As an OB/GYN, my north star has always been to ensure that all women — regardless of race, ethnicity, or socioeconomic level — receive the best clinical care possible. Unfortunately, too many pregnant women still face inadequate access to the best prenatal health care options.
Recently the California Department of Health announced plans to expand access to cell-free DNA testing, or cfDNA, which is the most accurate prenatal screen for genetic chromosomal abnormalities, through its Prenatal Screening Program.
While I certainly support increased patient access to cfDNA testing, I am disappointed that the proposed updates to the state program impose significant burdens and restrictions on healthcare providers and will actually lower — not elevate — the standard of care for California mothers.
My patients count on me and their providers as their personal, trusted advisor for medical advice throughout their pregnancy. This new program doesn’t take experience or clinical decision making into account. Instead, it restricts my ability to provide patients with all the appropriate prenatal screenings needed.
Set to go into effect in July 2022, the modified program limits the conditions screened for in cfDNA testing to only trisomies 21 (Down syndrome), 18 (Edwards syndrome), and 13 (Patau syndrome).
Prenatal ultrasound technology and genomic screening have made significant advances especially in the last decade. In fact, as a practicing maternal-fetal medicine specialist, It is hard to keep up with the latest technology offering non-invasive prenatal screening.
Today, I routinely order cfDNA testing for my patients that includes screening for a broader array of conditions, including sex chromosome abnormalities such as monosomy X, and microdeletion syndromes.
For example, I order cfDNA testing that includes screening for 22q11.2 deletion syndrome (DS), the most common microdeletion syndrome, for which early detection and interventions can profoundly impact outcomes for the child (e.g., a baby with 22q who isn’t delivered in a tertiary facility may face cardiac issues or unaddressed hypocalcemia issues, which can cause intellectual decline). This important condition is not included now in the proposed state program.
The medical industry is struggling with a significant shortage in healthcare workers. To screen my patients for these additional conditions, the California Department of Health will require that I go through an entirely new — and frankly unnecessary — process of paperwork and forms, and even collect a separate blood sample from the same patient.
These hurdles will force me and my team to do double the work if we hope to maintain the same level of care that we’re offering our patients today, creating inefficiencies and ultimately increasing healthcare costs. This is a step backwards.
The new screening program program will also increase disparities in access to the more comprehensive cfDNA screening options, particularly among some of the most underserved communities in California — an issue that I am particularly passionate about. If these changes are implemented, patients will have to pay out of pocket to be screened for these critical, additional conditions.
Only patients with the financial means to pay will be able to access this higher standard of care. In addition, only the most well-resourced medical offices will have the resources to manage the extra workload.
I have spent my entire career working to provide women with and advocate for access to the best maternal and prenatal care options. And now I call upon our leaders, legislators and community members to place a pause on this program and re-evaluate its impact. Our patients deserve better.
California’s policymakers must engage with healthcare providers who are closest to patients every day before implementing programs that will have such wide-ranging consequences. This includes the Prenatal Screening Program.
Let’s work together to make sure we aren’t lowering the standard of care available to mothers and babies in California.
Dr. Sean Daneshmand, MD, is an OB-GYN based in San Diego who specializes in maternal and fetal medicine. He is also the founder of Miracle Babies, a nonprofit dedicated to supporting mothers and families of infants born prematurely or with illnesses that require them to remain hospitalized after birth.