Sequencing of Circulating Cell-free DNA during Pregnancy

To the Editor

The review article by Bianchi and Chiu (Aug. 2 issue)1 offers an international scope and provides an accurate presentation of data showing the value of cell-free DNA (cfDNA) screening for common aneuploidies in all risk populations. The authors also acknowledge that insurance creates access challenges for many pregnant women.

As experts in obstetrics and genetic counseling, we can attest to the high performance and clinical usefulness of cfDNA screening. We also witness insurance coverage gaps that cause considerable disparity in access to quality prenatal care.

Although some commercial insurers cover cfDNA screening regardless of risk status, two major insurers continue to restrict coverage to high-risk pregnancies. A total of 11 state Medicaid programs and the District of Columbia do not cover cfDNA screening in high-risk pregnancies, despite universal support from professional guidelines. Currently, only 3 public insurers cover cfDNA screening in the general obstetrical population (Rhudy M, Coalition for Access to Prenatal Screening: personal communication). We hope that the authors’ optimistic prognosis regarding public insurance coverage of cfDNA screening in the general obstetrical population will soon become reality.

Jennifer M. Hoskovec, M.S., G.C.G.
UTHealth, Houston, TX

Annelise S. Swigert, M.D.
Southdale Obstetric and Gynecologic Consultants, Edina, MN

Ms. Hoskovec and Dr. Swigert report serving as clinical advisory board members for the Coalition for Access to Prenatal Screening; and Dr. Swigert, serving as a clinical advisory board member for Integrated Genetics. No other potential conflict of interest relevant to this letter was reported.

  1. 1. Bianchi DW, Chiu RWK. Sequencing of circulating cell-free DNA during pregnancy. N Engl J Med 2018;379:464473.

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