Medicine: Do All Babies Need Sonograms?

IN THIS AGE OF ELECTRONIC medicine, no family scrapbook is complete without a portrait of the child as a gestating fetus. Most American women receive at least one ultrasound exam, or sonogam, during pregnancy. By bouncing sound waves off the fetus, the $200 test creates an image that can reveal defects, enabling a doctor to attempt treatment or induce an abortion. But does routine ultrasound testing yield healthier babies in low-risk pregnancies? Researchers from several states recently conducted a huge experiment to find out. The answer, published in last week's New England Journal of Medicine, is a resounding no.

The researchers, led by Dr. Bernard Ewigman of the University of Missouri Medical School, divided 15,000 healthy pregnant women into two groups. One group automatically received two sonograms (one at 15 to 22 weeks and another at 31 to 35 weeks), while the second group skipped the test unless problems arose. Routine sonography did a good job of spotting major congenital defects. But most of the defects came to light at least 24 weeks into a pregnancy--when abortion was no longer an option--and women who got earlier warning often chose to deliver their babies anyway. Some women did decide to abort unhealthy fetuses, but a sonogram was rarely the first sign of trouble. Because a standard maternal blood test known as AFP often detects fetal abnormalities, abortion rates were the same for both groups. And at birth, babies who got routine sonography were no healthier than those who didn't.

The obvious implication is that the practice wastes money--about $500 million a year, by the researchers' conservative estimate. Don't expect doctors (or patients) to give it up willingly, expert panels have been advising against routine ultrasound screening since 1984. But as policy-makers try to tame the nation's health-care budget, $200 baby Pictures may be one of the first small luxuries to go.

© 1993