New ACOG Guidelines Improve Non-Invasive Prenatal Screening (NIPS) Accessibility

By Chloe Meier, MS, CGC · Dec 2020

In October 2020, The American College of Obstetricians and Gynecologists published updates to their Screening for Fetal Chromosomal Abnormalities guidelines 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 all patients must 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 trimester ultrasound. Any patient with a positive NIPS test result is urged to see a genetic counselor.