Poster Session 1
Saundra Albers, MD, MA
Resident
New York Presbyterian Weil Cornell
New York City, NY, United States
Sarah J. Weingarten, BA, MD (she/her/hers)
Maternal Fetal Medicine Fellow
Weill Cornell Medicine at New York Presbyterian
New York, New York, United States
Brittany Roser, MD
Attending
Stony Brook University Hospital
New York, New York, United States
.jpg "Stephen T. Chasen, MD (he/him/his) photo")
Stephen T. Chasen, MD (he/him/his)
Professor of Clinical Obstetrics and Gynecology
Weill-Cornell Medical College
New York, NY, United States
Effective screening involves not only the test’s availability but also its timing and the coordination of follow-up care. We evaluated the use of NIPT in patients with Medicaid versus private insurance to identify disparities in screening practices.
Study Design:
This is a retrospective cohort study of those with abnormal NIPT who underwent diagnostic testing from 2015-2022. We recorded demographic information, NIPT abnormality, type of invasive testing (CVS vs amniocentesis) and pregnancy outcomes. We excluded low fetal fraction results on NIPT. We compared gestational ages at first prenatal visit, NIPT, genetic counseling, invasive testing and abortion between the Medicaid and private insurance populations. Wilcoxon rank sum test was used to compare continuous data. Fisher's exact test and Pearson's Chi-squared test were used for categorical comparisons.
Results:
We identified 206 patients with abnormal NIPT, including 179 with private insurance and 27 with Medicaid. Results are in Table 1. Medicaid patients initiated prenatal care and underwent NIPT at later gestational ages and were less likely to have CVS than private insurance patients. Invasive testing had similar normal result rates and distribution of abnormalities. Abortion rates were comparable; however, Medicaid patients underwent abortion at later gestational ages. Intervals between NIPT, disclosure of results, invasive testing, and abortion are in Table 2. While Medicaid patients underwent NIPT at a later gestational age, there were no significant differences in the intervals for post-NIPT care between the groups.
Conclusion:
In patients with abnormal NIPT, those with Medicaid underwent screening, prenatal diagnosis, and abortion at later gestational ages. These disparities appear to arise from the later gestational age at first prenatal visit. The availability of early genetic screening, which can greatly affect the timing of prenatal diagnosis and abortion, identifies a clear benefit of earlier prenatal care. Redoubling efforts to initiate prenatal care earlier can alleviate disparities in pregnancies affected by genetic conditions.
