Disparities in Prenatal Carrier Screening Including Partner Testing by Insurance Status

Advances in prenatal genetic screening have improved the detection of fetal genetic conditions; however, disparities in utilization persist. Our objective was to determine whether implementation and timing of prenatal genetic testing, including partner testing, differs according to insurance payor status.

We conducted a retrospective chart review of pregnant patients who initiated prenatal care and delivered at our academic center in 2024. Patients were stratified by site: a resident clinic serving publicly insured, racially diverse patients and faculty practices serving predominantly privately insured, homogenous patients. Data were extracted from the electronic medical record, and statistical comparison was performed.

We reviewed 201 charts (101 resident clinic, 100 faculty practice). Compared with faculty practice patients, resident clinic patients were younger and more likely to be non-White, Hispanic, or non-English speaking. Among publicly insured patients, gestational age (GA) at initial visit was later, as was GA at genetic testing collection. Preconception screening was more common among privately insured patients. Concurrent testing and completion of screening was lower in publicly insured patients, and there were longer delays to partner testing.

Publicly insured patients had delayed prenatal genetic testing, reduced partner testing, and lower screening completion. Strategies are needed to provide equitable access to timely prenatal genetic testing.