Prioritizing the Health of Underserved Communities in Prenatal Genetics

Abstract: Prenatal cell-free genetic screening (cfDNA) for fetal chromosomal conditions, including aneuploidy and microdeletion syndromes, is increasingly offered in diverse patient populations and clinical settings, including in safety-net clinics and other public health settings. Companies testing for cfDNA have argued for first-tier cfDNA by state Medicaid programs, arguing that differences in coverage of these screens between public and private insurance constitute a health disparity. We contend that this framing is unhelpful considering the ongoing maternal and perinatal health crisis affecting low-income families and existing data on the primary drivers of disparate pregnancy outcomes. cfDNA technology has the potential for a significant impact on public health and prenatal health disparities, if panels were less expensive and addressed the leading causes of maternal and perinatal morbidity. Finally, we examine the role of prenatal genetics in public health and discuss promising prenatal technologies that could help address adverse pregnancy outcomes disproportionately affecting minoritized and underserved populations.