Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study

Hayeems, Robin Z.; Campitelli, Michael A.; Ma, Xinxin; Huang, Tianhua; Walker, Mark; Guttmann, Astrid

doi:10.9778/cmajo.20140110

Cited by 32 publications

(44 citation statements)

References 33 publications

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“…In their retrospective cohort study of 264 737 women who were at or beyond 16 weeks gestation in 2007–2009 in Ontario, Canada, Hayeems et al . identified lower screening rates among women living in a rural versus urban area (adjusted OR 0.64, CI 0.63–0.66) and among those in a lower income quintile (adjusted relative risk ®R 0.95, CI 0.94–0.96) . In NZ, further research is required to understand if variation in screening timing (first versus second trimester) by DHB of domicile relates to the availability of ultrasound and/or laboratory services in specific areas (as is a likely contributor in Whanganui DHB) or, is possibly influenced by characteristics of the LMC making the offer of screening.…”

Section: Discussionmentioning

confidence: 99%

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

Payne

Pillai

Wise

et al. 2017

Aust NZ J Obst Gynaeco

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Maori and Pacific women have the lowest uptake of completed first versus second trimester screening after adjusting for age, deprivation and DHB. Research is required to understand if this relates to characteristics of the carer making the offer of screening, language and/or cultural barriers to care or specific collective cultural or religious views held by women from these ethnicities. The lower completed first trimester versus second trimester prenatal screening in deprived areas, as well as variation by DHB, may relate to the availability of ultrasound and/or laboratory services in specific regions. Cost may be a contributing factor to inequity in timing of completed prenatal screening uptake, as first trimester screening incurs a part-charge to the individual, while second trimester screening is fully funded. Systemic factors within the NZ maternity model of care may also be contributory with a potential disconnect occurring for the woman between primary medical care and later registration with a Lead Maternity Carer in the first trimester.

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Section: Discussionmentioning

confidence: 99%

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

Payne

Pillai

Wise

et al. 2017

Aust NZ J Obst Gynaeco

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“…18 Lower rates of multiple-marker screening uptake were previously reported to be associated with living in a rural area, receiving first-trimester care from a family physician or midwife, and being in a lower income quintile in Ontario. 20 Possible reasons for the regional variation in both multiple-marker and cffDNA screening observed in the current study include disparities in access and personal choices, as well as provider differences in adopting and incorporating new technologies and recommendations. We plan to analyze this further and, with the advent of a provincial prenatal screening program, to address the modifiable factors that may be barriers to prenatal screening.…”

Section: Openmentioning

confidence: 85%

“…There is a wide range in reported rates of uptake of multiple-marker screening in studies from different countries and screening programs, from 35.2% in the Netherlands to about 76.0% in the United Kingdom and 91.6% in Denmark. 8,18,19 In Ontario, the overall rate of uptake of prenatal screening increased from 63% to about 68% over the past 5-7 years, 20,21 but regional variations remain. Publicly funded cffDNA screening has not substantially affected the overall prenatal screening uptake rate.…”

Section: Openmentioning

confidence: 99%

Trends in the use of prenatal testing services for fetal aneuploidy in Ontario: a descriptive study

Huang

Dougan

Walker

et al. 2018

cmajo

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Background: In 2014, Ontario augmented its publicly funded multiple-marker screening program for prenatal aneuploidy by incorporating cell-free fetal DNA (cffDNA) analysis for high-risk pregnancies. We assessed trends in the use of multiple-marker screening, cffDNA screening and prenatal diagnostic testing before and after implementation of public funding. Methods: We conducted a descriptive study based on data from the Better Outcomes Registry & Network (BORN) Ontario. The study population included all pregnant women in Ontario with a singleton pregnancy and an expected date of delivery between July 1, 2012, and Mar. 31, 2016, with pregnancy data captured in BORN. Pregnancy losses and terminations before 20 weeks' gestation not captured in BORN were excluded. We generated descriptive statistics to show trends and regional variations in use. Results: The study sample included 534 210 singleton pregnancies. After cffDNA screening was funded for specific indications, uptake of multiple-marker screening increased slightly, from 66.5% to 68.1% (p < 0.001). Uptake of cffDNA screening among women with a positive multiple-marker screening result increased substantially, from 3.2% to 48.8% (p < 0.001). In contrast, the rate of prenatal diagnostic testing in this group decreased from 54.8% to 30.8% (p < 0.001). Although women aged 40 years or older are eligible for primary cffDNA screening, only a small decrease in the use of multiple-marker screening was observed in this group. The greatest use of cffDNA screening and greatest decline in prenatal diagnostic testing were seen in women with a level of risk for trisomy 21 of 1:101-1:200 based on multiple-marker screening. Interpretation: After public funding of cffDNA screening was implemented in Ontario, there was a significant increase in cffDNA screening and a significant decrease in prenatal diagnostic testing among women with a positive multiple-marker screening result. These changing patterns show the significant impact of public policy and funding decisions on women's choices regarding prenatal testing.

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“…Rural residence, lower income, and family physician-delivered prenatal care have been associated with low screening rates in the first trimester of pregnancy in the general population. 18 As CL and CLP can be…”

Section: Incidence Of Ofc and Its Variationmentioning

confidence: 99%

Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada

Malic

Lam²,

Donelle

et al. 2020

JAMA Netw Open

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IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ 2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality.

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Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study

Cited by 32 publications

References 33 publications

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

Inequity in timing of prenatal screening in New Zealand: Who are our most vulnerable?

Trends in the use of prenatal testing services for fetal aneuploidy in Ontario: a descriptive study

Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada

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