and foremost, a really important question that you have to ask yourself and really answer truthfully, right, along with your partner, is what sort of information

you might like to have about the genetics of your baby during the pregnancy. And so there are screening tests. And so that's called aneuploidy screening. So aneuploidy is essentially looking to count, you know, are the correct number of chromosomes there. So most individuals have, most females are 46XX. So we have a set of X chromosomes that are sex chromosomes that are XX and males are 46XY. And Eupalidae is referring to an addition. So you'd be 47 or a deletion or a missing chromosome, which we call a monosomy. So you'd be 45. So we can screen during pregnancy or actually say we can test during pregnancy for the chromosome abnormalities. And that can be done through two ways. One is through screening. So that's a blood test that's non-invasive that

can be done as early as nine to 10 weeks and screens for the three most common chromosome conditions that we can test for. Number one is Down syndrome, which is trisomy 21. And then the two others are trisomy 13 and 18. It's a really good test. It's called cell-free DNA. It goes by a lot of names, cell-free DNA, NIPT, non-invasive prenatal testing, NIPS, NIPs, non-invasive prenatal screening. And that is a test, again, can be done very early in pregnancy. You don't need an ultrasound to do it. You just need some blood. And in addition to screening for trisomy 13, 18, and 21, can also tell you whether or not you're having a boy or girl. And you should have the option to also opt in for what we call sex chromosome aneuploidy,

which is not the first 22 chromosomes, but whether or not there's an abnormality or a difference within our sex chromosomes. And trying to explain that and understand all that information can be very, very overwhelming when you're like, oh, I just want to know the sex of the baby, or I'm not sure if I want to have that information. So the recommendation is that everybody should be offered testing. NIPT, cell for DNA, is the best screening test available. So everybody should be offered that. If they want to do it, great. If they don't want to do it, that's totally fine. But that screening, and that's going to tell you, comes back low risk or high risk, meaning do you have an increased chance for having a child with this condition? And I think something that's

really important to know is that if the test comes back and it says, oh, 99%, that doesn't mean there's a 99% chance that your baby has that. The actual likelihood is based on how old you are. So a screen in a 40-year-old woman who has a higher chance to have a child, for example, with Down syndrome, that test is much more likely to be a true positive than someone who may be 20 whose background chance for having a child with Down syndrome is lower than somebody who's 40s. So NIPT is a great option or cell for DNA is a great option, but everybody should also be offered the option to do a diagnostic test. So an amniocentesis or a CVS to learn about all of the chromosomes if they choose to. So that comes back to the first question, which is

what information would you like to have and how, not at what cost, but how far do you want to go to pursue that? Would you be willing to do a diagnostic test? And amnio and CVS and experienced hands like mine is incredibly safe, but you do enough procedures enough times, there may be complications. And if you haven't had a complication yet, then you haven't done enough procedures. And so some people aren't willing to accept that one in 500 or one in 1,000 risk of loss from a diagnostic procedure. So they might say, I'd prefer to get as much information and the screening test that's possible and then make some decisions after that. If you said, well, my risk of having a child with Down syndrome after I do this test is one in 40,000 and that

chance isn't low enough for me, great. Then there's additional tests that are available, but everyone should have the option to choose whether or not they want to do it. And if you're choosing different tests, there's, so in the early or mid first trimester, so nine, 10 weeks. You can do the cell for DNA or NIPT. You can do that at any point in time in your pregnancy. So there's no cutoff. You don't miss it if you're 20 weeks. I'm not sure why someone would choose to do a different test, but you can. Most of them are covered by insurance. And if not, there's a fairly reasonable out-of-pocket cost that you can pay direct to the company to have that test done. Sometimes they'll come out to your house to do it. Sometimes you can have it done in

your doctor's office. But I think if you wanted screening information, NIPT would be the best way to go. If you wanted 100%, here's, I want as much information as I can get and I'm willing to take the risk of a complication, then I would do a procedure. Yeah. People get really uncomfortable in those conversations because they think that you're asking for the information because they I think it's an automatic choice between terminating a pregnancy and not. But a lot of the time, if you're choosing to just get the information to have the ability to set yourself up financially for what you may be facing down the line or the care that you might need, the support system, it may be different depending on what those tests

uncover. And so the stigma of wanting that information, I really wish would go away, but that's for a whole nother conversation. now do you recommend oh okay so that's that's the first trimester and all that fun stuff and i do know in the typical pregnancy there's a 20-week anatomy scan is that what you would say is the next step in a normal pregnancy so yes so i'm going to dial that back the 20-week ultrasound is absolutely important but let's go back to the first trimester so people come in and they get their entry to pregnancy ultrasound that confirms they're eight weeks along. Wonderful. Many of them

