Assessing the Impact of the SOGC Recommendations to Increase Access to prenatal Screening on Overall Use of Health Resources in Pregnancy

• Published in: Journal of obstetrics and gynaecology Canada Vol. 35; no. 5; pp. 444 - 453
• Main Authors: Metcalfe, Amy, PhD, Lix, Lisa M., PhD, Johnson, Jo-Ann, MD, Bernier, François, MD, Currie, Gillian, PhD, Lyon, Andrew W., PhD, Tough, Suzanne C., PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.05.2013
• Subjects: Adolescent; Adult; Aneuploidy; Female; Fetal Diseases - diagnosis; Fetal Diseases - genetics; Health Resources - utilization; health services research; Humans; Middle Aged; Obstetrics and Gynecology; Pregnancy; Pregnancy Trimester, First; prenatal diagnosis; Prenatal Diagnosis - utilization; prenatal screening; Young Adult; Pregnancy; health services research; prenatal diagnosis; prenatal screening; pregnancy
• ISSN: 1701-2163
• DOI: 10.1016/S1701-2163(15)30935-X

Abstract Objectives The recommendation by the Society of Obstetricians and Gynaecologists of Canada that prenatal screening for fetal aneuploidy be offered to all pregnant women is an important change in clinical obstetrics. However, it is unknown how this recommendation might affect the use of other health resources during pregnancy. Methods Twelve clinical and administrative databases were linked, and care paths outlining typical service use in pregnancy were created based on the type of prenatal screening accessed (first trimester screening [FTS], maternal serum screening [MSS], invasive testing only, or no screening and/or diagnosis). Logistic, Poisson, and negative binomial models were applied to the data to examine the association between use of prenatal screening/diagnosis and other health services during pregnancy. Results Women who accessed prenatal screening/diagnosis were significantly more likely to have a consultation with a medical geneticist (FTS OR 2.42; 95% CI 1.75 to 3.33; MSS OR 4.84; 95% CI 2.92 to 8.03; and invasive testing OR 8.58; 95% CI 5.28 to 13.94), and women who accessed FTS had more prenatal visits (FTS incidence rate ratio 1.03; 95% CI 1.01 to 1.05) than women who did not access prenatal screening/diagnosis. Uptake of invasive tests did not differ between women who accessed FTS and those who accessed MSS. Use of prenatal screening/diagnosis was not significantly associated with use of most other health resources Conclusion In a publicly funded health care system, understanding the impact of recommendations to increase access to a specific service on other services is important. Recommendations to increase access to prenatal screening services may have some unanticipated downstream effects on the use of other services during pregnancy. However, most aspects of health resource use in pregnancy do not appear to be influenced by the use of prenatal screening services.