Pregnant woman
>> Important Prenatal Screening Service Announcement - Information for Health Care Providers <<

UPDATE (July 7, 2020) - The temporary measures outlined below came into effect on April 6, 2020 and have been extended to December 31, 2020. 

Ontario currently uses a two-step prenatal screening system, with enhanced First Trimester Screening (eFTS) generally being the first step. However, the COVID-19 pandemic is having an impact on how prenatal screening services in Ontario are being delivered:

  • Some diagnostic imaging centres are not offering dating and NT ultrasounds
  • Community blood collection services are being consolidated to a smaller number of labs 
  • Pregnant individuals in self-isolation are missing the NT ultrasound window 

In situations where an NT ultrasound is NOT performed, Prenatal Screening Ontario (PSO), supported by the Ministry of Health, is endorsing the following measures: 

Singletons: NT ultrasounds should be offered to all pregnant individuals whenever possible. If an NT ultrasound cannot be done, order the MSS.

  • MSS is the only validated serum screen in Ontario that can be used without ultrasound information, and can be done from 14 weeks to 20 weeks 6 days gestation. 
  • A concurrent change in the screening cutoff for MSS occurred, moving it from 1:200 to 1:350 (bringing the screening performance to a similar level as eFTS).
  • PSO cannot endorse first trimester serum-only screening because provincial data collected by BORN Ontario has insufficient numbers to allow for quality assurance.

Twins: Prioritize NT services. The Ministry of Health will temporarily fund NIPT for all twin pregnancies if a NT ultrasound is not available and can be ordered by any physician or nurse practitioner (effective April 6, 2020 until December 31, 2020).

  • NT ultrasounds are essential for twin pregnancies as serum screening alone is NOT possible for twin pregnancies (i.e. MSS is not a validated option). The value of NT ultrasounds extends beyond screening for Down syndrome and trisomy 18.

Higher-Order Multiples: The only option continues to be an NT ultrasound.

  • For triplets, quadruplets, or more, the only option is NT ultrasound (eFTS, MSS and NIPT cannot be done). 
  • Serum screening alone is not possible for higher-order multiples (i.e. MSS is not a validated option for twin pregnancies). 

EDUCATIONAL OUTREACH: Do you think your organization would benefit from a general educational session about prenatal screening in Ontario? Contact us to inquire about in person or virtual options 

 COVID-19 and Prenatal Screening - Information for Pregnant Individuals 

As a pregnant individual in Ontario, you have the option of undergoing screening tests to give you information about the health of your baby. The COVID-19 pandemic is impacting the availability of these tests and possibly your own ability to access them. The video below explains the typical prenatal screening options in Ontario and what recommendations we are endorsing with the support of the Ministry of Health if certain tests are not available to you during this time. The recommendations are applicable until December 31, 2020. 

 

COVID-19 video thumbnail
Typical Prenatal Screening Options
COVID-19 Impact on Access to Prenatal Screening
What if NT Ultrasound is Missed?
Resources
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Typical Prenatal Screening Options
COVID-19 Impact on Access to Prenatal Screening
What if NT Ultrasound is Missed?
Resources

 

 

 

 FAQ
 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. 

 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. 
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 Maternal Serum Screen (MSS) that is done in the second trimester, between 14 weeks and 20 weeks 6 days gestation. The MSS 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 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. 
 What is the accuracy of the Maternal Serum Screen (MSS)? 

Recent changes to the MSS have been implemented in the light of COVID-19, and its performance is currently similar to the eFTS. The detection rate of MSS is approximately 90%. This means that 90% of patients carrying a baby with Down syndrome will have a screen positive result using MSS.  Because screening cannot detect all cases, approximately 10% of pregnancies with Down syndrome will receive a screen negative result using MSS.

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 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 Screen (MSS) 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 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. 
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 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 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.  
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.   
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. 
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. The MSS is not possible for pregnancies with twins. Prenatal Screening Ontario is encouraging that NT ultrasounds be made available for individuals carrying twins or more, regardless of whether NIPT was initiated. NT ultrasounds can provide valuable information with regards to the health of the babies. 
  • The Ministry of Health temporarily approved funding for NIPT in the context of twin pregnancies if you do not have access to an NT ultrasound OR if you are 35 years or older.
  • If you are having triplets, quadruplets, or more, your option for screening the pregnancy for chromosome differences is limited to NT ultrasound only (eFTS, MSS and NIPT cannot be done). 

                                                

 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 conduct their own COVID-19 screening to defer services to individuals that pose a higher risk. We encourage you to contact the individual laboratories and ultrasound units to learn about their specific guidelines. For instance, the sites may not offer service if you have travelled outside of Canada within the last 14 days or if you have fever and/or respiratory-like symtoms such as coughing, shortness of breath, sore throat and runny nose.

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: Pregnancy, Birth, and the Newborn

A number of health organizations have reviewed the current evidence about coronavirus (COVID-19) and pregnancy, and released information. BORN Ontario has summarized this information below. This content will be updated as new evidence becomes available. 

What We Know Now (May 14, 2020)

• Pregnancy does not appear to increase a person’s risk of becoming infected with COVID-19. 

• Clinical signs and symptoms of a COVID-19 infection are usually the same in pregnant and non-pregnant people, which can include fever, cough, shortness of breath, body aches, fatigue and sore throat.

• The majority of pregnant people in Ontario are healthy and considered low-risk, with no pre-existing health conditions. Healthy pregnant people infected with COVID-19 usually have mild symptoms and recover at home without needing hospital care.

• Experts are not sure yet, but it seems that during pregnancy and birth the risk of transmission is low from a COVID-19 infected mother to their baby. After birth, the COVID-19 infected mother could pass the virus to the newborn if infection control measures are not taken, but the risk of transmission is unknown at this time. 

• Most babies born to COVID-19 infected mothers are usually healthy and do not require hospitalization, but some may be born too early or too small and might need longer hospital stays. 

What to Expect during Labour and Birth

• Pregnant people may identify one support person for the duration of their labour and birth. This support person needs to be free of signs and/or symptoms of COVID-19 infection, follow physical distancing and infection control instructions. This is important since some people can have a COVID-19 infection, without any signs and/or symptoms.

• Birthing facilities will welcome one support person if they have the following resources:

- staff available to screen the support person for COVID-19 and to ensure he/she complies with infection control measures

- enough space to maintain a safe distance from others

- personal protective equipment for the support person, such as masks and gowns  

• Keeping mothers and babies together continues to be recommended. This may not be possible for some COVID-19 infected mothers, because of maternal/newborn health concerns and available hospital resources. If separation is warranted, care providers should discuss reasons.

• Breastfeeding is still encouraged in infected people since it appears that COVID-19 does not transfer into breastmilk. Infected mothers should wear a mask and wash their hands and breast/chest area before breastfeeding. 

• Testing newborns for COVID-19 of infected mothers is recommended within 24 hours of birth.

It is important to continue to see your care provider for prenatal appointments and follow their recommendations.

 

 Key Resources