By Kierra Enns (Contributor) – Email
Print Edition: October 9, 2013
Every year, about 44,000 babies are born in British Columbia. Of these, about 62 will be born with Down syndrome.
Because Down syndrome is a chromosomal disorder, it is possible to assess risk for this abnormality while the fetus is still in the womb. Among other factors, the age of the mother is important in assessing risk, as pregnancies in older women are considered high-risk for chromosomal disorders. Early warning is valuable for a pregnant woman, as she may then choose to terminate her pregnancy, deliver at a high-risk birth centre, or prepare to raise a disabled child.
However, do we need to go to the length of expensive testing for every pregnancy in BC, considering the rarity of the disorder?
Serum Integrated Prenatal Screen (SIPS), an assessment of the probability of a child being born with Down syndrome, is offered to every woman in British Columbia as part of her prenatal care. The cost of SIPS is fully paid by the Canadian health care system, and is considered the standard risk assessment for normal and low-risk pregnancies. The cost to the province per SIPS is approximately $500 per pregnancy. Some women choose not to have the assessment done.
SIPS consists of two blood tests done at 10 to 12 weeks and then again at 15 to 20 weeks of pregnancy. It measures the levels of certain proteins and hormones to assess risk of chromosomal abnormality. It’s not actually very informative by itself, but it indicates to health-care providers whether or not a woman should have further testing done. It’s important to understand that SIPS is not an actual specific test for Down syndrome.
However, SIPS is non-invasive – the only test that can absolutely confirm chromosomal abnormalities is an amniocentesis (a needle inserted into the amniotic fluid surrounding the fetus), which is invasive and can, although rarely, be traumatic enough to cause miscarriage.
A new method of testing known as Non-Invasive Prenatal testing (NIPT) can actually detect fetal DNA in the mother’s blood and is usually conducted at 10 to 13 weeks of pregnancy. This test is substantially more accurate and does not require invasive testing to confirm results. As well, because the results are received earlier in the pregnancy, a woman intending to abort can do so without coming close to the point when terminating a pregnancy can become dangerous.
The downside? This test is not covered by the government, and the price tag is hefty at $1,100 per test.
Even with a public health care system, not every procedure or test can be covered by the provincial government. SIPS is now a well-documented method of assessing risk for Down syndrome and selecting women who would benefit from an amniocentesis. It’s already the system standard for pregnancy care in BC, and doctors offering the assessment understand it well, knowing which of their patients should be urged to have SIPS done, and which may not need it.
To provide NIPT to every pregnant woman would cost double what SIPS does and its advantages are simply not worth the cost. We have limited resources of health care dollars at our disposal, and for 62 diagnoses of Down syndrome a year, this would be an unreasonable over-extension of prenatal risk assessments.
We can absolutely ensure that all high-risk pregnancies are offered all of the necessary assessments and tests – covering NIPT tests for all mothers over the age of 35, for instance, would be reasonable – but we don’t need to pile new procedures onto a system already carrying the weight of one standard assessment. Ultimately, NIPT is a specialized test for a selective group of pregnancies, and we shouldn’t cover its cost for those who statistically don’t need it.
As a province, we need to understand collectively that we cannot tax our health care system indefinitely, and at one point or another, we need to tailor care to those who need it – not blanket everyone who may want it.
