Screening For All
New guidelines urge every pregnant woman to get early testing for risk of Down syndrome
Definitive. Recognizing that some women may want a yes or no diagnosis, ACOG now recommends that all expectant women be offered amniocentesis or CVS in addition to screening. "Some couples aren't comfortable with any risk and want a definitive test," says James Goldberg, medical director of San Francisco Perinatal Associates, who helped write the ACOG guidelines. "People weigh numbers differently."
Most insurance companies cover amniocentesis and CVS, which cost upwards of $1,000 each, only in women over 35 or those with abnormal screening results. That should change. "We plan to review these new recommendations within the next few weeks, but we typically follow the guidelines of ACOG," says Joanne Armstrong, a senior medical director for Aetna. Aetna and many other insurance companies already cover the screening tests.
But a more practical matter may limit early screening. Nuchal translucency is primarily available only in major medical centers and large city hospitals; it's not yet in most smaller ultrasound facilities. "It's becoming more popular, but it may take a year or two to reach all settings," Driscoll says. For those who can't get the sonogram, ACOG advises having the first- and second-trimester blood tests, which together can pick up 85 to 88 percent of Down cases.