Prenatal tests make doctors and labs money. Of course they also have diagnostic value, but I think the bottom line is profit.

A friend in Tokyo who was pregnant with her first child saw prenatal testing pamphlets in her doctor’s waiting room. Because the pamphlets were not particularly helpful given that they were a commercial tool aimed at selling the tests rather than providing unbiased information, she decided to ask her doctor. Her doctor told her that the tests were available and she could have them if she wanted. He offered her no additional guidance. He also made no attempt to reassure her that her risk of having a child with abnormalities was low because she was not over the advanced maternal age of 35. Good thing she’s friends with me and is also internet savvy so she could look up the information she needed.

Today, another friend was over with her 17-month-old daughter. She is pregnant with her second child and had received worrying results from her triple screen maternal blood test. Her doctor recommended that she follow-up with an amniocentesis so she’s travelling to Singapore on Sunday to get one. She was offered prenatal testing for her first pregnancy when she was only 29 years old and again this time at 31.

What I would do in her situation? I think that I would probably have refused prenatal testing in the first place. If I am over 35 during my second pregnancy (which is highly possible), I’m still not sure I would agree to be tested. The false positive rates of the triple screen blood test and other prenatal tests are very high–5-7% will get an abnormal triple screen result and of these, only 1-2% will actually have a baby with Down syndrome. And following up an abnormal result with an amniocentesis would expose me to the risk of miscarrying what might be a perfectly healthy fetus.

It’s a slippery slope, though. A seemingly more benign form of prenatal testing is the ultrasound. At my private clinic in Japan, every prenatal visit involved an ultrasound. I think I had about 16 ultrasounds during the course of my pregnancy. Maybe I should have avoided them completely because some would argue that the effects of ultrasounds on the growing fetus are not well documented or understood.

Balancing between the need to know and the realization that maybe we can’t do anything even if we knew is overwhelming. I’m glad that I don’t have to make this kind of decision today. I hope my friend won’t have to make a decision next week in Singapore either.