World Meta Studies on Ultrasound in Pregnancy

There so many discussions concerning pros and cons caused by ultrasound within pregnancy for the health of MotherBabies. The expert of our project, Hon Chair of the Association for Improvements in the Maternity Services (AIMS) for 40 years and formerly the Fellow of the Royal Society of Medicine; lay member of the Nursing and Midwifery Council; National Transformation Council, Beverley Ann Lawrence Beech (UK), an author of numerous books and articles about maternity care (incl. 'Am I Allowed?' and 'Ultrasound Unsound?') discloses crucial facts about ultrasound in pregnancy,

“Jean Robinson and I have been concerned for decades about the proliferation of ultrasound, the latest research from China, reviewed by Jim West in his bibliography ’50 Human Studies in utero, conducted in modern China’, increased our concern. As a result, we have written to the Minister of Health, Matt Hancock MP, pointing out some of the risks and asking for parents to be informed and for the long-term risks of ultrasound to be investigated.”

The Letter, comments of the experts from the UK (Michel Odent), South Africa(Marianne Littlejohn), Israel (Grigori Brekhman), and Ukraine (Valentina Ostrogliad) are stated bellow.

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Rt Hon Matt Hancock MP
Minister of Department of Health
London
29th March, 2019

Dear Minister,

Ultrasound Unsound

We are writing to draw your attention to research concerning ultrasound safety conducted by Chinese researchers and reviewed by Jim West in his Bibliography ’50 Human Studies indicate Extreme Risk Prenatal Ultrasound a New Bibliography’.

In October 1982 Jean Robinson and I wrote to the then Minister of Health – Dr Gerard Vaughan – telling him of our concern about the widespread use of ultrasound before it had been evaluated. To our astonishment, he replied that the Medical Research Council had considered the possibility of a trial to assess potential benefits and hazards of using ultrasound in pregnancy in 1976 and had rejected it stating:

"In the four years since then, the use of ultrasonic techniques have [sic] become so widespread that a controlled trial along the lines originally proposed would no longer be ethically possible.”

It was, apparently, “ethically possible” to expose almost every unborn child in the United Kingdom to a procedure whose safety had not been evaluated – and is still not properly evaluated more than forty years later.

In 1985, we were pressing the Department again. We told the Minister of our continued concern that there was still no evidence that routine ultrasound was medically effective, cost effective, and did not cause long-term damage. By now, the RCOG had published their report on “Routine Ultrasound Examination in Pregnancy” and we prepared a detailed critique of it for the Association for Improvements in the Maternity Services (Beech B et al., 1985). We said it was unscientific in its approach and it had been very selective in the research papers, which were quoted. Our criticisms were validated by the British Journal of Obstetrics and Gynaecology (May 1985) which said that “the scientific analysis did not show rigor which normally would be expected of its scientific committee.” When our criticisms were reported in the “New Scientist” (17th May 1984) Professor Stuart Campbell dismissed them saying “they show how desperate they are to cause trouble.”

Over the years numerous animal studies have suggested possible hazards of ultrasound, the following is a small selection:

• Alterations in baby monkeys’ behaviour (Tarental AF et al., 1993).
• A small but statistically significant number of neurons failing to acquire their proper position and remain scattered within inappropriate cortical layers and/or in the subjacent white matter (Ang ES et al., 2006).
• Short, intermediate and long-term memory impaired in chicks exposed to ultrasound before hatching (Scheider-Kolsky et al. (2009).
• Alterations and changes in bone mineral density (Md Dom S., 2012).
• Mice exposed to diagnostic ultrasound in utero are less social and more active in social situations relative to controls (McClintic AM, 2013).

The animal studies have been consistently ignored or dismissed as not relevant to human babies.

It was not until women began to purchase ‘Keepsake or Souvenir Videos’ that the medical profession issued a warning, but their words were carefully chosen:

• “B-mode ultrasound used for clinical reasons from conception to 10 weeks of gestation is safe and the benefits outweigh any theoretical risks. We are adopting a precautionary approach and are highlighting the small but possible risks to women so that they can make informed choices.
• We also emphasise that any healthcare professional involved in the use of ultrasound is aware of the safety principles of ultrasound.” (Dr Sadaf Ghaem-Maghami, Chair of the RCOG’s Scientific Advisory Committee, 3 Mar 2015).