think, okay, I don't get another ultrasound until I'm 20 weeks. And here's another opportunity for you to advocate for yourself, which is to request a first trimester ultrasound, which is typically done somewhere between 11 and 13 weeks. And why is that important? It's important because that ultrasound can also provide an opportunity to look for or screen for any potential structural differences or abnormalities that might result in a pregnancy that may not progress the way that you expect it to. So at that 12-week ultrasound, we can look for the skull. We can look to see if there's something called a crania or anencephaly, which is life-limiting or lethal because you can't survive without your skull and your brain. We can screen for things like, is the heart inside the

chest? The heart can actually be outside the chest in a condition that's called pentrology of Cantrell. That's very, very complicated. We can look at the anterior abdominal wall. Does the umbilical cord insert into the middle of the belly button? We're looking for anterior abdominal wall defects. Some of those can also be life-limiting depending on the severity. Are there two arms and two legs? Do we have a limb anomaly? Are the correct number of blood vessels in the umbilical cord present? So some of these things are not life-changing or life-limiting from a pregnancy, but having that information at 12 weeks also gives you time to prepare as opposed to waiting for some of these things at 20 weeks. Is there anything that they're seeing at 20 weeks that

they wouldn't have seen in this first trimester ultrasound? So the 20-week ultrasound is a, there's two types of ultrasounds that are done at the anatomy scan. One is called a basic or standard ultrasound that looks at, we have a checklist of things that we need to see. And then there's a detailed or a comprehensive ultrasound. That's just exactly what it sounds like. It's a much more comprehensive scan that's looking at more images to help us identify if there are the potential for problems. So for example, on a detailed ultrasound, we look at the palate to see if there could be a cleft palate. We don't look at the palate on the basic ultrasound. When we look on the basic ultrasound, we look to see are arms and legs present? Are

there two feet? Yes. We don't look at the way that the foot is positioned to say, oh, there's a club foot. So some babies are born and people often ask like, well, how did that get missed? And not so much that it was missed, it wasn't evaluated because those things aren't looked at on a standard ultrasound. So the 20-week ultrasound is a comprehensive ultrasound of organ systems. It also looks at the placenta. It looks at your ovaries. It looks at your cervix. But there's major information that we can get from a 12-week ultrasound. We can also look at a space behind the back of the neck called the nuchal translucency. The nuchal translucency, when it's increased, is also a marker for chromosome abnormalities, but it's also a

marker for congenital heart disease, which is the most common sort of birth defect in a developing baby. So it gives us information that might allow us to change the care of a pregnant person. So instead of having a basic ultrasound, you might have a detailed ultrasound. If you said, I wasn't interested in doing any genetic aneuploidy screening, but now there's a marker that suggests there might be a slightly higher chance, that's a conversation that we can have and counsel about, here are my concerns. Here are different ways that we can manage this. How would you feel about, you know, next steps in terms of doing some testing? Would you be interested in this information? Does this information change, you know, your previous thoughts on whether or not

you wanted to do testing or not? And again, not for necessarily for purposes of ending or interrupting a pregnancy, but do I need to be referred to a specialist like a maternal fetal medicine specialist? Do I need to see a pediatric surgeon, a pediatric neurologist, a pediatric cardiologist? Is a small hospital where I'm going to deliver that does not have a NICU the correct place for me to get my care? Do I need to go to a fetal care center? Do I need to deliver at a level three or level four hospital that has neonatologists on staff 24-7? And so those things can impact your birth, can impact the first moments, hours, minutes, weeks of your baby's life. You want to make sure that you're delivering at a place that has all of the services that are

available to give your baby the best chance possible. Now, is your OBGYN able to do the detailed ultrasound, the nuchal translucency, or is that always going to be a specialist? So some OB practices will offer that. And I think it's always a great conversation starter of asking and again, advocating when someone says, okay, you know, we'll see you again at 20 weeks to say, well, I've heard that I can have this 12-week ultrasound that will look at these parts to the baby. Is that something that you do in the practice? If not, can you refer me to a specialist who does offer those services? Same thing, you come in for your 16-week visit and they say, great, we'll see you at 20 weeks for your ultrasound. I've heard about the anatomy

ultrasound. I understand that there are different types of anatomy ultrasounds. what type of anatomy ultrasound am I being scheduled for? And is that the correct type of ultrasound I should have given my, you know, my pregnancy concerns? And then take it a step further because most people here are like, oh, the baby's okay. You know, and you're thinking, great, I'm all set. Halfway through my pregnancy, we're going to go buy a bunch of stuff. But do you have any idea what anatomy was looked at? You know, in a basic ultrasound, right? So congenital heart disease, so let me, I'll take that a step back. Three to five percent of all babies are born with a birth defect. Three to five percent. Usually to people who have no family history of

