Effect of Provider Practices and Genetic History on the Implementation of ACOG Carrier Screening [ID 1584]

INTRODUCTION: The American College of Obstetricians and Gynecologists (ACOG) recommends that all pregnant patients and those planning pregnancies receive information on carrier screening. Few studies have evaluated provider practices and patient factors that might influence carrier screening counseling and completion. METHODS: This two-part study surveyed obstetric providers about their application of carrier screening guidelines and retrospectively reviewed the charts of 600 patients who delivered between July 2020 and June 2021 at a single institution. Survey data was reviewed and patient demographics, obstetric history, and 11-item ACOG genetic screening were collected and analyzed for association with carrier screening counseling and completion. RESULTS: Fifty-three (52%) of 102 clinicians completed the survey. Twelve (22.6%) providers estimated always offering preconception carrier screening, and 18 (36%) estimated always offering carrier screening at initial prenatal visits. Of 523 patients meeting inclusion criteria, 71 (14%) were offered and 24 completed carrier screening. Of the 374 patients who answered genetic screening questions, 46 (12.3%) were offered carrier screening (X2 1.82, P .18); 17 of these patients (37%) completed carrier screening ( P .60*). Patients with positive genetic screen (n=145) were not offered carrier screening more frequently than those with negative screen (13% versus 87%, P .75*) but were more likely to complete carrier screening when offered (58% versus 42%, P .03*). CONCLUSIONS/IMPLICATIONS: Providers overestimated how often they offered carrier screening. Understanding family history provides valuable information, but use of ACOG’s genetic screening did not increase carrier-screening counseling frequency. Patients with a positive genetic screen were more likely to accept carrier screening when offered.