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Uptake of Prenatal Screening

Prenatal screening is a way to determine the chance that a baby has or does not have trisomy 21 (Down syndrome) and trisomy 18 (Edwards syndrome). It is available to all pregnant individuals in Ontario who want screening and can be ordered through their health-care practitioner. There are two main categories of publicly-funded prenatal screening: Multiple Marker Screening (MMS) which is available to all pregnant individuals and Non-Invasive Prenatal Testing (NIPT) which is available to pregnant individuals meeting the NIPT funding criteria at the time of blood draw (those who do not meet the funding criteria can choose to self-pay; data contained in this report refers to self-paid NIPTs from Dynacare® and LifeLabs® only). NIPT can also screen for additional genetic conditions. Further information about prenatal screening can be found on our website.

The overall uptake of prenatal screening* was 78%.

*Prenatal screening refers to Multiple Marker Screening (MMS) and/or Non-Invasive Prenatal Screening (NIPT) (publicly-funded and self-paid)

Remember, to have or not have prenatal screening is a choice. Therefore, we do not aim for the uptake to be 100%. 

PSO provides information to help individuals decide if prenatal screening for trisomy 21 and trisomy 18 is right for them. Check this out today for use in your practice!

BORN Ontario, 2020-2023

Screening uptake for singleton pregnancies among Ontario residents.

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.

Of all the pregnancies that had prenatal screening, what type(s) (modality) of screening did they have? 

Of all the pregnancies that had prenatal screening:

  • 81% had MMS only
  • 8% had NIPT* only
  • 11% had both MMS and NIPT.*

As expected, use of MMS decreased in the aged 40 and over population because these pregnancies are eligible for publicly-funded NIPT based on age, unless there is an IVF pregnancy with an egg age less than 40 years old.

Figure 2. Proportion of screening, stratified by modality and pregnant individual age at EDD.
Age at EDD MMS Only (%) NIPT only (OHIP-funded and self-paid) (%) MMS and NIPT (OHIP-funded and self-paid) (%)
under 20 95.7 0.9 3.0
20-24 95.0 1.3 3.7
25-29 92.3 2.7 5.0
30-34 84.8 6.4 8.8
35-39 72.2 11.1 16.7
40 and over 19.8 42.9 37.2

BORN Ontario, 2020-2023

Type of prenatal screening stratified by modality and pregnant individual age at EDD for singleton pregnancies among Ontario residents.

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.

The most common type of screening used was MMS,* with an overall uptake of 71%.  What type of MMS did pregnant individuals have?

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

BORN Ontario, 1Apr2020 - 31Mar2023

MMS uptake for singleton pregnancies among Ontario residents, stratified by modality.

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 1 Oct, 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 MMS report date.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

The overall uptake of NIPT* was 15%.

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

Hover over the pictograph in figure 4 to read more details about publicly-funded and self-paid NIPT, and use the arrow in the top right corner to scroll to see the volume of publicly-funded NIPT by clinical funding indicator. 

Check out the publicly-funded NIPT eligibility criteria to learn more about who qualifies for publicly-funded NIPT.

Figure 4. Proportion of NIPT by funding type and proportion of publicly-funded NIPT by clinical funding indicator.

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

Hover over the pictograph in figure 4 to read more details about publicly-funded and self-paid NIPT, and use the arrow in the top right corner to scroll to see the volume of publicly-funded NIPT by clinical funding indicator. 

Check out the publicly-funded NIPT eligibility criteria to learn more about who qualifies for publicly-funded NIPT.

Figure 4. Proportion of NIPT by funding type and proportion of publicly-funded NIPT by clinical funding indicator.

Figure 4. Proportion of NIPT by funding type and proportion of publicly-funded NIPT by clinical funding indicator.
Population Volume of NIPT by funding type Volume of publicly-funded NIPT by clinical funding indicator
publicly-funded NIPT 49.8% of pregnancies with NIPT had publicly-funded NIPT   
Self-paid NIPT 50.2% of pregnancies with NIPT had self-paid NIPT.



Of all the pregnancies with NIPT, 21.0% self-paid for microdeletion testing. To note, guidelines do not support the use of NIPT to screen for microdeletion syndromes at this time.



