December 11, 2013 — Jennifer Margulis, PhD and Manuel Casanova, MD

with Kelly Brogan, MD

BusinessofBabybookJoin Kelly Brogan, MD, as she speaks with Jennifer Margulis, author of the acclaimed book, The Business of Baby and Manuel Casanova, the Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry and a Professor of Anatomical Sciences and Neurobiology at the University of Louisville. They will discuss the latest, best research on the most universally applied intervention in pregnancy: ultrasound.

Why do women get ultrasounds? Are they requested and desired? Are they recommended? Is there prior discussion or consent? What is known about risks? What is suspected? What about autism? What might be a more reasonable or cautious application of the technology? Should it be abandoned?

Jennifer MargulisJennifer Margulis, PhD is a senior fellow at the Schuster Institute for Investigative Journalism. A former Fulbright Fellow and an award-winning journalist, she has worked on a child survival campaign in Niger, West Africa, and championed the rights of rescued child slaves in Pakistan. Her cover story for Smithsonian magazine was chosen by Natalie Angier for inclusion in Best Science Writing 2009. The Business of Baby is her fifth book. Its research was partially made possible by the Fund for Investigative Journalism.

manuel.f.casanovaManuel Casanova, MD, the Gottfried and Gisela Kolb Endowed Chair in Outpatient Psychiatry and a Professor of Anatomical Sciences and Neurobiology at the University of Louisville, researcher and investigator into the role of ultrasound technology in brain-based pathology seen in autism. His research has focused on the cell minicolumn, a vertical unit of 80 to 100 neurons having a common latency of response to stimulation. His most recent studies have investigated the presence of abnormalities of minicolumnar organization and lateralization in the brains of patients who exhibit language disturbances, including autism, Asperger’s syndrome, and dyslexia. He is internationally known for his work in autism.

kelly-cropKelly Brogan, MD is Medical Director of Fearless Parent and mom of two. She is board certified in Psychiatry, Psychosomatic Medicine, and Integrative and Holistic Medicine. Holistic living, environmental medicine, and nutrition are the bedrock of her functional medicine practice. She serves as medical advisor to GreenMedInfo, Pathways to Family Wellness, and Fisher Wallace. Kelly holds degrees from MIT and Cornell Medical School.

For the science geeks among us, we invite you to read Kelly’s latest post (below).

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Perils of Peeking into the Womb: Ultrasound Risks

“Clinical use of diagnostic ultrasound imaging during pregnancy has a long history of safety and diagnostic utility, as supported by numerous human case reports and epidemiological studies.

However, there exist in vivo studies linking large but clinically relevant doses of ultrasound applied to mouse fetuses in utero to altered learning, memory, and neuroanatomy of those mice.”

How may doctors and unknowing patients be colluding to harm unborn babies? This recent study suggests that the seemingly benign practice of obstetrical ultrasonography is one practice that deserves urgent reassessment. Researchers exposed pregnant mice at 14.5 days gestation (a neurologically vulnerable window) to 30 minutes of fetal ultrasound and assessed the pups’ behavior at 3 weeks of age. They found that the exposed pups were significantly less interested in social interactions and had significant levels of behavioral hyperactivity, in the presence of an unfamiliar mouse.

Why did ultrasounds become routine?

Today’s children have been exposed to an unprecedented level of ultrasound technology, both in frequency and intensity. In 2001, 67% of pregnant women had at least 1 ultrasound, and in 2009, that percentage jumped to 99.8% with an average of 3 per woman. What accounts for this increase? Do we have evidence to suggest that this intervention is saving lives, changing outcomes, and that it is safe? What about safety in the settings it is applied most frequently, such as advanced maternal age, metabolic syndromes, and complications? Could these higher risk pregnancies represent a category of fetus that is more vulnerable to potential side effects of an intervention like ultrasound?

It appears that, answers to these questions remain elusive despite widespread application for the following conventionally accepted reasons:

  •     Gender determination
  •     Screening for anomalies
  •     Assessment of size/fluid level
  •     Visualization for bonding/curiosity/entertainment
  •     Assessment of placental position

As one survey concluded,

“Women appear to want sonograms for reasons that may not assist their provider with immediate clinical decision making. This is a potentially important disagreement between cost-saving and patient satisfaction that maternity care providers must consider when deciding whether to perform prenatal sonography for women with low-risk pregnancies.”

In other words, women are lured into the prospect of reassurance and information about an uncertainty-laden bodily experience, and providers may cater to that desire in neglect of accumulating concerns, lack of benefit, and conflict around financial gains ($86-102/scan).

Are they safe and effective?

[Continue reading Perils of Peeking Into the Womb: Ultrasound Risks]