In 1985 the FDA regulation limited ultrasound exposure to 46 mW/cm2 spatial peak intensity, but in 1992 increased this to a possible limit of 720 mW/cm2, a fifteen times increase in output by ultrasound devices that incorporate an approved real-time output display in their design. (Miller D, 2008).

Unfortunately, the research shows that many healthcare professionals are not aware of the restrictions that should be in place. A questionnaire to doctors, sonographers and midwives found that only one third understood mechanical and thermal safety indices, fewer than a third understood where to find the safety indices on the screen and just over one in five (22%) knew how to adjust the energy output on their machine (Salvesen K, 2011).

Indeed, recent headline news informed us of new “beautiful” 3D images of foetuses in utero which can now be produced through ultrasound imaging and MRI scanning techniques. Although ostensibly developed to help plan for babies with heart defects; the news programmes described “amazing images”, as they showed the vulnerable foetus exposed to intense ultrasound exposure. Nowhere in the Radio 4 broadcast or the Ten o’clock News was there any mention of safety.

Jim West in his bibliography of 50 human studies undertaken by Chinese researchers highlights the findings from research papers involving 2,651 women. Because of China’s one baby policy many babies were aborted, but the Chinese researchers obtained agreement from the mothers to expose their babies to varying amounts and duration of ultrasound and then conduct examination of the babies’ brains post abortion. After the abortions the babies’ brains, kidneys, eyes or chorioamnion tissue were examined and electron microscopes used to visualise sub-cellular damage. The results are of considerable concern. It is clear from the research that the ultrasound exposure significantly affects the brain structure. Because there has been no research examining the long-term effects of ultrasound, one can only speculate on the long term effects.

These studies would not have come to light were it not for the efforts of Jim West whose book ‘Diagnostic Ultrasound: A New Bibliography, Human Studies Conducted in Modern China’ reveals the evidence, and Sarah Pope whose article in ‘The Healthy Home Economist’ revealed the findings.

In 2000, Professor Ruo Feng, of the Institute of Acoustics, Nanjing University, recommended the following action:

1. Ultrasound should only be used for specific medical indications.
2. Ultrasound, if used, should strictly adhere to the smallest dose principle that is the ultrasonic dose should be limited to that which achieves the necessary diagnostic information under the principle of using intensity as small as possible, the irradiation time as short as possible.
3. Commercial or educational fetal ultrasound imaging should be strictly eliminated. Ultrasound for the identification of fetal sex and fetal entertainment imaging should be strictly eliminated.
4. For the best early pregnancy [1st trimester], avoid ultrasound. If unavoidable, minimize ultrasound. Even later, during the 2nd or 3rd trimester, limited ultrasound to 3 to 5 minutes for sensitive areas, e.g. fetal brain, eyes, spinal cord, heart and other parts.
5. For every physician engaged in clinical ultrasound training, their training should include information on the biological effects of ultrasound and ultrasound diagnostic dose safety knowledge. (quoted in West J, 2015)

While acknowledging that ultrasound can be of value in specific instances we believe that women should be alerted to the risks so that they can make properly informed decisions about whether or not to expose their baby in utero and the long-term effects of ultrasound exposure should be investigated.

We look forward to hearing what action you intend taking.
Yours sincerely
Beverley A Lawrence Beech                                                  Jean Robinson

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The comment of Dr Michel Odent (UK), Ob/Gyn, public figure, researcher,

“Policy makers can only take into account human epidemiological studies. They cannot consider, for example, animal experiments and anatomical studies of aborted foetuses. The conclusions of such studies may be radically different from the conclusions of human epidemiological studies. Since 1986, I collect valuable epidemiological studies in our database. Go to primalhealthresearch.com. Click on “keywords”. Select the keyword “Ultrasound scan”. You'll find about 10 valuable studies.”

Here beneath (Table 1) there are 7 valuable examples (from USA, Sweden, Norway, Australia, UK), including a randomized controlled trial with a 20 year follow-up, where only US research demonstrates the correlation between the autism evolvement (ASD) and the first trimester ultrasound. Other studies (Table 1) deny the correlation between ultrasound in pregnancy and growth and development (body weight or height, speech, deficits in attention, motor control, behaviour, etc.) in childhood, and childhood cancer.

