Pregnant woman
 COVID-19 and Prenatal Screening
 
 FAQ

Q: What is the typical pathway of prenatal screening?

The prenatal screening pathway usually starts with enhanced First Trimester Screening (eFTS), which includes a nuchal translucency ultrasound and bloodwork performed between approximately 11 weeks and 2 days and 13 weeks and 3 days gestation to provide you with information about trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome). Depending on the type of test result received from eFTS, the typical next step in prenatal screening involves the detailed anatomy ultrasound, performed between 18-20 weeks gestation. Some patients may also have the option of pursuing OHIP-funded Noninvasive Prenatal Testing (NIPT). Alternatively, some patients may wish to pay out of pocket for this testing. NIPT can be performed as early as 9 weeks gestation depending on the company, and a dating ultrasound is recommended prior to having your blood drawn. 

 

Q: What does COVID-19 mean for my access to prenatal screening?

Given the current situation, you may be wondering what options are available to you that minimize the amount of time spent in public areas. Some individuals are not able to attend their ultrasound appointments due to being in self-isolation and may miss the time window for eFTS. Clinics and hospitals may also be prioritizing and reallocating their resources due to COVID-19 and as a result, you may encounter difficulties accessing some ultrasound services. Blood collection labs are also closing and consolidating services at a lower number of sites across the province. There are currently ongoing efforts to provide patients with alternative pathways for obtaining robust government-funded screening during their pregnancies in the event that a time-sensitive screen or ultrasound is missed.  We are here to support you and your care provider in providing you with the most optimal care in light of your specific circumstances. 

 

Q: I am not able to access a nuchal translucency (NT) ultrasound in my area. Can I still obtain prenatal screening?

If you are not able to access a NT ultrasound, the eFTS cannot be completed. However, a comparable alternative screen to eFTS is the Maternal Serum Quadruple Screen (MSS-Quad) that is done in the second trimester, between 14 weeks and 20 weeks 6 days gestation. The MSS-Quad is a validated test that has been in use for years in Ontario in circumstances where the first trimester screening test is missed. NT ultrasound information is not required for this test. The MSS-Quad uses a combination of maternal age and blood work to give information about trisomy 21 (Down syndrome) and trisomy 18 (Edward syndrome). You may also have the option of pursuing OHIP-funded NIPT if specific criteria are met. If you do not meet criteria for OHIP-funded NIPT, you may still choose to pursue self-pay NIPT. NIPT can be done at any point in the pregnancy starting at 9 or 10 weeks gestation depending on the lab. Check with your local blood collection lab (LifeLabs or Dynacare) to ensure they can still provide NIPT services at their location. 

 

Q: I was not able to access a nuchal translucency (NT) ultrasound but my doctor sent me for a prenatal screening blood draw and I am less than 14 weeks gestation. If my blood has already been drawn, what result can I expect from this? 

If your blood has been drawn for screening in the first trimester, some blood labs will not process this sample and will recommend that you return for a blood draw after 14 weeks gestation to initiate a MSS-Quad. Some labs may be able to provide you with a first trimester MSS-Quad if they receive a blood sample from you and there was a dating ultrasound done earlier in the pregnancy.

 

Q: I am over 14 weeks gestation and I have not had access to any ultrasounds in my pregnancy. What are my options for screening? 

If you have missed the window for a dating and a nuchal translucency ultrasound, please be assured that you will still have options for prenatal screening. The MSS-Quad can be done based on the first day of your last menstrual period if you are unable to access an ultrasound prior to having your blood drawn. You may also have the option of pursing OHIP-funded or self-funded NIPT which can be done at any point until the end of the pregnancy. Please note that the performance of both MSS-Quad and NIPT may be affected if the last menstrual period dating is not accurate, or if there is more than one fetus and this information is not known at the time of the blood work. 

 

Q: I would like to do NIPT. How can I have my blood drawn and will there be a delay in obtaining results?

There has been a reduction in the number of lab collection centers offering blood draw services. We encourage anyone planning to have their blood drawn for NIPT to check with Dynacare and LifeLabs for the most up-to-date information on which locations are in operation. There are currently no changes to how long it takes for results to be reported but this may change in the future.   

                                                                                                          

Q: I am in self-isolation and I am worried about being able to have prenatal screening. What are my options? 

It is important to follow public health directives during this time and follow social distancing or self-isolation guidelines as prescribed. We are anticipating that some individuals in self-isolation will not be able to attend appointments during that time and may miss the window for certain time-sensitive blood tests and ultrasounds. Be assured that you will still have the option of doing prenatal screening tests once you are no longer in self-isolation, and those options will be dependent on your gestational age and other factors. Please contact your health care provider for further guidance if you find yourself in this situation. 

 

Q: I am expecting more than one baby (e.g. twins, triplets). Do I have the same options for prenatal screening as those who carry one baby?

