Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program by the National Health Insurance in Poland

Abstract

Objective: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program. Material and Methods: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study. They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocentesis were compared between the groups. Results: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wallis test; p<0.001). Maternal age, fetal malformation in the previous pregnancy, and anxiety were less frequent in group B (p<0.0001, p=0.0008 and p=0.0156, respectively). In contrast, a higher frequency of positive biochemical screening and abnormal ultrasound results as indications for amniocentesis was found in group B (p<0.0001 and p=0.0008, respectively). Conclusions: The introduction of the Prenatal Screening Program by the National Health Insurance shifted the proportion of indications for amniocentesis from maternal age to positive results in biochemical and ultrasound screenings, and increased the number of invasive testing. Further observation of the trend and its influence on the detection rate is imperative to confirm that the proposed Program is adequate and does not require adjustments.