During the first trimester of pregnancy, it’s common for prenatal care providers to order a standard lab workup. As a loss parent, you may be nervous about these routine tests[1]“Routine Tests During Pregnancy,” American College of Obstetricians and Gynecologists (ACOG), June 2020, https://www.acog.org/womens-health/faqs/routine-tests-during-pregnancy, which can detect conditions that might put you or your baby at risk for complications. The good news is that most of these problems can be treated during pregnancy. That’s why it’s important to complete the testing in early pregnancy[2]“Prenatal Testing During Pregnancy,” Colleen de Bellefonds, What to Expect, March 5, 2019, https://www.whattoexpect.com/pregnancy/pregnancy-health/prenatal-testing/.

woman discussing tests with her doctor - routine tests done in early pregnancy

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While some tests are done with a blood draw, others use a urine sample. The staff at your provider’s office will often perform this round of lab work at your first prenatal appointment[3]“Prenatal Tests: First Trimester,” reviewed by Armando Fuentes, MD, Kids Health from Nemours, https://kidshealth.org/en/parents/tests-first-trimester.html. Depending on your medical history, this could be as early as six weeks or later in the first trimester.

So, what tests are involved in this routine lab work? What exactly is your provider looking for? Let’s dive in!

What Tests Will My Provider Order in Early Pregnancy?

Complete Blood Count (CBC)

This test counts the number of different types of cells that make up your blood. These include red blood cells, white blood cells, and platelets. Why is this information relevant? A lower than normal number of red blood cells might indicate anemia. In addition, your white blood cell count tells your care team how many disease-fighting cells are in your blood, and the number of platelets can reveal a blood clotting problem.

Blood Type and Rh Factor

Your medical team will document your blood type just in case you would need a blood transfusion — a rare occurrence during pregnancy, birth, and postpartum. The Rh factor is a protein that can be found on the surface of red blood cells. When your blood cells have this protein, you are Rh positive. Without the protein, you are considered Rh negative.

If an expectant parent is Rh negative and the baby is Rh positive, the parent’s body can make antibodies against the Rh factor, causing damage to the fetus’s red blood cells. This incompatibility occurs in about 15 percent of pregnancies and is more likely to cause problems during subsequent pregnancies, not a first pregnancy. It can be dangerous if not detected but is completely treatable with medication that prevents antibodies.

HCG Blood Test

Human Chorionic Gonadotropin (HCG), often called the pregnancy hormone, begins forming in the body after a fertilized egg implants in the uterus. An at-home pregnancy test is a qualitative urine test, meaning it simply detects whether HCG is present. Your healthcare provider may order a quantitative HCG blood test, which measures exactly how much of the hormone is in your body[4]“What is HCG?” American Pregnancy Association, https://americanpregnancy.org/getting-pregnant/hcg-levels-71048/. It’s important to note that your care team may not order this lab work, which is also normal. However, it is more common for providers to request this test for patients who’ve experienced loss, especially multiple losses.

A single quantitative HCG blood test does not mean much, so your provider will have you repeat the HCG test about 48 hours after the first one. In most viable pregnancies, the number will double every 48-72 hours in the early weeks. The further along you are, doubling time lengthens to about 96 hours. At around 8-11 weeks’ gestation, HCG levels off. If your provider is concerned with your HCG results, he or she will likely order an ultrasound, which is a more accurate way of diagnosing a problem. In other words, don’t make too much out of HCG levels alone.

Urinalysis

Urine tests are common at most prenatal appointments, but the first one in early pregnancy gives your provider a baseline for important measurements. They will be looking for the following.

Red or white blood cells. These can indicate a urinary tract infection (UTI). A urine culture will typically show if there are bacteria, another sign of a UTI. Even if you don’t have symptoms, your provider may prescribe an antibiotic.
Glucose. High levels of blood sugar can be a sign of type 2 diabetes or a warning sign of gestational diabetes (GD) later in pregnancy. (You will be screened for GD in the second trimester.)
Protein. Your protein level can be compared to levels in the second and third trimesters. High protein levels may signal preeclampsia, or pregnancy-induced high blood pressure. It’s a serious complication that can happen later in pregnancy or after the baby is born.

Rubella Testing

Sometimes called German measles, rubella can lead to birth defects if the infection is present during pregnancy. A blood test will show if you have had the disease or been vaccinated against it. In both cases, you are immune to rubella. If your test reveals you’re not immune, you should avoid contact with anyone who has the disease. Because of the high vaccination rate, rubella is rare in the United States, but the disease is easily spread. The measles-mumps-rubella (MMR) vaccine is not recommended during pregnancy, but you can get the immunization after your baby is born.

Hepatitis Testing

Hepatitis is a virus that infects the liver. Expectant parents who have hepatitis B or C can pass the virus to their unborn baby. Most prenatal testing includes hepatitis B, and anyone who has risk factors may be tested for hepatitis C. Being infected with hepatitis B or C may require some special care during pregnancy. Soon after birth, the baby will receive the hepatitis B vaccine, and you can still breastfeed if you choose even if you are infected.

Testing for Sexually Transmitted Infections

Standard prenatal testing for sexually transmitted infections (STIs) includes syphilis, chlamydia, HIV, and sometimes gonorrhea. This is important because STIs can cause complications for you and your unborn baby. If you are infected with an STI, you and your sexual partner will have treatment options, and you will likely be tested again to determine if the treatment has worked. While HIV cannot be eliminated, medication can greatly reduce the chance of the virus being passed to your baby.

Takeaways About Routine Tests in Early Pregnancy

While prenatal testing can sometimes be nerve-wracking for loss parents, it’s an important step in monitoring your health and the health of your baby. Be open with your provider if you have fears or anxieties about certain tests and ask your care team to be considerate of those concerns.

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