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Disparities in prenatal screening uptake revealed

4 October 2021
Appeared in BioNews 1115

Non-invasive prenatal testing (NIPT) uptake in socioeconomically disadvantaged neighbourhoods of the Netherlands is significantly lower than in other parts of the country.

NIPT is increasingly being implemented in healthcare systems as a safe and reliable screening test to rule out common fetal aneuploidies in high-risk pregnancies. However, out-of-pocket costs for NIPT might lead to disparities in the uptake of screening, which undermines the goals of fair healthcare access. 

The Netherlands study was inspired by author Caroline Kooij's observations while working as a midwife in a socioeconomically disadvantaged area of Amsterdam. 'She noticed in her neighbourhood that new guidelines or innovations in maternity care often either do not meet the needs of pregnant women or women are unable to afford them,' first author Karuna van der Meij from the Amsterdam University Medical Centre told Contemporary OB/GYN.

The study published in the journal Prenatal Diagnosis analysed the NIPT uptake, postal code and the age of 156,562 pregnant women who received pre-test counselling for NIPT in 2018. Postal codes were used to categorise the neighbourhoods as being socioeconomically disadvantaged or not. 

NIPT is offered at a cost of €175 to all pregnant women in the Netherlands as part of a government-supported prenatal screening programme. 

The average NIPT uptake in socioeconomically disadvantaged neighbourhoods was found to be 20.3 percent compared to 47.6 percent in other areas. The difference in NIPT uptake between socioeconomically disadvantaged neighbourhoods and other areas was smaller in the youngest maternal age group (25 years and under) compared to all other age groups.

'Our findings have both ethical and policy implications, and can assist policymakers in promoting the equitable implementation of NIPT within public healthcare systems' said the study authors, who suggest that free access to NIPT might decrease inequalities in testing uptake. 

A US-based study published in the American Journal of Obstetrics and Gynecology looked at the possible reasons underlying NIPT uptake discrepancies by analysing 1103 patient records. Their findings suggest that pregnant women, who present for prenatal care later in pregnancy, are less likely to receive genetic counselling.

The authors speculate that by missing the first prenatal visits, healthcare providers are challenged to condense more information into one second-trimester visit and thus more likely to overlook genetic counselling. 

SOURCES & REFERENCES
Evaluating for disparities in prenatal genetic counseling
American Journal of Obstetrics and Gynecology |  24 September 2021
Non-invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods
Prenatal Diagnosis |  9 September 2021
Uptake of NIPT lower in disadvantaged neighborhoods
Contemporary ObGyn |  28 September 2021
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