birth defects, who did everything right in preparing for pregnancy and were taken by surprise at their anatomy scan with the finding of a structural concern. Of that three to five percent, heart defects are the most common at a half a percent to one percent. So one in 100 to 1 and 200. A basic ultrasound looks at the four-chamber view and then looks at the two outflow tracts, the right and left outflow tract. If technically feasible, they say you should look at something called the three-vessel view and three-vessel trachea view. I think every baby should have those looked at. The three-vessel trachea view is my favorite view. It gives me so much information and I can rule out so many things just from that view that is not done on

a standard ultrasound or is only done if it's technically feasible. And so when you hear everything is right, you have no idea what has been evaluated. The American Institute of Ultrasound Medicine offers an accreditation for different practices. It's a lot of work, but you can know that if you go to a practice that's AIUM accredited, there is a standard list of all the things that they are supposed to see. And you'll get your report that says, we saw it well. It was seen, but it was suboptimally seen, or we didn't see it. And then that gives you an opportunity after you have your ultrasound to say, did you see everything that you needed to? Were there any structural concerns? Or are there soft markers? Soft markers are what we call often

normal variants. They're subtle findings that can be associated with genetic or chromosome issues that don't usually often represent a structural problem, but not always. And again, because they can be associated with chromosome abnormalities. If you haven't had any aneuploidy testing, if you haven't done NIPT, it's a great opportunity to have a conversation about whether or not you want to do NIPT. And it's also an indication for a more detailed ultrasound. The detailed ultrasounds are not often done at OB offices. Those are often done at maternal fetal medicine offices. And that's usually because the OB ultrasonographers, the sonographers may not have the experience to be able to obtain those detailed views. And many OBGYNs receive very,

very little ultrasound training in their residency to feel comfortable to be able to read an ultrasound. I know many of my OB friends will rely on their seasoned sonographers to help discern if something is right or wrong, or call and send me a text message saying, hey, can you look at this? Does this heart look normal? And you don't know that's happening behind the scenes. So advocate for yourself, who's reading my ultrasound? What views are being obtained? How am I going to get this information? Will I come back? Who's going to communicate the results to me? And can I, you know, if this is not the appropriate ultrasound for me, who's going to do the ultrasound that I need? Wow. It's so much, but then you think about it as I've done more research

on like under eye concealer. And I think I can speak for a lot of women than I have on prenatal or natal. Is that the term? Yeah. Antipartum. Right. During pregnancy, right before birth. Yeah. Yeah. It's fine. But that's just, I'm embarrassed to admit that, but this is why you're on the podcast. Would you recommend this for somebody who's going through IVF, who has a PGT-tested, quote, normal embryo? Yes. So PGTA, right, pre-implantation genetic testing, the A stands for aneuploidy,

can be done for a lot of different things, is a screening test. PGTA is sampling the cells that become the placenta. It's not sampling the cells that become the fetus or the baby. Right. Most of the time, the genetics of the placenta and the baby match, but not always. there's something called confined placental mosaicism, right? Mosaics are tiles. So they're

made of different sorts of things. And so the genetics of a placenta don't always match the genetics of a baby. And because PGTA is a screening test, we are test blind to that. I am so glad people do PGTA, usually helps them to be able to, you know, have a healthy baby when compared to transferring, you know, an embryo that may not have been genetically normal. but you should still be offered an IPT. That is not common. No. Many people think, oh, I don't need to do that. Yes. We are test blind. It's great that it's there. I'm still going to offer it to you. Yeah. So IVF, again, wonderful way to build and grow families. The process of IVF doesn't increase your chances of having a baby with a chromosome abnormality.

So you do your NIPT, but you should also have a detailed ultrasound. There are some studies suggesting a slightly higher chance for structural abnormalities with IVF. And we see higher rates of high blood pressure problems, so preeclampsia. We see higher rates of fetal growth restrictions to smaller babies. And unfortunately, we also see a higher risk of stillbirth or a higher chance for stillbirth. So outside of just NIPT and a 20-week ultrasound, growth ultrasounds in the mid-trimester, third trimester, most babies put most of their weight on in the third trimester. So even if you're using the tape measure and trying to figure out, oh, yeah, I'm 28 weeks and I'm measuring normally, most practices would and should offer an IVF pregnancy, a third trimester growth ultrasound. And the risk of stillbirth, you know, increases as you get further along.

