Prenatal Screening for Individuals 40 Years and Over at EDD

Like all pregnant individuals, those aged 40 and over at EDD have the option to have prenatal screening. However, these individuals qualify for publicly-funded NIPT based on their age at EDD. Therefore, those who choose to have screening should be offered publicly-funded NIPT instead of MMS, unless the NIPT result is uninformative. For pregnancies with in vitro fertilization, those with eggs aged 39 and over at the time of retrieval (self or non-self) are eligible for publicly-funded NIPT.

A stand-alone nuchal translucency ultrasound should still be offered to pregnant individuals having NIPT.

Taylor's Story

Meet Taylor. Taylor will be 40 years old at EDD. She is currently 8 weeks’ gestation with a singleton pregnancy. She would like to have prenatal screening to understand the chance for her current pregnancy to have trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome). She has a discussion with her health-care practitioner about her screening options and is appropriately offered publicly-funded NIPT because she meets the NIPT funding criteria of being 40 years and over at EDD.

Taylor's health-care practitioner also notes that a stand-alone nuchal translucency (NT) ultrasound should still be offered to individuals having NIPT, and this is offered to Taylor as well.

Remember, always order publicly-funded NIPT (instead of eFTS) for pregnant individuals aged 40 and over at EDD. For IVF pregnancies, order publicly-funded NIPT if the age of the egg at retrieval is aged 39 and over.

The overall uptake of prenatal screening* in individuals age 40 and over was 81%.

*MMS and/or NIPT (publicly-funded or self-paid)

Figure 8. Overall uptake of prenatal screening* in pregnant individuals age 40 and over at EDD.

*refers to MMS and/or NIPT (publicly-funded or self-paid

What types of prenatal screening did pregnant individuals age 40 and over have?

Remember, pregnant individuals age 40 and over qualify for publicly-funded NIPT.

Why are some pregnancies having MMS only? Our data showed that only a small number of these pregnancies appropriately had MMS because of an IVF pregnancy with egg age less than 40 years old, therefore, these pregnancies did not qualify for publicly-funded NIPT.
Why are some pregnancies having MMS and NIPT? Our data showed that only a small number of these pregnancies appropriately had MMS after an uninformative NIPT result.

Remember, MMS should not be ordered if the individual qualifies for publicly-funded NIPT (but do order a stand-alone NT ultrasound).

Figure 9. Proportion of prenatal screening by modality in pregnant individuals age 40 and over at EDD.

*refers to publicly-funded or self-paid NIPT

The overall uptake of NIPT* in pregnant individuals age 40 and over was 65%. How many pregnancies had publicly-funded NIPT?

*NIPT only (publicly-funded or self-paid) or with MMS

Remember, pregnant individuals aged 40 and over qualify for publicly-funded NIPT. However, 5.2% of them self-paid for NIPT. In FY 2020-2021, only a small number of these pregnancies appropriately had self-paid NIPT because of an IVF pregnancy with an egg age <40.

Figure 10. Proportion of NIPT by funding status in pregnant individuals age 40 and over at EDD.

Data notes:

BORN Ontario, 2020-2023

Screening uptake by modality for singleton pregnancies among Ontario residents, stratified by maternal age at EDD.

1. BORN Ontario strives to better understand how our data can be used to inform health system partners on the intersection between social determinants of health, indigeneity, and perinatal and child health outcomes. This table includes data that may or may not support reflections on indigeneity and health equity. We cannot conclusively or accurately identify the extent to which BORN data reflect indigeneity and equity-deserving groups. This pursuit is ongoing, and we appreciate your support and ideas related to enabling our efforts in pursuit of more equitable outcomes and programming.

2. Data were extracted from the BORN Information System (BIS) on 8 Nov, 2024. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

3. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

4. The cohort timeline was defined by pregnant person estimated date of delivery.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

7. BORN Ontario strives to better understand how our data can be used to inform health system partners on the intersection between social determinants of health, indigeneity, and perinatal and child health outcomes. This table includes data that may or may not support reflections on indigeneity and health equity. We cannot conclusively or accurately identify the extent to which BORN data reflect indigeneity and equity-deserving groups. This pursuit is ongoing, and we appreciate your support and ideas related to enabling our efforts in pursuit of more equitable outcomes and programming.

BORN Ontario, 2020-2021
Total number of pregnancies with MMS and maternal age >=40 at EDD or with self-paid NIPT and maternal age >=40 at EDD among singletons pregnancies of Ontario residents, and number and percentage of these pregnancies with oocytes <40 years at EDD.

1. Data were extracted from the BORN Information System (BIS) on 4 Oct, 2023. Note that data submission to the BIS is both voluntary and open to updates and amendments. This table represents a snapshot of the BIS on the date of data extraction.

2. Fiscal year was defined by estimated date of delivery. Each fiscal year ranges from April 1 to March 31, inclusive.

3. The cohort timeline was defined by pregnant person estimated date of delivery.

4. Only singleton pregnancies were included in this analysis.

5. Only Ontario residents were included in this analysis.

6. Only IVF cycles with a cycle start date in or before 2021 were included in this analysis.

7. BORN Ontario strives to better understand how our data can be used to inform health system partners on the intersection between social determinants of health, indigeneity, and perinatal and child health outcomes. This table includes data that may or may not support reflections on indigeneity and health equity. We cannot conclusively or accurately identify the extent to which BORN data reflect indigeneity and equity-deserving groups. This pursuit is ongoing, and we appreciate your support and ideas related to enabling our efforts in pursuit of more equitable outcomes and programming.

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