Prenatal screening varies significantly based on where women live and who provides their care

TORONTO, June 11, 2015 — Women who live in urban areas, are from high income neighbourhoods and whose pregnancy care is provided by an obstetrician are more likely to receive prenatal screening, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (SickKids).

It is recommended that all pregnant women be offered a range of prenatal screening tests to identify pregnancies at risk for specific chromosome abnormalities and open neural tube defects (birth defects of the brain, spine, or spinal cord). Most women will gain reassurance in the first or early second trimester that their fetus is unlikely to be affected by a specific disorder; those identified to be at high risk will be offered diagnostic testing to guide further counselling and decision-making about pregnancy course and necessary care at delivery.

“Although women may chose not pursue prenatal screening, our findings, especially around the regional differences in screening rates highlight existing gaps in the prenatal screening system in Ontario and have important implications for goals of equitable delivery of evolving screening services,” said Dr. Astrid Guttmann, Chief Science Officer at ICES, Staff Paediatrician at SickKids and senior author of the study published today in CMAJ Open.

The researchers conducted a study with 264,737 Ontario women who were more than 16 weeks pregnant in 2007-2009. Overall, 62 per cent received screening but there was almost a threefold difference in screening rates across Local Health Integration Networks (LHINs). A greater proportion of women initiated screening in the first rather than second trimester (50.0 per cent vs. 12.2 per cent, respectively). Screening rates were lower among rural compared to urban women. Compared with women receiving first trimester care from obstetricians, those receiving family physician or midwifery care were less likely to be screened. Women in lower income neighbourhoods were slightly less likely to be screened. Immigrants, including refugees, were more likely to be screened than non-immigrants. This might be related to the fact that most immigrants live in large, urban centers.

“The expanding presence of market-driven pressures from US-based vendors offering non-invasive prenatal testing for private pay can only fuel further access challenges, warranting a unified and forward-thinking response from the prenatal care community,” said Dr. Robin Hayeems, lead author and Scientist-Track Investigator in Child Health Evaluative Sciences at SickKids.

The researchers add that while these findings are from Ontario, national research and policy attention to prenatal screening infrastructure is needed as this recommended service is inconsistently funded and/or available across jurisdictions.

“Disparities in uptake of PNS in Canada: A population-based cohort study,” was published today in CMAJ Open.

Author block: Hayeems RZ, Campitelli M, Ma X, Huang T, Walker M, Guttmann A.