In looking at a snapshot of these data, in fiscal year 2020-2021 at least 7.6% (689) of individuals who self-paid for NIPT were either eligible for publicly-funded NIPT at the time of blood draw or became eligible for publicly-funded NIPT during the pregnancy based on maternal age ≥40 at EDD and/or an increased nuchal translucency measurement (≥3.5mm) and/or a screen positive MMS result. Individuals who are eligible for publicly-funded NIPT on the date of NIPT blood collection can typically be reimbursed, whereas individuals who were not yet eligible cannot be reimbursed. Pregnant individuals could consider waiting for their NT ultrasound and MMS results before deciding to self-pay for NIPT, although some may prefer to have NIPT as early as possible.		  
Pregnant individual age 40 and over only   37.0% of the pregnancies with publicly-funded NIPT had an indication of "maternal age 40 and over only."
Positive MMS only   40.0% of the pregnancies with publicly-funded NIPT had an indication of "positive MMS only."
Increased NT only   2.0% of the pregnancies with publicly-funded NIPT had an indication of "increased NT only."
Previous trisomy 13, 18, or 21 only   4.9% of the pregnancies with publicly-funded NIPT had an indication of "previous T21, T18, or T13 only."
Congenital anomalies only   2.0% of all the pregnancies with publicly-funded NIPT had an indication of "congenital anomalies only."
Risk greater than positive MMS only   5.8% of the pregnancies with publicly-funded NIPT had an indication of "risk greater than positive MMS only."
Risk of sex-linked condition/DSD only   0.6% of the pregnancies with publicly-funded NIPT had an indication of "risk of sex-linked condition/DSD only."
Multiple indication categories   7.6% of the pregnancies with publicly-funded NIPT had a multiple indications.

BORN Ontario, 1Apr2020 - 31Mar2023

Screening uptake of NIPT for singleton pregnancies among Ontario residents, stratified by funding status.

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 1 Jun 2024 and 1 Oct 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.

 

BORN Ontario, 2020-2021

Number of singleton pregnancies among Ontario residents that received self-paid NIPT who could have qualified for publicly-funded NIPT based on maternal age >= 40 and/or a screen positive MMS result and/or an NT level >= 3.5 mm.

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. S = Suppressed due to cell size <6.

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.

Trends in prenatal screening uptake

Considerations for MMS:

  • The decrease of "other MMS modalities" between FY 2017-2018 to 2018-2019 is because Integrated Prenatal Screening (IPS), which was included in this category, was discontinued in January 2018.
  • eFTS was introduced during the period of April 2016 to May 2017, hence the increase in uptake between FY 2017-2018 and 2018-2019.

Figure 5. Trends in uptake of Multiple Marker Screening (MMS) and Non-invasive Prenatal Testing (NIPT) by fiscal year. All MSS combined includes eFTS, STS, and other modalities. All NIPT combined includes publicly-funded and self-paid NIPT. 

Figure 5. Trends in uptake of Multiple Marker Screening and Non-Invasive Prenatal Testing by fiscal year. All MMS combined includes eFTS, STS, and other modalities. All NIPT combined includes OHIP-funded and self-paid NIPT.
Fiscal Year All MMS Combined eFTS STS Other MMS All NIPT combined OHIP-funded NIPT Self-paid NIPT
2017-2018 99,419 65,765 6,249 27,405 14,432 9,312 5,120
2018-2019 97,722 89,934 6,110 1,678 17,065 10,385 6,680
2019-2020 98,646 91,287 5,992 1,367 19,155 10,931 8,224
2020-2021 102,009 94,781 5,558 1,670 22,165 11,362 10,803
2021-2022 98,440 91,242 5,699 1,499 23,287 11,479 11,808
2022-2023 97,449 90,143 5,901 1,405 23,233 11,342 11,891

BORN Ontario, 1Apr2017-31Mar2023

MMS and NIPT uptake for singleton pregnancies among Ontario residents, stratified by fiscal year.

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 1 Oct, 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 MMS report date.

5. Only singleton pregnancies were included in this analysis.

6. Only Ontario residents were included in this analysis.

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Contact Us

Prenatal Screening Ontario 
CHEO Research Institute 
Centre for Practice-Changing Research Building 
401 Smyth Road 
Ottawa, ON K1H 8L1

Information line
Phone: 613-737-2281
Toll-Free: 1-833-351-6490

Monday to Friday, 9:00 AM to 3:00 PM EST

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