Prenatal Testing: Expanded AFP Screening vs. Integrated Screening??

  1. I just got back from my 12 week prenatal appointment and was asked what type of genetic testing I wanted to do. California offers to all moms-to-be the expanded AFP screening (also known as the triple screen) that checks for Downs, trisomy 18 and neural tube defects. This is free, as are any follow up diagnostic tests.

    The nurse also told me about the integrated screen. This test is more accurate (info page says the Integrated Screening has higher detection rate for Downs 88% vs. 60%, reducing the chance that a Down syndrome pregnancy is missed and decreasing the chance of a false positive result compared with the AFP screening). This test also includes an ultrasound in the first trimester that measures the nuchal translucency and measures an additional protein. This tests cost about $600.

    I’m 33 and since I don’t have a family history of Downs, etc, insurance wouldn’t pay for the more accurate test. We’d be ok with paying $600, but then I’m worried that any additional diagnostic tests, such as an amnio (if necessary) may also not be covered.

    What do most moms-to-be do? Do you just take the expanded AFP, or opt for the integrated screening? DH thinks we should just do the expanded AFP, especially as the odds are good that everything is fine, this is probably the test most moms take and that it would be a waste of money. I keep changing my mind. One minute I think it’s worth it to get the more accurate test, the next I think the AFP test should be fine. Please share your experiences, thoughts. TIA.
     
  2. I opted out of both of them
     
  3. I have just been through this, but in Canada.
    With your age, you could just do the triple screen and if the screening shows something iffy, then do an amnio.
    I am 38 and just did our equivalent of the integrated screening and have decided against amnio since my numbers all look really good.
     
  4. It's really a personal decision that depends on your comfort level and the level of certainty you need in order not to stress about it after you get the results, and whether you would potentially terminate the pregnancy depending on the results.

    I'm in California, but since I already knew I wanted a diagnostic test rather than a screening test (I'm also 35 so didn't have the insurance issue), I didn't pay a lot of attention to the booklet, though I know I got it. What about calling your insurance carrier and asking them about the coverage for future diagnostic tests if you opt for the integrated screen? That would give you an indication if you'd just be paying for the $600 or would be stuck with anything after that. I would think that if you had the integrated screening and it indicated a potential issue, that would be enough for insurance to cover future tests if needed, but they should be able to give you a definitive answer.

    Personally, I knew I'd worry about that remaining degree of uncertainty, so I did an amnio, but again, it's totally about what you would be comfortable with.
     
  5. I'd say just go with the triple screen and see what kinds of numbers you get. BTW, the test is not free - if your insurance doesn't cover all the costs, the State will bill you.
     
  6. I did the AFP test. I was VERY thankful that all of the results came back negative. BUT... I have heard and read many things about false positives due to miscaculations of the due date and other factors so that would be a rather crap situation to be in.
     
  7. With my first pregnancy, I just had the triple screen done. Now with my second, my OB recommended that I have the integrated screening, so I did it. Luckily for me, my insurance covers both types of screening.

    The advantage of the integrated screening is that it is done much earlier in the pregnancy then the AFP usually is. I had mine done at 11 weeks. Last pregnancy I think the AFP was done at 20 weeks. Good luck!
     
  8. This is strange. I wonder why they are doing the triple screen instead of the quad screen? Most people in our area are doing the quad screen which includes another marker. You may want to look into it as it might be covered (as opposed to the integrated). You can also find out which lab is running the test. Different labs take different insurances. A friend of mine had insurance that Quest did not accept so they advised her to go to another physician so she could have the test offered by Genzyme. It's worth looking into. Good luck!
     
  9. I did not do the intergrated screening but I did do some testing without an amino testing. I was 17 weeks and I'm 39. Even if the test became postive what could you really do at 17 weeks? The doctor checked the baby out by testing my blood. I then had to see a utrasound doctor twice so he could measure the lenght and look for signs of downs or spinal biffida?? The heart screening was done at 24 weeks and he is okay!!!!
     
  10. According to my Sis-in-Law, who's an OB/GYN, the test is "designed to be conservative", which means that to us patients, it gives a lot of false positives (the doctors don't view it this way -- to them it's caution.) They want to pick up as much as possible for further testing, rather than let things slip through, so a lot of people get scary results on the screens. ITA that it would be incredibly miserable to be in this position. I was a basket case just waiting for my amnio results, and that was without any indication that things were bad.

    Based on the info about the labs also, I would definitely call your insurance and get full details from them about what's covered, when, and where.