Noninvasive prenatal testing decreased diagnostic testing but not first-trimester screening.

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

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Abstract

INTRODUCTION:

We report here the changes in first-trimester screening and diagnostic testing after the introduction of noninvasive prenatal testing in a single practice.

METHODS:

Monthly rates of first-trimester screening (and noninvasive prenatal testing) and diagnostic (chorionic villus sampling and amniocentesis) procedures were recorded from billing records and retrospectively compared 1) before introduction of noninvasive prenatal testing in our practice (April-July 2009, 2010, and 2011 to account for seasonal variation in patient number); 2) initial 4 months of noninvasive prenatal testing (April-July 2012); 3) 4 months before the American College of Obstetricians and Gynecologists committee opinion on noninvasive prenatal testing (August-November 2012); and 4) 4 months after the American College of Obstetricians and Gynecologists' noninvasive prenatal testing statement (December 2012 to March 2013). Data also were evaluated per 100 targeted ultrasound scans to control for variability in patient visits and compared using analysis of variance.

RESULTS:

A total of 3,794 first-trimester screens (and noninvasive prenatal testing) and 607 diagnostic tests (chorionic villus sampling and amniocentesis) were performed over the study period. Average monthly screening procedures and screening procedures per 100 targeted ultrasound scans were not different between any time period before or after noninvasive prenatal testing introduction, suggesting that the rate of first-trimester screening was unaffected by noninvasive prenatal testing. However, average monthly diagnostic procedures and procedures per 100 targeted ultrasound scans significantly decreased after noninvasive prenatal testing introduction. Diagnostic testing and testing per 100 targeted ultrasound scans decreased by 44.0% and 41.0%, respectively, after the American College of Obstetricians and Gynecologists' statement on noninvasive prenatal testing.

CONCLUSION:

As a screening method, noninvasive prenatal testing did not significantly affect the rate of screening performed in the first trimester but did significantly decrease the rate of diagnostic testing in our practice.