More on HCG

I finally heard back from my midwife today! Talking with her made me feel a lot better.

First, she explained to me about the fetus's risk for chromosomal abnormalities. She told me that the risk for Down Syndrome baby in a woman my age is normally 1 in 620. After my screen, it went way down to 1 in 3500. She then discussed the risk for Trisomy 18. She said the likelihood of a woman my age giving birth to a baby with Trisomy 18 is 1 in 2200. After my screen, my risk dropped to 1 in 10,000. She told me that the results from my screen are very reassuring, and my risk is very, very low.

She then went on to talk about the HCG. She explained that HCG is very important for at-risk women in the first trimester. It can indicate if a pregnancy is progressing well, if a woman at-risk for a miscarriage might miscarry (in the case of low HCG). She said it can indicate a molar pregnancy (in the case of high HCG). She then went on to say that I'm in the second trimester (well, almost), and she said that monitoring HCG is not really important any more. Kate said she doesn't know the exact statistic, but she'd estimate that about 10-20% of women have elevated HCG. Basically, she said, it's not a rare condition that causes a lot of alarm.

At this point, she said, we're not really worried about what caused the HCG, and the cause is unknown. She said we're now worried about the potential side effects from the high HCG. She told me that the place I went to for my screen, Obsentrix, deals with high-risk women all the time. She said they handle women who are pregnant with triplets and quadruplets, and she said they really know their stuff. She didn't call them experts exactly, but it seemed implied. Kate said she would never tell anyone to ignore their advice. She added that baby aspirin poses little risk to a pregnant woman, and they want me to take it to reduce my risk for high blood pressure. She said that research has shown that women who have pre-eclampsia often have high HCG in their second-trimester screen. She said they want to reduce my risk for hypertension later in the pregnancy and during delivery. She went on to say that the research is mostly on women who start the baby aspirin early in the first trimester. Apparently, women who are at-risk for the condition (based on past pregnancies) are often put on baby aspirin from the moment they know they're pregnant. Kate told me that there's not a lot of information out there on women who start baby aspirin during the second trimester, but she said she'd try to find an article on the subject for me.

I told Kate I was reluctant to take baby aspirin to reduce my risk for hypertension because aspirin can be so dangerous to the fetus and placenta. It's true that my blood pressure rose during my last pregnancy (my systolic went from under 100 to close to 140 during the second trimester but then dropped off again during the third), but I have very low, stable blood pressure right now and have a fairly healthy diet and lifestyle. I made a mental note at that moment to sign up for prenatal yoga classes, too. She told me that I am an adult and should be able to make that decision myself. She told me it's her job to arm me with information and then let me choose what is best for me. She said if this was absolutely vital for my health, she would tell me so. She said this isn't one of those recommendations that is an absolute must.

I'm so glad she said that. Sometimes, I feel like doctors give you their medical opinion and then treat it as the only option. In those situations, it's frustrating to not be able to have an opinion or a voice in the decision-making. I feel good to know that the baby aspirin is recommended to me as a preventative measure to help ensure my good health, but it isn't absolutely vital. There's a chance I'll kick myself later if I develop high blood pressure, but at least I'll know it was my choice.

Elevated HCG

I received a call back from the place at Swedish Hospital that did my ultrasound and screening last week. Most of what I was told was reassuring. The likelihood that our fetus has Down Syndrome is 1 in 3500, and the likelihood that our fetus has Trisomy 18 is 1 in 10,000. Both of these are very low risk, so my screening is over.

The nurse practitioner then told me that I have elevated HCG levels. HCG is the hormone your placenta releases, and it's what is tested for in those at-home pregnancy tests. High HCG levels can indicate many things that we know I don't have, such as twins/multiples, an ectopic pregnancy, or a molar pregnancy. I later read it can be an indicator for things like ovarian cancer (in non-pregnant women) or even Downs Syndrome. It can also (supposedly) cause pre-term delivery, low birth weight, and even still birth. Finally, it can also just be a normal pregnancy.

It's unnerving to hear that something is abnormal in a pregnancy, even if it doesn't seem to be anything dangerous. She said my levels were at 3.22, when the highest normal range is 2.88. She said it's not really a level that is very worrisome. She said it calls for extra ultrasounds to make sure the fetus continues to grow normally and that the placenta is OK. She then added that they recommend a take a baby aspirin at night because they found a baby aspirin helps the placenta work properly (and high HCG can be indicative of the placenta working too hard/inadequately).

I don't want to take a baby aspirin every night. I want the baby to be healthy, most definitely. However, aspirin is a big no-no in pregnancy. It can lead to growth problems in the fetus, bleeding problems in the mother, and problems with the placenta (including a detached placenta that can lead to the death of both the mother and baby). The nurse practitioner assured me that the levels of a baby aspirin are low enough that it's safe to take, but I can't find much information that says a baby aspirin helps the placenta. I read that it can help if a doctor suspects blood clots in the placenta. Conversely, I keep reading (everywhere) that a woman should never take aspirin, especially during the third trimester. It makes me so reluctant to take it. I was honest with the nurse practitioner, and I told her so. She said she understands my concerns and recommends I talk to my midwife (from whom I'm currently waiting for a call back).

I read that an abnormal HCG reading can also be a fluke. I read it should be tested again, so I think I'm going to ask my midwife to run that test one more time. I think that's a reasonable place to begin. I also am not entirely convinced that she hadn't run it previously. If she had, the levels were normal because all my blood work has come back normal until now. I'm just not sure if the HCG was ever run before this. I'm hoping that the results will come back normal. At this point, I'm nearly 13 weeks pregnant (according to the ultrasound, I already am 13 weeks pregnant), so the HCG levels should start declining naturally.

The thing is, I know that this news isn't that big of a deal. I know the nurse practitioner was trying to tell me it's really probably not anything at all. But, still, as a pregnant woman, I can't get my mind off of the fact that something isn't exactly perfect with the pregnancy, and I hate that. I'm hoping I'll have some good news to share soon.