Changes in prenatal testing trends after introduction of noninvasive prenatal testing.

Larion S1, Romary L, Mlynarczyk M, Abuhamad AZ, Warsof SL.

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Abstract

INTRODUCTION:

Noninvasive prenatal testing is a highly sensitive and specific prenatal screening method that offers significant advantages over traditional testing modalities such as first-trimester combined screen, chorionic villus sampling (CVS), and amniocentesis. We report noninvasive prenatal testing uptake and the changes in first-trimester combined screen, CVS, and amniocentesis testing after noninvasive prenatal testing introduction in a single academic practice.

METHODS:

Average monthly procedure rates for four prenatal tests (noninvasive prenatal testing, first-trimester combined screen, CVS, and amniocentesis) were compared retrospectively over four time periods: 1) before noninvasive prenatal testing introduction (April-July of 2009, 2010, and 2011, to account for seasonal variation); 2) the first 4 months of noninvasive prenatal testing in clinical practice (April 2012 to July 2012); 3) 4 months immediately preceding the formal American College of Obstetricians and Gynecologists' statement on noninvasive prenatal testing (August 2012 to November 2012); and 4) 4 months after the American College of Obstetricians and Gynecologists' recommendation of noninvasive prenatal testing (December 2012 to March 2013). Data were also normalized per 100 targeted ultrasound scans to control for fluctuations in patient visits.

RESULTS:

A total of 977 noninvasive prenatal testing, 2,817 first-trimester combined screen, 100 CVS, and 507 amniocenteses were performed during the study period. Once available, noninvasive prenatal testing showed high uptake, increasing over the study intervals by 17.4% per 100 targeted ultrasound scans. First-trimester combined screen significantly decreased after noninvasive prenatal testing introduction, decreasing by 47.5% per 100 targeted ultrasound scans over the study intervals. The rate of CVS and amniocentesis also significantly decreased after the introduction of noninvasive prenatal testing, decreasing by 90.4% and 63.5% per 100 targeted ultrasound scans over the study intervals, respectively.

CONCLUSIONS:

Noninvasive prenatal testing was quickly adopted by our clinic population and significantly decreased other screening and diagnostic methods in a short period of time.