Uptake of Prenatal Screening

Prenatal screening is a way to determine the chance that a baby has or does not have trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome). It is available to all pregnant individuals in Ontario who want screening and can be ordered through their health-care practitioner. There are two main categories of OHIP-funded prenatal screening: Multiple Marker Screening (MMS) which is available to all pregnant individuals and Non-Invasive Prenatal Testing (NIPT) which is available to pregnant individuals meeting the NIPT funding criteria at the time of blood draw (those who do not meet the funding criteria can choose to self-pay; data contained in this report refers to self-paid NIPTs from Dynacare® and LifeLabs® only). NIPT can also screen for additional genetic conditions. Further information about prenatal screening can be found on our website.

The overall uptake of prenatal screening* was 78%.

*Prenatal screening refers to Multiple Marker Screening (MMS) and/or Non-Invasive Prenatal Screening (NIPT) (OHIP-funded and self-paid)

Remember, to have or not have prenatal screening is a choice. Therefore, we do not aim for the uptake to be 100%.

PSO provides information to help individuals decide if prenatal screening for trisomy 21 and trisomy 18 is right for them. Check this out today for use in your practice!

Data notes:

BORN Ontario, 2020-2023

Screening uptake for singleton pregnancies among Ontario residents.

1. BORN Ontario strives to better understand how our data can be used to inform health system partners on the intersection between social determinants of health, indigeneity, and perinatal and child health outcomes. This table includes data that may or may not support reflections on indigeneity and health equity. We cannot conclusively or accurately identify the extent to which BORN data reflect indigeneity and equity-deserving groups. This pursuit is ongoing, and we appreciate your support and ideas related to enabling our efforts in pursuit of more equitable outcomes and programming.

2. Data were extracted from the BORN Information System (BIS) on 8 Nov, 2024. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by pregnant person estimated date of delivery.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

Of all the pregnancies that had prenatal screening, what type(s) (modality) of screening did they have?

Of all the pregnancies that had prenatal screening:

81% had MMS only
8% had NIPT* only
11% had both MMS and NIPT.*

As expected, use of MMS decreased in the aged 40 and over population because these pregnancies are eligible for OHIP-funded NIPT based on age, unless there is an IVF pregnancy with an egg age less than 40 years old.

Accessible text:

Figure 2. Proportion of screening, stratified by modality and pregnant individual age at EDD.
Age at EDD	MMS Only (%)	NIPT only (OHIP-funded and self-paid) (%)	MMS and NIPT (OHIP-funded and self-paid) (%)
under 20	95.7	0.9	3.0
20-24	95.0	1.3	3.7
25-29	92.3	2.7	5.0
30-34	84.8	6.4	8.8
35-39	72.2	11.1	16.7
40 and over	19.8	42.9	37.2

Data notes:

BORN Ontario, 2020-2023

Type of prenatal screening stratified by modality and pregnant individual age at EDD for singleton pregnancies among Ontario residents.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by pregnant person estimated date of delivery.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

The most common type of screening used was MMS,^* with an overall uptake of 71%. What type of MMS did pregnant individuals have?

*MMS only or with NIPT (OHIP-funded and self-paid)

Data notes:

BORN Ontario, 1Apr2020 - 31Mar2023

MMS uptake for singleton pregnancies among Ontario residents, stratified by modality.

2. Data were extracted from the BORN Information System (BIS) on 1 Oct, 2024. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by MMS report date.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

The overall uptake of NIPT* was 15%.

*NIPT only (OHIP-funded and self-paid) or with MMS.

Hover over the pictograph in figure 4 to read more details about OHIP-funded and self-paid NIPT, and use the arrow in the top right corner to scroll to see the volume of OHIP-funded NIPT by clinical funding indicator.

Check out the OHIP-funded NIPT eligibility criteria to learn more about who qualifies for OHIP-funded NIPT.