Table 1. Primal Health Databank Entry on Ultrasound Scanning in Pregnancy (primalhealthresearch.com)

No	Title	Author(s)	Place of Study	Abstract
1	Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound.	Webb S, Garrison MM, et al	USA	In a retrospective study of a national sample of children with ASD, the researchers looked for a possible relationship between the severity of ASD symptoms and ultrasound exposure during the first trimester of pregnancy in offspring with a genetic predisposition to ASD. The sample included 1749 children with ASD for whom genetic information on the presence or absence of copy number variants (CNVs) was available. CNVs represent a specific class of genetic defect that has been associated with ASD and other neurodevelopmental disorders. For the group as a whole, exposure to first-trimester ultrasound, in comparison with no exposure, was related to lower observed social affective symptoms but greater parent-reported restrictive and repetitive behaviors, the authors report. For the 133 children with ASD in whom CNVs had been identified, exposure to first-trimester ultrasound was related to statistically significantly lower nonverbal IQ in comparison with no exposure. There were also trends toward more impaired adaptive behaviors, as reflected in parent report, and trends toward increased observed repetitive behaviors.
2	Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age: follow-up of a randomised controlled trial	Newnham JP, Doherty DA, Kendall GE, Zubrick SR, Landau LL, Stanley FJ	Australia	The aim of this study was to investigate the possible effects of multiple prenatal ultrasound scans on growth and development in childhood. Physical and developmental assessments were done on children whose pregnant mothers had been allocated at random to a protocol of five studies of ultrasound imaging and umbilical artery Doppler flow velocity waveform between 18 and 38 weeks’ gestation (intensive group n=1490) or a single imaging study at 18 weeks’ gestation (regular group n=1477). Examinations were done at 1, 2, 3, 5, and 8 years of age on children born without congenital abnormalities and from singleton pregnancies. The follow-up rate at 1 year was 85% (2310/2714) and at 8 years was 75% (2042/2714). By 1 year of age and thereafter, physical sizes were similar in the two groups. There were no significant differences indicating deleterious effects of multiple ultrasound studies at any age as measured by standard tests of childhood speech, language, behaviour, and neurological development.
3	Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing	Kieler H, Haglund B, et al.	Sweden	This is a follow-up of 3265  8-9 year old children born to women who participated in a randomised controlled trial of ultrasound during pregnancy. No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children, or between exposed and un-exposed children were found.
4	Does prenatal sonography affect intellectual performance?	Kieler H, Haglund B, Cnattingius S, Palmgren J, Axelsson O	Sweden	To assess a possible association between prenatal ultrasound and intellectual performance, the authors studied men born in Sweden from 1973 to 1978 who enrolled for military service from 1991 to 1996. There were 7999 eligible men born in a hospital (Malmo) that included ultrasound scanning in standard antenatal care (exposed) and 197,829 men born in hospitals without ultrasound scanning programs (unexposed). The authors found lower intellectual performance scores (mean difference = -0.16; 95% confidence interval = -0.21 to -0.11) and an increased risk of subnormal performance (odds ratio = 1.28; CI = 1.18 to 1.38) among ultrasound-exposed compared with unexposed. However, men born in Malmo before scanning was introduced also had lower scores, and the decrease in test scores after the introduction of ultrasound was small. Moreover, there were no differences in intellectual performance within pairs of brothers as a result of ultrasound exposure. This study failed to demonstrate a clear association between ultrasound scanning and intellectual performance.
5	Pregnancy ultrasound and childhood cancer: a second report from the Oxford Survey of Childhood Cancers	Sorahan T, Lancashire R, et al.	UK	The Oxford Survey of Childhood Cancers is a nationwide study into the aetiology of childhood cancer; eligible cases are those children dying of cancer before their 16th birthday in the UK. Findings for 1982-4 deaths are reported here. Interview data were sort from parents of 1373 children who died from cancer. The results of this study do not indicate that pregnancy ultrasound influences the risk of childhood cancer.
6	Routine ultrasonography in utero and school performance at aged 8 to 9 years	Salvesen KA, Bakketeig LS, et al.	Norway	At the age of 8 or 9 years children of women who had taken part in two randomised controlled trials of routine ultrasonography during pregnancy were followed up. The school performance of 2011 children was assessed by their teachers on a scale of 1-7. A sub-group of 603 children underwent specific tests for dyslexia. There were no statistically significant differences between children screened with ultrasound and controls in the teacher reported school performance. Results from the dyslexia test sample showed no differences between screened children and controls in reading, spelling and intelligence scores, or in discrepancy scores between intelligence and reading or spelling.
7	Multiple prenatal ultrasound scans and ocular development: 20-year follow-up of a randomized controlled trial.	Forward H, Yazar S, et al	Australia	2743 pregnant women recruited to the Western Australian Pregnancy (Raine) Cohort study during 1989-1991 were randomized to receive at King Edward Memorial Hospital, Western Australia either multiple prenatal ultrasound scans and Doppler flow studies (intensive group) or a single ultrasound scan at 18 weeks' gestation. At age 20 years, participants underwent a comprehensive ophthalmic examination including measurement of ocular biometry and visual acuity. Complete data were available for 1134 adult offspring participants. There was no statistically significant difference between the two groups with regard to ocular biometric or visual outcomes, except for slightly higher intraocular pressure identified in individuals exposed to multiple ultrasound scans (P = 0.034). Although infants in the intensive-ultrasound arm were more likely to have birth weights in the lower quartiles, this was not reflected in adult eye development.

