Prenatal chromosomal microarray uptake with invasive prenatal diagnosis: How many patients take the leap?

Objective Characterize the uptake of chromosomal microarray analysis (CMA) among women undergoing invasive prenatal diagnosis at a large academic institution over a 4‐year time period. Methods Retrospective database review of women who underwent invasive prenatal diagnosis via chorionic villus sampling (CVS) or amniocentesis. Entries were reviewed for demographic and clinical information. Results Nine hundred forty‐six diagnostic procedures were performed at our institution over a 4‐year time period including 259 CVS and 687 amniocentesis procedures. Overall, 32% elected CMA, with a significant increase in uptake over time. Women with Medicaid/CHIP insurance were more likely to elect CMA than those with private insurance (OR = 1.59, 95% CI, 1.18‐2.14), while multigravida women were less likely than primigravidas to elect CMA (P = 0.003). Women with ultrasound findings were more likely to elect CMA than any other indication. Those with structural abnormalities in multiple systems (OR = 3.75, 95% CI, 1.60‐8.79) or abnormalities in a single system (OR = 3.22, 95% CI, 1.47‐7.05) were more likely to elect CMA than with any other types of ultrasound findings. Conclusion The uptake of CMA significantly increased over a 4‐year period at a large academic institution. Women with ultrasound indications, specifically structural abnormalities, are the most likely to elect CMA. What is already known about this topic? Chromosomal microarray (CMA) is being incorporated as a standard test offered to women undergoing invasive prenatal diagnosis Two small cohort studies shortly before and soon after the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine committee opinion showed women were most likely to elect CMA in the context of fetal abnormalities What does this study add? Cohort from a large, diverse patient population across a 4‐year time period where CMA is routinely offered to all patients undergoing invasive prenatal diagnosis, making results more universally applicable Ultrasound findings remain the strongest predictor of CMA uptake, with patients more likely to elect CMA in the presence of specific subcategories of ultrasound findings Patients with private insurance are less likely to elect CMA, suggesting financial considerations may play a role in decision to pursue CMA