Non‐invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods

Abstract

Objective Non‐Invasive Prenatal Testing (NIPT) is increasingly being implemented worldwide. In public health programs, equitable access to healthcare is a fundamental principle which also applies to fetal aneuploidy screening. However, the out‐of‐pocket costs of NIPT may lead to sociodemographic disparities in uptake of screening. This study assessed whether there is a difference in the uptake of NIPT in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, where NIPT is implemented in a national screening program (TRIDENT‐2 study). Method NIPT uptake, postal code and age of 156,562 pregnant women who received pre‐test counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used as a proxy to categorize neighborhoods as being either socioeconomically disadvantaged or other. The out‐of‐pocket costs for NIPT were €175. Results NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% whereas uptake in all other neighborhoods was 47.6% (p < 0.001). The difference in NIPT uptake between socioeconomic disadvantaged neighborhoods and other areas was smaller for the youngest maternal age‐group (≤25 years) compared to other age‐groups. Conclusion The variation in uptake suggest underlying disparities in NIPT uptake, which undermines the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access. This has ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.

Insurance and geographic variations in non‐invasive prenatal testing

“…Our findings on geographic variation are consistent with research from Australia and the Netherlands which found that people living in socioeconomically disadvantaged neighborhoods were less likely to receive NIPT 9,10 . The finding that people with Medicaid coverage were less likely to receive NIPT is inconsistent with a single‐site study in Wisconsin which found that pregnant people with Medicaid were more likely to receive NIPT than those with commercial coverage 6 .…”

Cell-Free Fetal DNA and Non-Invasive Prenatal Diagnosis of Chromosomopathies and Pediatric Monogenic Diseases: A Critical Appraisal and Medicolegal Remarks

“…Such a difference in NIPT uptake was reportedly smaller for the youngest maternal age-group (≤25 years). However, this variation in uptake could create disparities that would undermine the goals of a national fetal aneuploidy screening program [ 47 ].…”

Patient experience with non-invasive prenatal testing (NIPT) as a primary screen for aneuploidy in the Netherlands

“…One study found some evidence for the former when it presented vignettes to Dutch citizens and found that respondents agreed less with a pregnant woman declining NIPT when the testing was fully funded [24]. A recent study showing that NIPT uptake in the Netherlands was two times lower in socioeconomically disadvantaged neighborhoods provides strong support for the latter [25]. The out-of-pocket cost for NIPT will disappear in the Netherlands as of April 2023 [26], which will eliminate the barrier to equitable access, but may introduce other concerns such as less informed decisionmaking and routinization.…”