And many practices will offer some weekly fetal monitoring that starts usually the last month of pregnancy. again out of an abundance of caution even if you're feeling the baby move and the baby's growing normally it's still an independent risk factor that we cannot strip away and so you've worked very hard yeah to have your baby we want your baby alive and our side it's a little bit of some monitoring that's done again to make sure everything is okay and it's just a check-in point for us to say yes this is looking good we're okay to keep going right why is that why are the chances of stillbirth higher? Do they know with IVF? We don't. We don't know. It's kind of similar to structural concerns. Is it something about an individual inherently who may struggle with

infertility? Is it something about the IVF procedure itself? We just don't know. So interesting. Okay. So we've talked a little bit about birth defects and a lot about you know, really sunny times over here. I know. You're like, yeah, come talk to me. I'll have a load of fun. So in this really interesting time of people being really opinionated on termination and who gets to decide and why it would be necessary, you know, I think in this conversation that I have with a lot of people who are just naive and they don't know that there are actually birth defects that can be fatal to the person carrying the baby and who also can be fatal to the baby, make it actually impossible for the baby to live outside of the uterus to be born and

maybe survive a couple of days. I guess I just want to get into that because I'm kind of sick of the ignorance around the reality that it's not always sunshine and daisies. No, we didn't promise you a rose garden, right? And that's what's really, really hard, right? You go through this whole journey, this experience, this hike, and you think, right, the end is my prize. And that's not always the case. Not every person gets to take home a baby who's alive. And so there are a number of life-limiting conditions I mentioned earlier. There's a crania or anencephaly and hypoplastic left heart. So it's another condition that's a heart condition. Unless a surgical intervention is performed, there's three stages of that surgery

that's also associated with a very shortened lifespan. You need your kidneys. Kidneys make amniotic fluid. They filter our blood. Sometimes babies are born with missing kidneys called renal agenesis, which is also lethal. There's another kidney condition called multicystic dysplastic kidney where the kidneys don't get the instructions to develop correctly and they look like a cluster of grapes. They're just these fluid-filled cysts. And the baby doesn't produce in a year and if you have bilateral, so both multi-cystic dysplastic kidneys. Skeletal dysplasias, there's a gene called the FGFR3 that undergoes a mutation that can be associated with severe bone abnormalities, which are also lethal.

There are no children who are living that have this condition. There's a condition called osteogenesis imperfecta. There's something called the limb-body-wall defect, which is just devastating, which is essentially the anterior part of the body is plastered against the placenta and just doesn't develop into a normal, healthy baby. And then there are some conditions that, whether it's due to metabolics, genetics, a structural concern, an infection that can lead to something called hydrops, which is fluid accumulating around the heart, the lungs, body edema. And what's really concerning about hydrops is that it can also cause something

called mirror syndrome. So hydropic babies are very, very sick and moms can develop symptoms that mirror what's happening to their babies and they can become very, very sick as well. So these are so severe that a baby can't survive either before birth or shortly after delivery even with all of the amazing medical care that's available. And it's just cruel and an unusual form of punishment to not allow someone to have that choice on how they want to manage something that's devastating and life altering that they didn't ask for,

that they couldn't prevent and then force them to have to carry a pregnancy because their life is not as valuable as the non-viable pregnancy that they're carrying. So yeah, if you're in a total ban state, these pregnancies are continuing at the risk of all involved? Yes. Right.

Yes. There are no exceptions for these sorts of things. Wow. No exceptions. It's devastating. Wow. Yes. So in those cases, in our great state of Texas,

it's a little even more challenging simply because your friend or neighbor can tell on you, tell on you, tattle on you. Yes. And so we can place referrals. And I tell patients when faced in these situations, when we talk about all of our pregnancy options, because pregnancy continuation is absolutely an option. So is pregnancy interruption. But it should be made after you're fully informed about all of the potential things that could happen. And that's not meant to instill fear or to coerce someone into doing something. It's just the reality of where we are, which is you can continue. You could choose to interrupt. You can't end your pregnancy in the state we live in, but I can make

a referral for you to get a second opinion so that you could see someone and receive the counseling and discuss your options so that you can make the decision that's right for you. What a time. On that note, I've kept you too long. I feel like I owe you money for this because the information that I and everyone else were receiving, it's really so informative. It can be overwhelming, but I believe information is power. And I really do thank you for doing all that you do, especially on Instagram for people who don't have access to someone like you. So where can people find you if they have not found you already? Easiest place to go is just to find me on Instagram. I'm at Amanda Horton, MD. You can

send me a DM. I look at all of them. I respond to them. And I am licensed in many states. And if I can't help you, I can find somebody who can. Okay. Thank you so much for being here. Thank you for having me. you