Never underestimate the power of an expectant mother's love -- or worry.
Even though clinicians agree that routine pregnancies don't warrant ultrasound exams, nearly all women expect the tests and are willing to pay for them -- regardless of medical need, according to researchers at the University of Michigan School of Medicine in Ann Arbor.
Their findings, presented at the Radiological Society of North America annual meeting last week in Chicago, underscore the difficulty healthcare systems and managed-care organizations have in making medically based practice guidelines stick.
"Pregnancy is a very emotionally challenging condition," said Ella Kazerooni, M.D., a radiologist at the University of Michigan. And despite solid scientific evidence that ultrasound results won't influence birth outcomes for the vast majority of pregnancies, most women say an ultrasound picture would help them "worry less."
More than 95% of the 318 women surveyed at the first doctor visits of their pregnancies said having an ultrasound was very important to making sure their babies are healthy. Nearly 97% expected an ultrasound, and 44% were willing to pay at least $200 for the exam, Kazerooni's research showed. In fact, almost two-thirds of women disagreed with the statement that an ultrasound should only be performed if there is reason to believe something is wrong with their pregnancies.
Maybe that's because nonmedical reasons also weigh heavily on the minds of mothers to be. About 60% of women wanted an ultrasound just to see their babies and to determine whether they are boys or girls, the study showed.
But patients' preferences mean big dollars are spent for medically unnecessary tests. Charges for ultrasound studies range from about $200 to $400, according to the researchers. And there are millions of such exams performed each year, said Robert Bree, M.D., a radiology professor at University of Michigan and a co-author of the study.
Some health plans decline to cover the diagnostic test for low-risk pregnancies, while others fearful of alienating members pay anyway, the researchers said. One possible solution would be a patient copayment for elective ultrasounds, an option Kazerooni's study suggests would be palatable to many women.
Ironically, only 1% to 2% of ultrasound screening exams pick up abnormalities, while the incidence at birth runs between 5% and 6%, Bree said. In addition, results on ultrasound that would heighten a women's anxiety can sometimes turn out to be clinically insignificant or nonexistent upon further testing.
Kazerooni is planning to study whether patient education can reduce ultrasound utilization. But she's not optimistic.
Two-thirds to three-quarters of pregnant women probably would have an ultrasound even after aggressive education, she estimates.
A case in point: Kazerooni herself. Pregnant at the start of the study, she had an ultrasound despite an absence of risk factors. "It's that emotional," she said.