title: Women's views and the impact of noninvasive prenatal testing on procedures in a managed care setting.
abstract: OBJECTIVE
  To prospectively determine the impact of noninvasive prenatal testing (NIPT) on invasive procedure utilization in a managed care setting and to elucidate women's views.
  
  
  METHODS
  Pregnant women at 10- 20 weeks' gestation with high-risk indications for fetal aneuploidy in the Kaiser Permanente Southern California organization were eligible. Enrolled patients received routine prenatal counseling, completed a questionnaire and were offered the option of NIPT by a genetic counselor. Downstream data through 28 weeks' gestation were collected from the electronic medical record (EMR). The EMR was also used to identify a matched historical cohort from 1 year prior to NIPT availability. Rates of invasive prenatal procedures were compared using McNemar's test.
  
  
  RESULTS
  Two hundred women completed the questionnaire and underwent NIPT. Twenty-two subjects (11%) in the prospective cohort underwent an invasive prenatal procedure compared with 58 (29%) in the historical cohort (p<0.0001). Safety and accuracy were the most important factors in considering NIPT. At the time of survey, only 12% indicated being very comfortable with the possibility of undergoing amniocentesis.
  
  
  CONCLUSIONS
  This prospective study demonstrates a 62% reduction in invasive prenatal procedures after NIPT testing and finds safety, accuracy, and personal beliefs key to women's decision-making.
authors.affiliation: Department of Genetics, Southern California Permanente Medical Group, Los Angeles, CA, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Tiller
authors.forename: Hilary B
authors.initials: HB
authors.lastname: Kershberg
authors.forename: John
authors.initials: J
authors.lastname: Goff
authors.forename: Christin
authors.initials: C
authors.lastname: Coffeen
authors.forename: Wayne
authors.initials: W
authors.lastname: Liao
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Sehnert
mesh_terms: D000293:Adolescent; D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data*; D000782:Aneuploidy; D001294:Attitude to Health; D002140:California; D015193:Chorionic Villi Sampling / Q000706:statistics & numerical data*; D025063:Chromosome Disorders / Q000097:blood* / Q000175:diagnosis; D015331:Cohort Studies; D004247:DNA / Q000097:blood*; D003657:Decision Making; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008329:Managed Care Programs; D008875:Middle Aged; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004247:DNA