NIPT, migraines, and preventing tears

Welcome to the weekly ZIP - your Zenith Informed Pregnancy!

Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research. 

This week's top pregnancy questions:

1️⃣ Is it normal to get migraines during pregnancy? What can I do for them?

2️⃣ Understanding my options for NIPT?

3️⃣ What can I do before or during labor to improve my odds of not tearing?

Is it normal to get migraines during pregnancy? What can I do for them?

Bad headaches and migraines can show up or change during pregnancy, sometimes even for the first time. Here’s what’s considered normal, why they can be triggered, and evidence-backed options for relief. 

📚The tl;dr from the evidence: Especially in the first trimester, migraine and headache can absolutely be a normal pregnancy symptom. Why? One basic reason is that common migraine triggers happen to be heightened or more common during pregnancy - from stress, poor sleep, dehydration, nausea or missed meals - leading to the onset of migraine. It sounds simple, but focusing on these areas can make a big difference in managing and preventing pregnancy migraines. 

There are a number of medications commonly used to treat migraine, depending on your circumstances and where you are in your pregnancy. Tylenol is commonly used as a first-line treatment, and sometimes along with caffeine (within the 200mg/day daily suggested limit) which can help with migraine pain. If stronger relief is needed, anti-nausea medication like metoclopramide is considered an option, as is sumatriptan, but all medications are suggested to be managed at the lowest effective dose and under the guidance of your provider. 

There are some instances where a migraine requires urgent attention, and is not a normal/common symptom – where your  headache might be a result of another more serious condition or complication. The keys to look out for here are headache(s) that: feel different from the usual pattern, are very sudden and severe, brings vision changes, confusion, or new weakness/numbness. Severe headache accompanying other symptoms like high blood pressure, hand/face swelling, or shortness of breath is also worth immediate attention. If you experience these, reach out to your doctor right away to get checked and treated appropriately. 

👀 Read Penny’s full summary of the evidence for more on migraines & relief

Understanding my options for NIPT?

NIPT, or NonInvasive Prenatal Testing, is an important and effective tool in prenatal care, but can (understandably!) be the source of a lot of anxiety. What will the results be? How accurate is it really? What’s “fetal fraction”? What questions to ask and what to expect? Here’s a breakdown on what it’s best for, its limitations, and how you can prepare. 

📚The tl;dr from the evidence:  NIPT is a blood test done as early as ~10 weeks of pregnancy, and importantly - is a screening test, not a diagnostic test. It is designed to estimate the chance of certain chromosomal conditions in your pregnancy, and is best at screening for the common trisomies – genetic conditions characterized with an extra copy of a chromosome. 

The standard NIPT focuses on trisomy 21 (Down syndrome)/18/13, and is where the performance/accuracy is best validated. There are additional tests available, such as NIPT with sex chromosome screening or “Expanded” NIPT which can include more rare autosomal trisomies or other abnormalities. It can be helpful to talk through the different options with your OB or a genetic counselor before NIPT, as there are pros and cons depending on your specific situation and goals with some of the additional / expanded screening options. 

Results are presented as “high chance” or “low chance,” indicating the likelihood of trisomy 21/18/13 in the baby – or in some cases, a “no-call” result which can be a result of low fetal fraction. Fetal fraction refers to the amount of pregnancy-derived DNA in the blood, and low fetal fraction means that the amount in the blood sample is too small to confidently interpret the result. This can be a result of a few different factors - but commonly, testing too early, as fetal fraction rises as pregnancy progresses.

A “high chance” result means the risk is higher than average, but it’s not a diagnosis - so the next steps include further diagnostic testing, with procedures like amniocentesis or CVS (Chorionic Villus Sampling). Similarly, “low chance” greatly reduces the chance of a chromosomal abnormality, but can’t guarantee a “healthy” baby, especially as there are many conditions the NIPT doesn’t screen for. Combining NIPT with ultrasound is often recommended, as ultrasound can detect structural issues that the NIPT wouldn’t identify. 

And finally, a reminder - while it can feel scary to wait on results, the vast majority of pregnancies screened are low chance. Your doctor and care team are there for you to help you prepare emotionally, and support you through the results and next steps from your NIPT results.

👀 Read Penny’s full summary of the evidence for more on NIPT

What can I do before or during labor to improve my odds of not tearing?

Tearing during childbirth is one of the most widely held fears about the birth experience - so it makes sense that any proactive ways to prepare and minimize the chances of a tear are hot topics. There are tons of Reddit threads and Instagram reels out there sharing “the one thing I did to have a natural birth with no tearing!”.... so which, if any, of these promises are backed by research?

📚The tl;dr from the evidence:  Unfortunately, nothing can guarantee no tearing during birth – some level of tearing is fairly common, particularly in first pregnancies. However, some approaches - both prior to labor, and during labor - can decrease the risk of severe tearing. 

In late pregnancy, perineal massage (starting anywhere from 34-36 weeks) has been shown to slightly reduce the risk of perineal injury during birth. The impact is real, but modest - so not a guarantee, but something you can try that’s within your control as you prepare for birth. 

During labor, research does not show a clear or consistent “best” position for tear prevention; while the evidence is not conclusive, some observational studies have demonstrated potential benefit to side-lying positions, and some data suggests that squatting/stool positions may be linked with more tearing. Additionally, perineal massage during the pushing stage has been linked with fewer severe tears, as has warm compresses on the perineum while pushing. 

Before labor begins, it’s a good idea to discuss what flexibility you’ll have to try different birthing positions or labor interventions with your care team, so you can understand what will be available to you given the other aspects of your birth (pain management plan, fetal monitoring plan, etc). 

👀 Read Penny’s full summary of the evidence for more on tear prevention

🤓 Zenith's top read of the week

Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!

Stopping Antidepressants During Pregnancy Can Be a Health Risk, Research Shows (Christina Caron, The New York Times) - Often, the risk of medication use during pregnancy is framed specifically around the potential of the exposure to harm the developing baby – but this framing misses a critical question, which is: what is the risk of stopping the medication?

This recent NYT coverage highlights new (although not yet peer reviewed/published) data coming out of the annual Society for Maternal-Fetal Medicine conference last week, and the insight is powerful – stopping SSRI use during pregnancy may be more harmful than continuing it. The researchers found that women who stopped the medication were about twice as likely to experience a mental health emergency during pregnancy, as compared to counterparts who continued the medication. 

We eagerly await the publication of the full study, and it’s exciting to see researchers look into the equally-important questions of risk introduced by stopping a medication, not just the risk of the medication exposure. More studies like this, for SSRIs and other classes of medications, can help moms and care teams have more informed discussions and decisions about medication continuation during pregnancy.

Key excerpt:

“The data, which has not yet been peer-reviewed, showed that a majority of women stopped taking their antidepressants during pregnancy. Those who discontinued their medication had, in total, over 500 more emergency department visits for behavioral health reasons than those who kept taking the drugs….

An estimated 10 to 20 percent of women in the United States experience depressive symptoms during pregnancy. And many of them receive conflicting information, often from medical providers or social media, about the safety of using antidepressants while trying to conceive or while pregnant.”