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The comment of Marianne Littlejohn (South Africa), professional midwife and doula,

“I was one of the first people who read Mrs. Beech’s book and wrote about the detrimental effects in my article (Littlejohn, 2017) “Ultrasound – is it Safe during Pregnancy?” According to the Chinese Human Studies (West 2015), this view (that ultrasound is safe during pregnancy) could not be further from the truth. Prenatal ultrasound harms DNA, cells and neurons of babies during pregnancy. These Chinese Human Studies have not been acknowledged by the medical fraternity in the Western world.

Learn to be aware of your baby’s movements and learn to listen to your body for signs of ill health, so that you can seek help when you need it. Ask your obstetrician/midwife to palpate your abdomen with his hands and to measure the growth (with a tape measure) and position of the baby.

Hands, eyes and ears are good diagnostic tools and an observant doctor or midwife can provide vital information in a normal healthy pregnant woman. Diagnostic ultrasound needs to be used only when medically indicated and with extreme caution, particularly in the first trimester of pregnancy.

A hand held fetal monitor and hand fetal doppler are also ultrasound diagnostic tools, and it is possible to use a Pinard fetal stethoscope to listen to the baby’s heartbeat without risk to the baby. The fetal hand held doppler, though, is a lower intensity and dose than imaging ultrasound doppler and is predominantly used during labour when the risks to the baby are lower than in the early months of the pregnancy. A cardiotocograph, which is strapped to the mother during labour, is also an ultrasonic tool and if the baby has many exposures from conception until birth, it all adds up to levels beyond what is necessary for good health. A mother can ask her caregiver to use a Pinard [Pinard fetal stethoscope] during pregnancy and labour.”

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The comment of Grigori Brekhman (Israel), Ob/Gyn, world-renowned perinatal psychologist,

“I have no scientific evidence regarding the effect of ultrasound on an unborn child. However, besides medicine, I am familiar with the basics of quantum physics, quantum mechanics, with the theory of particle-wave dualism of matter, with wave genetics, etc.

Considering this knowledge, I consider the human body as an energy-informational psychosomatic system. This view allowed us to consider the preconditions for the formation of mental trauma, more precisely, psychosomatic trauma, starting from the prenatal period. From these positions in my obstetric practice, I used ultrasound only in extreme cases, keeping in mind the health of the baby.

From this point of view, the data obtained in experiments with ultrasound do not surprise me, but in fact confirm the view to a human being from the moment of his conception”.

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The comment of Valentina Ostrogliad (Ukraine), hereditary midwife, doula,

“I am not against the echography, if mommy is worried about the baby. Then either what she sees on the computer screen will calm her down, or she will find out the truth about some serious deviations. You need to listen to your intuition; this is the surest way and in each case - an individual approach.

I had a case when one mother (who approached me) and her previous baby have got a lot of ultrasounds (about 20!). And the baby was born dead. I don’t know the reasons, and the doctors didn’t know either ... When this woman came to me, pregnant with a new baby, she had already managed to do 6 ultrasounds for up to 18 weeks of gestation! I suggested that she stop doing this examination, although the doctor sent her many times (“medical indications” to multiple ultrasound scans with the second baby were merely “the death of the first baby”). The woman began to refuse ultrasound for this child and gave birth to a wonderful healthy baby-girl.

