Tech helps moms to be
Expert says some tools, tests are more accurate than othersJanuary 18th, 2018
Even as the future of health care remains uncertain, the industry continues to develop technology designed to make managing health easier.
While it might seem like there’s a new phone app or do-it-yourself test for everything, Dr. Lacey Marks, an OB-GYN and the section head of MultiCare Rockwood’s OB-GYN & Midwifery Center, says some of those technologies already are making a difference, particularly in the area of women’s reproductive health.
“Many of these tests and technologies are still new, so it’s still important to discuss them with your provider,” she says. “But it’s good to see women becoming more aware of their options and choosing to be proactive about their health.”
Originally from Massachusetts, Marks has been a part of MultiCare Rockwood’s all-female OB-GYN team, which includes five physicians, two nurse practitioners, and seven midwives, for three years now.
“We’re one of the only all-female teams here in Spokane and offer a unique model that allows patients to choose the birth tract that’s right for them,” she says.
MultiCare Rockwood’s OB-GYN & Midwifery Center offers a range of services including preconception counseling, infection screening and treatment, women’s wellness, and annual gynecological exams, as well as prenatal, labor, delivery and postpartum care.
Marks says her practice also performs about 600 deliveries annually at Deaconess MultiCare Birth Center, which is about 43 percent of the estimated 1,400 deliveries that take place at Deaconess Hospital each year.
Marks says she spends the majority of her time seeing patients at the department’s offices on the third floor of the Deaconess Health & Education Center, at 910 W. Fifth.
“Practically all of my patients now use phone apps for tracking their menstrual cycle or ovulation window,” she says. “Many are also very interested in prenatal testing and carrier screenings that can test for genetic conditions that may affect their baby.”
Although new technology and testing options can be exciting, Marks says she and her colleagues caution patients against relying too heavily on their accuracy.
“We routinely recommend that patients who are trying to get pregnant track their menstrual calendar, basal body temperature, and ovulation using a home urine kit,” she says. “We make those recommendations because those tests are well researched, and have documented reliable results.”
While phone apps can make it easy to chart some of that same data, Marks says they’re not always as accurate when it comes to interpreting it.
“The trouble with apps is they rarely show you what formula they’re using to determine a woman’s fertile period, and don’t always account for individual conditions that limit fertility,” she says.
Because apps can be unreliable, Marks says women should check in with their physicians, who can confirm those factors using accurate tests.
In addition to phone apps, Marks says there are many tests patients can buy and use themselves including at-home kits that test for fertility and sexually transmitted infections, and even a do-it-yourself Pap smear kit.
However, Marks says she views most of those tests as tools for capturing the small percentage of anxious patients who, for whatever reason, are reluctant to visit a doctor about reproductive care.
“A home test is better than nothing,” she says. “But if you get a positive result, you really need to see your physician to confirm it and get treatment.”
Marks says home tests are also expensive and generally less reliable than those covered in a visit to your physician. Also, she says, results from home tests aren’t tracked by a public health department, which makes it harder for health officials to determine which populations are most affected and how successful various treatments are.
When it comes to do-it-yourself testing, Marks says one of the more popular products on the market today is a saliva-based genetic test kit created by California-based 23andMe Inc., a privately held personal genomics and biotechnology company.
Customers complete a kit and mail it to the company, which creates an online profile listing inherited traits and genetic disorder risks, as well as an ancestry-related component capable of tracing origins and matching a person with their blood relatives.
“Genetic test kits have been an exciting and interesting tool both for our patients and the general population,” Marks says. “However, it’s difficult to make a definitive conclusion based solely on genetic risk factors, and most physicians feel there’s still insufficient data to support the accuracy of those tests.”
Marks says many who complete such tests also don’t consider the consequences of allowing companies access to their health history.
“A lot of these tests still face concerns over how to keep information confidential,” she says. “Also, if you should turn out to be a carrier for a disease, it could affect your insurance rates and may make future tests necessary.”
Marks says for patients who are looking to find out their genetic history and risk of developing diseases or passing them on to their offspring, MultiCare Rockwood offers several testing options.
“Most of my patients are looking at carrier screenings and prenatal testing options,” she says. “We start with a discussion of family history and ethnicity, and based on that we can help patients choose which conditions they should test for.”
Marks says carrier screenings are usually done prior to or early in a pregnancy, and are used to determine whether you or your partner carry a genetic mutation that could cause a serious inherited disorder in your baby.
“If it’s determined that the mother is a carrier for a certain condition, we’ll then test the father and if both are carriers the couple may be advised to do prenatal testing for that disorder,” she says.
Marks says prenatal tests, which are conducted during a pregnancy, are used in actual diagnosis of chromosomal conditions and genetic disorders.
She says two of the more common prenatal diagnostic tests are chorionic villus sampling, a procedure that removes a small test sample of placenta tissue from the uterus, and amniocentesis, in which a sample of amniotic fluid surrounding a fetus is removed from the uterus.
Because both CVS and amniocentesis are invasive procedures that carry slight risks, Marks says more of her patients are asking about noninvasive prenatal testing.
“NIPT is the latest in prenatal screening, and uses a maternal DNA sample to determine risk for chromosomal conditions,” she says. “Some prefer to start with a NIPT because, unlike traditional screening, it’s capable of determining risk for basic conditions with 99.9 percent accuracy, which can eliminate the need for more invasive diagnostic tests.”
While the noninvasive test is highly accurate in determining risk, Marks says, in order to confirm whether the baby actually has a condition, the patient would need to take one of the more invasive diagnostic tests.
Marks says NIPT has been available for about eight years, but has only recently become popular as more insurance carriers opt to cover it.
“This test is approved and available for all women, but we especially recommend it for those of advanced maternal age,” she says.
Marks says MultiCare Rockwood offers patients both its carrier screening and prenatal testing options through California-based genetic testing company Natera Inc.
“Natera provides experts to discuss results, and Deaconess also has genetic counselors available to help patients understand their results,” she says.
In addition to carrier screening and prenatal testing, Marks says MultiCare also offers patients MyRisk, a genetic test for hereditary cancer.
“The MyRisk testing database is one of the largest of its kind,” she says. “They’re constantly adding to and comparing data, which helps to identify new genetic mutations and leads to advances in research and treatment.”
While most patients may think it’s better to know their risk of developing life-threatening disease, Marks says patients who are interested in testing also need to be prepared for the consequences of that knowledge.
“If they test positive, they have to be prepared for a lifetime of further testing and possibly preventative procedures,” she says.
Along with advancements in prenatal and genetic testing, Marks says other technologies are being developed that show potential for treating women’s health conditions.
Among them is a blood test being developed by San Francisco-based Dot Laboratories that’s designed to identify the presence of endometriosis, a painful disorder in which tissues that normally line the inside of the uterus grow outside of it instead.
Marks says there’s currently no cure for endometriosis, and no way to diagnose it without surgery.
“This test still needs a lot of research,” she says. “However, what makes it so exciting is that it would allow for diagnosis of the condition without the need for surgery.”
Another new technology that’s close to being approved for widespread use, Marks says, is a procedure called the Mona Lisa Touch, which is designed to help women suffering from vaginal atrophy brought on by menopause.
Marks says MultiCare is currently researching the possibility of offering the Mona Lisa Touch to patients here.
“This is another procedure that’s considered a nonsurgical treatment,” she says. “It also has the potential to be used to treat other conditions, so it’s exciting to be considering it.”