Evaluating for disparities in prenatal genetic counseling

Area of Science:

• Medical Genetics
• Obstetrics
• Public Health

Background:

• Prenatal genetic counseling is recommended for all pregnant individuals, covering aneuploidy and carrier screening.
• Previous research indicates racial and ethnic disparities in prenatal genetic testing completion.
• Few studies have examined disparities in the *offering* of these crucial genetic services.

Purpose of the Study:

• To evaluate disparities in prenatal genetic counseling by assessing its provision at the first prenatal visit.
• To determine if financial barriers are the primary driver of disparities in genetic counseling access.

Main Methods:

• Retrospective cross-sectional study of 1103 patients attending their first prenatal visit before 20 weeks' gestation.
• Patients completing prenatal genetic testing were categorized as counseled.
• Medical records were reviewed for counseling status (yes/no) for aneuploidy and carrier screening.

Main Results:

• 97.2% received aneuploidy counseling, but only 73.3% received carrier screening counseling.
• Later gestational age at presentation was linked to less aneuploidy and carrier screening counseling.
• Factors like younger maternal age, Black race, and single relationship status were associated with less aneuploidy counseling on univariate analysis.

Conclusions:

• Prenatal genetic counseling, especially for carrier screening, is less likely to be offered to patients presenting later in pregnancy.
• This disparity disproportionately affects less privileged women who are more likely to seek care later.
• Improving access to early prenatal care and developing specialized pathways for second-trimester entrants can mitigate these disparities.