title: Assessing the impact of the SOGC recommendations to increase access to prenatal screening on overall use of health resources in pregnancy.
abstract: OBJECTIVE
  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
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Amy
authors.initials: A
authors.lastname: Metcalfe
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg MB.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lix
authors.affiliation: Department of Obstetrics and Gynaecology, University of Calgary, Calgary AB.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Johnson
authors.affiliation: Department of medical Genetics, University of Calgary, Calgary AB.
authors.forename: François
authors.initials: F
authors.lastname: Bernier
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary AB; Department of Community Health Sciences, University of Calgary, Calgary AB.
authors.forename: Gillian
authors.initials: G
authors.lastname: Currie
authors.affiliation: Department of Pathology and Laboratory Medicine, Saskatoon Health Region and College of Medicine, University of Saskatchewan, Saskatoon SK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Lyon
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Tough
mesh_terms: D000293:Adolescent; D000328:Adult; D000782:Aneuploidy; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000235:genetics; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: health services research; pregnancy; prenatal diagnosis; prenatal screening