Importance: Prenatal genetic testing (PGT) allows pregnant people to make informed decisions. ACOG guidelines recommend that testing be offered to all pregnant people; however, gaps in PGT uptake exist by age, race/ethnicity, and socioeconomic status.

Objective: Assess PGT utilization rates overall and by age, race/ethnicity, and insurance type.

Methods: This prospective observational study used EHR data from a large integrated health system in Western Pennsylvania. Those included in the study had age, race/ethnicity, and insurance data and a delivery between January 1, 2019 and October 31, 2022. Descriptive statistics and logistic regressions estimated the association between social factors and PGT, amniocentesis, and/or CVS uptake.

Results: Of the 31,408 individuals in this study, 377 (1.20%) received PGT. Individuals aged 35 or older (AMA) were 110.6% (95%CI: 1.682, 2.637) more likely to receive PGT, 74.9% (95%CI: 1.317, 2.322) more likely to receive amniocentesis, and 210.3% (95% CI: 2.103, 4.577) more likely to receive CVS than individuals aged 34 or younger. Race/ethnicity was not significantly associated with PGT uptake. Medicaid or Medicare/VA insurance was not significantly associated with PGT and amniocentesis uptake; however, those with Medicaid insurance were 0.333 (95%CI: 0.206, 0.537) as likely to receive CVS than commercially insured individuals.

Conclusions: Individuals of AMA were significantly more likely to receive PGT, which may be related to clinical factors that are more prevalent among this cohort. There was no evidence of difference in PGT uptake by race/ethnicity and insurance status. Future research should evaluate the impact of policy on access to PGT.