Abstract
Since its introduction in 2011, noninvasive prenatal testing (NIPT) has spread rapidly around the world. It carries numerous benefits but also raises challenges, often related to sociocultural, legal, and economic contexts. This article describes the implementation of NIPT in nine countries, each with its own unique characteristics: Australia, Canada, China and Hong Kong, India, Israel, Lebanon, the Netherlands, the United Kingdom, and the United States. Themes covered for each country include the structure of the healthcare system, how NIPT is offered, counseling needs and resources, and cultural and legal context regarding disability and pregnancytermination. Some common issues emerge, including cost as a barrier to equitable access, the complexity of decision-making about public funding, and a shortage of appropriate resources that promote informed choice. Conversely, sociocultural values that underlie the use of NIPT vary greatly among countries. The issues described will become even more challenging as NIPT evolves from a second-tier to a first-tier screening test with expanded use.
Highlights
Since its introduction in 2011, noninvasive prenatal testing (NIPT) has taken prenatal care by storm
Several terms are currently used in the literature to describe NIPT: noninvasive prenatal screening, cell-free DNA screening, and cell-free fetal DNA screening
The technology was commonly referred to as noninvasive prenatal diagnosis, but as it became clear that the method is not diagnostic, the terminology has increasingly shifted toward noninvasive prenatal screening [61]
Summary
Since its introduction in 2011, noninvasive prenatal testing (NIPT) has taken prenatal care by storm. Participants in this study were enthusiastic about public funding, they thought it could create subtle pressure on pregnant people to use NIPT [63] In another qualitative study with Lebanese HCPs, cost was seen as potentially increasing disparities in access to prenatal testing (since only those of higher socioeconomic status would benefit from private coverage) and limiting NIPT’s ethical implementation [64]. Another issue was the potential use of NIPT for sex-selective terminations, either because of a preference for boys or for family balancing, which are culturally important in some regions of Lebanon [64]. Such limits on access to termination can impact the use of NIPT for those who test with the intent of terminating an affected pregnancy
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