In my life with my own children, I did an ultrasound once (with the second baby out of six children) when my employer told me that they would not give the maternity leave without US scanning. I didn't want to do an ultrasound scan, I felt that the baby didn't need it either, but I didn't know that I needed to consult a lawyer and defend my right to get maternity leave without ultrasound results.”

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Our Conclusions

Above mentioned studies (Table 1) and a number of non‐randomized and randomized studies about ultrasound exposure during pregnancy (except Chinese studies [West, 2015]) witness about the absence of the official significant (or consistent) relation to congenital anomalies, birth size, cancer/tumours, heart disease, general neonatal and child outcomes, ocular development, and specific psychopathology such as schizophrenia and psychosis. There have been several reports of increased left-handedness in males in relation to foetal ultrasound exposure (Kieler et al., 1998 a, b, 2002, 2001; Salvesen et al., 1993). The USA study about the correlation between ultrasound in the 1st trimester of pregnancy and autism (ASD and CNVs) (Table 1) is the only official study proving the disruptive effect of ultrasound scanning.

At the same time, we are not inclined to ignore:

1. The results and conclusions of the Chinese studies (West, 2015) and the strong appeal of Mrs Beech and Mrs Robinson indicated in the aforecited Open Letter. “Their conclusions are stunning, with recommendations that ultrasound sessions should be completely avoided “for a quality pregnancy”. Only if there are specific medical indications should ultrasound be recommended, and at minimum intensity settings. A session should last no more than 3 minutes, 5 minutes at most. Multiple sessions should be avoided.” (West, 2015)
2. The fact that healthy pregnancy does not require ultrasound. A mother should rely on her sensations, intuition, and the contact with baby at any stage of the pregnancy. A caregiver should still rely on his/her eyes, hands, ears and heart providing prenatal care (that shouldn’t be “prenatal scare” using ultrasound scanning).
3. The evidence that pregnancy is not the right time for making experiments, bating parent’s curiosity of the baby’s sex, and storing up souvenirs as ultrasonic images (“keepsakes”).
4. The experience of midwives, which shows that with multiple ultrasound (7-20) a large percentage of miscarriages and stillborn babies.

We also cannot ignore the studies in animals and abortion human foetuses. If those experiments/studies are not considered relevant to humans then it is unethical to do investigations with animals!

We also should keep in mind that ultrasound does not improve health for babies. A case for the echography procedure for the mother is often its ability to detect abnormalities, but detection is limited. Of the more than 5,000 potential chromosomal abnormalities (Witters et al., 2011), ultrasound can detect only a few like Down’s syndrome. Ultrasound can also misdiagnose abnormalities when there are none, or detect abnormalities about which nothing can be done. Moreover, the echography might be the cause of parents' suffering from fears and desperation the whole pregnancy due to the caregivers’ diagnoses based on the ultrasound scans.

Frequently mothers (parents) would like to use the sonography to detect abnormalities early enough to choose to abort (and the medical staff supports and/or insists). At the same time we believe and would like to remind that the baby and ill/defected/abnormal child is not “a broken toaster”, which you’re able to "return" to the God…

“Still, anecdotal evidence suggests that if pregnant women see images of a fetus — especially their own — they are less likely to terminate a pregnancy”, Malcolm Nicolson, the author of “Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound”, said (Nicolson, 2013).

Since the time the ultrasound scanning for pregnant women has started to be used for clinical purposes (1956), we’ve learned a lot about its functions for the medical staff. However, no one still knows for sure what effects ultrasound have on the developing unborn baby. Pregnancy is not only the point of the medicine, but also the realm of quantum physics, quantum mechanics, wave genetics, perinatal psychology, metaphysics, and ultimately it is still (and hopefully will remain forever) an esoteric miracle that is given as a divine gift. Such a gift needless to be intervened and changed in the womb.

The author of the article would like to tremendously thank the respected Michel Odent, Beverley L Beech, Valentina Ostrogliad, Grigori Brekhman and Marianne Littlejohn for invaluable and long-term research and practical work in the field of maternity protection and primal human health! Actions speak louder than words...

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