If you are carrying twins, your options for prenatal screening are eFTS and NIPT. If you are over 35 years of age and you are carrying twins, you can obtain OHIP-funded NIPT. You may also be eligible for OHIP-funded NIPT if you are under age 35 and meet other funding criteria. Please note that the MSS-Quad is not possible for pregnancies with twins. If you are having triplets, quadruplets, or more, your option for screening the pregnancy for chromosome differences is limited to NT ultrasound only. PSO is encouraging that NT ultrasounds be made available for individuals carrying twins or more.  

 Staying Up-to-Date
While blood collection laboratories and obstetrical ultrasound units are providing essential health care services, sites may have implemented new protocols for patient visits.  At some facilities, this may not include particular ultrasound examinations such as dating scans and nuchal translucency ultrasound.  If you are unable to obtain a first trimester ultrasound, please consult your physician to discuss alternative screening options.  Prior to seeking testing or ultrasound, we recommend consulting the websites of your chosen location to learn about any changes in service, hours, or closures.
  • Life Labs 
  • Dynacare 
  • For ultrasound units, refer to our interactive map to find contact information for all sites that normally offer nuchal translucency (NT) scans.  Please contact the sites near you to confirm that NT scans are available, given changes in services due to COVID-19. 

Please be aware that sites may not offer service if you have:

  1. travelled internationally within the last 14 days OR
  2. been in contact with an affected person within the last 14 days OR
  3. a new onset/worsening cough, shortness of breath or fever.

If you are concerned that you may have been exposed to, or are experiencing symptoms of COVID-19, please start by visiting the Ministry of Health website and taking their self-assessment.

The current situation with COVID-19 is changing daily and we will update the Prenatal Screening Ontario website frequently to keep you informed. As always, Prenatal Screening Ontario’s genetic counsellors are available to answer your questions and can be reached by calling 1-833-351-6490, Monday to Friday from 8am to 4pm.

 COVID-19 Infection in Pregnancy

A number of health organizations have issued statements for pregnant individuals and families related to the coronavirus disease (COVID-19) pandemic. 

What we know to-date (March 27, 2020):

  • There is currently limited information to guide pregnant individuals and their care providers about optimal care and effects of infection during pregnancy on the fetus.  Based on the latest evidence, transmission of the virus (SARS-CoV-2) from mother to fetus/infant via the placenta, breastmilk, or the birth process cannot be ruled out at this moment.
  • Evidence to-date suggests that pregnant individuals are not more likely to become infected with COVID-19 than the general population.
  • Pregnant individuals seem to have the same clinical signs and symptoms of the disease as those experienced by non-pregnant adults and include fever, cough, shortness of breath, body aches, fatigue and sore throat. Should you experience any of these symptoms, please contact your health care provider. 
  • It is still too early to know the potential impact of COVID-19 in early pregnancy.  However, there is some evidence that prolonged high fever, particularly in the first trimester, carries a small increased risk for some birth defects.  
  • Small studies from China suggest that while pregnant individuals don’t seem to have bad outcomes themselves, their newborns may be born too early or too small and have longer hospital stays.  
  • Most children infected with COVID-19 have mild, moderate, or no symptoms at all. Few children have required hospitalization and they tend to recover well. Children younger than one year of age seem to experience more severe symptoms than children in older age groups.

It is clear that certain infections can cause problems for pregnant individuals, likely because of the body’s adaptations to pregnancy. This happened with the 2009 H1N1 flu pandemic and other viral outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Fever and other illness symptoms may lead to being born too early or too small.    

It is extremely important to follow your care provider’s guidelines for prenatal care appointments, follow social distancing or self-isolation guidelines as prescribed and keep informed of public health directives in your region. All pregnant individuals regardless of gestational age should not travel outside of Canada.

 

COVID-19 - Labour, Birth & Newborn Care

Recommendations for pregnant individuals who have been exposed to COVID-19 and have symptoms (positive or unknown test result):

  • The Society of Obstetricians and Gynaecologists of Canada recommends making decisions about separating mother and baby, breastfeeding, and delaying umbilical cord clamping on a case-by-case basis, considering the patient’s and family’s values, the latest evidence, and the availability of resources.
  • They do not routinely recommend separating mother and baby, but a family may prefer to do so until the mother’s symptoms stop.
  • They encourage and support breastfeeding. However, mothers with confirmed or suspected COVID-19 should wear a facemask while breastfeeding, and wash their hands before touching the baby, the breast pumps, or the bottles. The same recommendations apply for skin-to-skin contact or when handling the baby.
  • There is very little evidence at this moment on whether specific protection for COVID-19 can be passed on to the baby through breastfeeding.
  • Delayed umbilical cord clamping is still routinely recommended unless it is contraindicated for other reasons.

Please note that these recommendations might change as more evidence becomes available.

 Key Resources