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Prenatal genetic screening and diagnostic testing during the COVID-19 pandemic in the Bronx, NY
Molecular Genetics and Metabolism ; 132:S320-S321, 2021.
Article in English | EMBASE | ID: covidwho-1735103
ABSTRACT

Introduction:

The Coronavirus Disease (COVID-19) pandemic has changed the landscape of both inpatient and outpatient healthcare. During the height of the pandemic, most elective and many nonelective procedures were halted. Prenatal care services including ultrasound and genetic screening and testing remained active (given gestational age dependence) while shifting from in-person towards telehealth counseling. NewYork Citywas at the epicenter of the pandemic fromMarch through June 2020. Elective procedures at Montefiore Medical Center, which serves a diverse urban population in the Bronx, NY,were cancelled from March 16, 2020 to June 20, 2020. Prenatal ultrasound shifted from a dating ultrasound and a nuchal translucency ultrasound to one first trimester ultrasound and anatomy scans were scheduled at 20–22 weeks gestation rather than 18–20 weeks. The majority of counseling sessions were conducted via telehealth and prenatal diagnostic procedures (including amniocentesis and chorionic villus sampling [CVS]) were performed with a limited team to adhere to COVID-19 protocols. We examined the impact of this shift on rates of prenatal genetic screening and diagnostic procedures before and during the COVID-19 pandemic. Previous literature has revealed that since the advent of noninvasive prenatal screening (NIPS), prenatal genetic diagnostic procedures rates have been on the decline.We hypothesized that the rate of genetic diagnostic procedure rates would decrease and NIPS would increase as compared to the similar period in 2019.

Methods:

Retrospective analysis of data collected in a secure institutional logbook at Montefiore Medical Center Department of Obstetrics & Gynecology and Women’s Health (Division of Reproductive and Medical Genetics and Division of Fetal Medicine and Ultrasound) from January 1, 2019–December 31, 2020. Collected data included number of procedures, gestational age, and indication for procedure (categorized as advanced maternal age (AMA), ultrasound anomalies, positive screening test, hereditary disease in the family possibly affecting fetus (including family history or genetic carrier), or other. Procedures for multiple gestations were considered as a single procedure..

Results:

503 diagnostic procedures (359 amniocenteses and 144 CVS) were included. Most common indication (ultrasound anomaly) and average gestational age (13 weeks for CVS and 19 weeks for amniocentesis) were the same in 2019 and 2020. In total, 275 procedures were performed in 2019 as compared to 228 in 2020 (20.6% decrease) ( p = 0.018). Specifically, amniocentesis decreased from 187 to 172 (8% decrease) ( p = 0.214) and CVS decreased from 88 to 56 (36% decrease) ( p = 0.004). NIPS increased from 1,312 tests in 2019 to 1727 tests in 2020 (31.6%) ( p < 0.001). The same data points were then analyzed during the four-month period at the height of the pandemic in New York City. We compared numbers of procedures from the period March 1, 2019–June 30, 2019 to March 1, 2020–June 30, 2020. Total prenatal diagnostic procedures during this period were 91 in 2019 and 81 in 2020 (12.3% decrease). This included 59 amniocenteses compared with 60 in the same period in 2020 (1.6% increase) and 32 CVS in 2019 compared to 21 in 2020 (34.3% decrease). Noninvasive prenatal screening increased from 348 to 510 (increase of 46.5%) during this period.

Discussion:

At Montefiore Medical Center in the Bronx, NY, prenatal genetic diagnostic procedures decreased while NIPS rates increased during the pandemic. This trend may reflect patient’s concerns for a COVID-19 exposure during in-office procedures, shift to telehealth counseling, or be reflective of the overall trends seen since the widespread offering of NIPS to prenatal patients. The decrease in CVS may be explained by an intentional system delay of combining ultrasound and blood draw to a single visit at the end of the first trimester. Future studies should investigate how access to care and gestational age at the time of presentation influenced prenatal genetic screening and testing cho ces during the pandemic, in order to better explain the identified trends.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Diagnostic study Language: English Journal: Molecular Genetics and Metabolism Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Diagnostic study Language: English Journal: Molecular Genetics and Metabolism Year: 2021 Document Type: Article