Impact of noninvasive prenatal testing in regionally dispersed medical centers in the United States.
OBJECTIVE
Noninvasive prenatal testing using cell-free DNA is a new alternative to screen for common fetal aneuploidies. It is not known what impact regional location may play on noninvasive prenatal testing implementation and downstream invasive prenatal procedure use in the United States.


METHODS
Six different regionally based centers collected data on noninvasive prenatal testing indication and results between February and November 2012, as well as their invasive prenatal procedure rates before and after offering noninvasive prenatal testing. Statistical analyses were performed using the 2-proportion Z-test.


RESULTS
Of 1477 patients who underwent noninvasive prenatal testing; 693 (47%) were from centers in the West; 522 (35.3%) from centers in the East; and 262 (17.7%) from 1 center in the Midwest. Statistically significant differences were observed between West Coast and nonWest Coast sites for gestational age (14.1 weeks; P ≤ .0001). Advanced maternal age (AMA-only) was the most frequent indication in 5 of 6 sites (range, 21.8-62.9%) A total of 98 invasive prenatal procedures performed on 94 (6.4%) patients of which 64 (65.3%) were performed at centers in the West. More invasive procedures were performed following negative noninvasive prenatal testing results (n = 61) than abnormal noninvasive prenatal testing results (n = 30). The overall rate of patients undergoing invasive procedure after an abnormal noninvasive prenatal testing result was 32.6% (30 of 92). All 6 centers reported a decrease in invasive procedure volume after noninvasive prenatal testing introduction.


CONCLUSIONS
This study demonstrates differences in clinical implementation of noninvasive prenatal testing across regionally dispersed centers in the United States, suggesting patient demographics and views toward prenatal testing influence use as well as downstream management.
Center for Fetal Medicine and Women's Ultrasound and the Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
Lawrence D
LD
Platt
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, CT.
Mary Beth
MB
Janicki
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Minneapolis, MN.
Tracy
T
Prosen
Prenatal Diagnosis Center, San Francisco Perinatal Associates, San Francisco, CA.
James D
JD
Goldberg
Desert Perinatal Associates, Las Vegas, NV.
Joseph
J
Adashek
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, CT.
Reinaldo
R
Figueroa
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, CT.
John
J
Rodis
Department of Clinical Affairs, Illumina, Redwood City, CA.
Wayne
W
Liao
Department of Clinical Affairs, Illumina, Redwood City, CA.
Amy J
AJ
Sehnert
Department of Genetic Services, Illumina, Redwood City, CA.
Holly L
HL
Snyder
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA.
Steven L
SL
Warsof
D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data*; D015193:Chorionic Villi Sampling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D062145:Maternal Serum Screening Tests / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
noninvasive prenatal test; regional implementation