Non-Invasive Prenatal Screening (NIPS) may become more accessible with ACOG’s new guidelines

By Chloe Meier

In October 2020, The American College of Obstetricians and Gynecologists published updates to their Screening for Fetal Chromosomal Abnormalities guidelines (behind paywall) for the first time since 2016. One of the major changes to the guidelines is that ACOG now recommends that NIPS (non-invasive prenatal screening) be offered to all pregnant people regardless of age or risk.

Why is this ACOG guideline update important?

Past guidelines recommended that physicians offer patients with a high risk of prenatal aneuploidy non-invasive prenatal screening. Since this guideline recommends NIPS for all pregnant people regardless of risk, the hope is that insurance companies will start to cover this expensive testing.

Will insurance cover Non-Invasive Prenatal Screening (NIPS)?

Often, insurance coverage follows guidelines. Hopefully, these new guidelines will make NIPS more accessible to women. It can take a while for insurance companies to catch up to guidelines, so it is hard to tell how soon these changes will take place. 

 Does this guideline mean that it is necessary for all patients to pursue NIPS?

This guideline only states that healthcare providers should offer all pregnant patients NIPS. There are many reasons that patients may or may not want NIPS or other tests done during pregnancy. NIPS can indicate to a parent the sex of the baby or the risk for common chromosomal disorders (including Down Syndrome). These results may prompt patients to consider further diagnostic testing. All pregnant patients should be offered this screening, but also counseled regarding the potential outcomes and their options. 

Both pre-test and post-test genetic counseling can guide patients in making informed decisions for themselves. After pursuing testing, patients may be faced with decisions that are best handled with the support of a genetic counselor. 

If a patient chooses to pursue NIPS, what should they do when they receive their results? 

Firstly, it is important that healthcare providers emphasize and patients understand that NIPS is a screening test, not diagnostic. A positive test result does not necessarily ensure a chromosomal abnormality, and a negative test result does not ensure that the fetus is unaffected. Patients with a positive test result should see a genetic counselor and discuss the possibility of pursuing diagnostic testing. 

What else do ACOG’s screening guidelines discuss?

Although the recommendation of NIPS for all pregnancies is a notable update to ACOG guidelines for prenatal aneuploidy screening, the guidelines also make other important recommendations. Patients should only have one screening approach at a time to avoid stressful discordant results. Additionally, all patients should be offered a second semester ultrasound. Any patient with a positive NIPS test result is urged to see a genetic counselor. 

To learn more about these new guidelines from Emily Goldberg, MS, CGC, a certified  genetic counselor, check out this episode of the Genotypecast podcast.

For Patients:

• If you are pregnant or plan to become pregnant in the near future, insurance companies may cover non-invasive prenatal screening for you, even if you are under the age of 35. Typically, it takes about a year for insurance companies to catch up to these new guidelines.
• Meeting with a genetic counselor can help you to understand all your options as well as the implications of any prenatal test results, including carrier testing results. You can schedule a telehealth prenatal prenatal genetic counseling appointment online here. 
• The ideal time to meet with a genetic counselor to discuss testing options during pregnancy is before you become pregnant! You can schedule a telehealth preconceptual genetic counseling appointment online here. 

For Healthcare Providers:

• If you work with a prenatal genetic counselor, reach out to them to discuss if you should change workflow or referral patterns related to the new recommendation that all patients should be offered NIPS. 
• In order to comply with these new guidelines, more patients will need access to genetic counselors to discuss NIPS. 
  • Even if you do not have a genetic counselor you can refer to within your healthcare system, you can still follow ACOG guidelines by referring them to Grey Genetics for genetic counseling. Patients can then decide whether or not they want to pursue genetic counseling and pay out of pocket.
  • If you are interested in covering the cost of genetic counseling for your patients, you can also pre-pay for prenatal telehealth appointments for your patients, then just give them the booking code and let them schedule their telehealth online at their own convenience. 

References and Further Reading: 

Rose, Nancy C., et al. “Screening for Fetal Chromosomal Abnormalities.” The American College of Obstetricians and Gynecologists, vol. 226, 2020, doi:10.1097/aog.0000000000004084. 

Staff Reporter. “ACOG Guidelines Recommend NIPT for All Pregnancies Regardless of Risk.” GenomeWeb, 17 Aug. 2020.

“National Council on Disability Recommends More Regulation of NIPT.” October 23, 2019. Genome Web.Thompson, Stephanie. “Adoption as an Option.” Grey Genetics News Corner.

Kamp, Bailey “Mitigating Misinformation: Spreading Awareness for Down Syndrome.” Grey Genetics News Corner.

Related Podcasts

Down Syndrome and Adoption as an Option with Stephanie Thompson 

Unexpected Joys on the Scenic Route with Down Syndrome with Julie McConnell 

ACOG Now Recommends that NIPS be offered to all pregnant women – with Emily Goldberg, MS, CGC