Where in the Prenatal Screening Pathway do Ethnic and Socioeconomic Inequalities Occur? A UK Retrospective Cohort Study

ABSTRACT Objective To examine if and where ethnic and socioeconomic inequalities arise within the English NHS prenatal screening pathway by investigating associations between ethnicity, socioeconomic deprivation, screening test type, further testing uptake, and pregnancy outcomes. Method This retrospective cohort study analysed data from 6339 women offered prenatal screening and diagnostic testing at a UK tertiary hospital between January and December 2023. Logistic regression and chi‐squared tests assessed associations between ethnicity, socioeconomic deprivation and testing patterns. Only complete cases were analysed. Results The odds of receiving the less accurate quadruple screening test were higher for women from Black (OR 2.07, 95% CI 1.54–2.77) and Mixed ethnic groups (OR 1.82, 95% CI 1.17–2.73), compared to White women, and higher for those in the most deprived areas (OR = 2.34, 95% CI: 1.44–4.00). Further‐testing patterns varied by ethnicity following a high chance screening result, with Black women overrepresented among those recorded as having declined further testing ( χ 2 = 22.06, p = 0.007); however, numbers were small. Pregnancy outcomes appeared broadly aligned with test results, with no clear evidence of variation by ethnicity or socioeconomic deprivation. Conclusion Ethnic and socioeconomic inequalities were most evident in the earlier stages of the prenatal screening pathway, particularly among Black women. Prioritisation of equitable access to timely screening is critical to ensure prenatal testing benefits all families.