Accessible text:

Figure 4. Proportion of NIPT by funding type and proportion of OHIP-funded NIPT by clinical funding indicator.
Population	Volume of NIPT by funding type	Volume of OHIP-funded NIPT by clinical funding indicator
OHIP-funded NIPT	49.8% of pregnancies with NIPT had OHIP-funded NIPT
Self-paid NIPT	50.2% of pregnancies with NIPT had self-paid NIPT. Of all the pregnancies with NIPT, 21.0% self-paid for microdeletion testing. To note, guidelines do not support the use of NIPT to screen for microdeletion syndromes at this time. In looking at a snapshot of these data, in fiscal year 2020-2021 at least 7.6% (689) of individuals who self-paid for NIPT were either eligible for OHIP-funded NIPT at the time of blood draw or became eligible for OHIP-funded NIPT during the pregnancy based on maternal age ≥40 at EDD and/or an increased nuchal translucency measurement (≥3.5mm) and/or a screen positive MMS result. Individuals who are eligible for OHIP-funded NIPT on the date of NIPT blood collection can typically be reimbursed, whereas individuals who were not yet eligible cannot be reimbursed. Pregnant individuals could consider waiting for their NT ultrasound and MMS results before deciding to self-pay for NIPT, although some may prefer to have NIPT as early as possible.
Pregnant individual age 40 and over only		37.0% of the pregnancies with OHIP-funded NIPT had an indication of "maternal age 40 and over only."
Positive MMS only		40.0% of the pregnancies with OHIP-funded NIPT had an indication of "positive MMS only."
Increased NT only		2.0% of the pregnancies with OHIP-funded NIPT had an indication of "increased NT only."
Previous trisomy 13, 18, or 21 only		4.9% of the pregnancies with OHIP-funded NIPT had an indication of "previous T21, T18, or T13 only."
Congenital anomalies only		2.0% of all the pregnancies with OHIP-funded NIPT had an indication of "congenital anomalies only."
Risk greater than positive MMS only		5.8% of the pregnancies with OHIP-funded NIPT had an indication of "risk greater than positive MMS only."
Risk of sex-linked condition/DSD only		0.6% of the pregnancies with OHIP-funded NIPT had an indication of "risk of sex-linked condition/DSD only."
Multiple indication categories		7.6% of the pregnancies with OHIP-funded NIPT had a multiple indications.

Data notes:

BORN Ontario, 1Apr2020 - 31Mar2023

Screening uptake of NIPT for singleton pregnancies among Ontario residents, stratified by funding status.

2. Data were extracted from the BORN Information System (BIS) on 1 Jun 2024 and 1 Oct 2024. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by pregnant person estimated date of delivery.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

BORN Ontario, 2020-2021

Number of singleton pregnancies among Ontario residents that received self-paid NIPT who could have qualified for OHIP-funded NIPT based on maternal age >= 40 and/or a screen positive MMS result and/or an NT level >= 3.5 mm.

1. Data were extracted from the BORN Information System (BIS) on 4 Oct, 2023. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

2. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

3. S = Suppressed due to cell size <6.

4. The cohort timeline was defined by pregnant person estimated date of delivery.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

Trends in prenatal screening uptake.

Considerations for MMS:

The decrease of "other MMS modalities" between FY 2017-2018 to 2018-2019 is because Integrated Prenatal Screening (IPS), which was included in this category, was discontinued in January 2018.
eFTS was introduced during the period of April 2016 to May 2017, hence the increase in uptake between FY 2017-2018 and 2018-2019.

Accessible text:

Figure 5. Trends in uptake of Multiple Marker Screening and Non-Invasive Prenatal Testing by fiscal year. All MMS combined includes eFTS, STS, and other modalities. All NIPT combined includes OHIP-funded and self-paid NIPT.
Fiscal Year	All MMS Combined	eFTS	STS	Other MMS	All NIPT combined	OHIP-funded NIPT	Self-paid NIPT
2017-2018	99,419	65,765	6,249	27,405	14,432	9,312	5,120
2018-2019	97,722	89,934	6,110	1,678	17,065	10,385	6,680
2019-2020	98,646	91,287	5,992	1,367	19,155	10,931	8,224
2020-2021	102,009	94,781	5,558	1,670	22,165	11,362	10,803
2021-2022	98,440	91,242	5,699	1,499	23,287	11,479	11,808
2022-2023	97,449	90,143	5,901	1,405	23,233	11,342	11,891

Data notes:

BORN Ontario, 1Apr2017-31Mar2023

MMS and NIPT uptake for singleton pregnancies among Ontario residents, stratified by fiscal year.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by MMS report date.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

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Uptake of Prenatal Screening

The overall uptake of prenatal screening* was 78%.

Of all the pregnancies that had prenatal screening, what type(s) (modality) of screening did they have?

The most common type of screening used was MMS,* with an overall uptake of 71%. What type of MMS did pregnant individuals have?

The overall uptake of NIPT* was 15%.

Trends in prenatal screening uptake.

The most common type of screening used was MMS,^* with an overall uptake of 71%. What type of MMS did pregnant individuals have?