What does NIPT test for and how much is it?

NIPT, or Non-Invasive Prenatal Testing, is a method of determining the risk of a fetus having certain genetic abnormalities without the need for invasive procedures such as amniocentesis or chorionic villus sampling (CVS)¹. It is performed by analyzing fragments of fetal DNA that circulate in the mother’s bloodstream.

What does NIPT test for?

Chromosomal Abnormalities

The most common use of NIPT is to screen for trisomies (three copies of a chromosome instead of the usual two) that can lead to such conditions below.^{2, 3}

1. Down Syndrome (Trisomy 21): This is the most common trisomy at the time of birth. Affected individuals have intellectual disabilities along with characteristic physical features.
2. Edwards Syndrome (Trisomy 18): This condition is associated with severe intellectual disability and physical abnormalities in many parts of the body. Most babies with trisomy 18 die before birth or within their first month.
3. Patau Syndrome (Trisomy 13): Similar to trisomy 18 but less common, trisomy 13 causes severe intellectual disability and physical abnormalities. Most babies with this condition die within their first days or weeks of life.

Sex Chromosome Abnormalities

NIPT can also detect abnormalities such conditions below.

1. Turner Syndrome (Monosomy X): A condition where a female has only one X chromosome.
2. Klinefelter Syndrome (XXY): Males have an extra X chromosome.
3. Triple X Syndrome (XXX): Females have an extra X chromosome.
4. XYY Syndrome: Males have an extra Y chromosome.

Microdeletions

Some NIPTs can detect small missing pieces of chromosomes, known as microdeletions, which can lead to conditions like DiGeorge syndrome.

Fetal Sex

NIPT can also determine the sex of the fetus early in the pregnancy, though this is a secondary benefit.

Rare Genetic Conditions

Some new NIPT tests can screen for additional genetic conditions, though this varies by brand and region.

Detecting rare disorders through NIPT is a relatively newer application of the technology. Traditionally, NIPT has been used mainly to detect common chromosomal aneuploidies, like trisomies 21, 18, and 13. However, with advancements in sequencing technologies and data analysis, some NIPTs are now being extended to screen for rarer chromosomal abnormalities and genetic disorders.

Here’s how rare disorders can be detected through NIPT:

1. Enhanced Sequencing
   NIPT relies on cell-free DNA (cfDNA) sequencing. Enhanced and deeper sequencing methods can pick up rarer chromosomal aberrations and microdeletions that could be indicative of a rare disorder.
2. Microdeletion and Microduplication Analysis
   Some rare disorders are caused by small deletions or duplications in certain chromosome regions. Some advanced NIPTs have been developed to screen for these microdeletions and microduplications.
3. Bioinformatics and Advanced Analysis
   Modern NIPTs use sophisticated bioinformatics tools to analyze the sequencing data. These tools can pick up and interpret subtle changes in the genome, allowing for the detection of rarer disorders.
4. Expanding the Panel
   The conditions that NIPT screens for are determined by the specific “panel” of disorders included in the test. Some companies now offer expanded panels that cover a broader range of conditions, including rarer ones.

How much is it?

The cost of NIPT can vary significantly based on several factors.

1. Geographical Region
   In the U.S., for instance, the cost can range from $100 to over $2,000. In other countries, the price might be different, depending on healthcare infrastructure, insurance coverage, and the prevalence of private vs. public healthcare.
2. Insurance Coverage
   Some insurance plans may cover the cost of NIPT, especially if the pregnancy is deemed high risk or if the mother is over a certain age (typically 35). However, insurance might not cover it for younger mothers or in low-risk pregnancies.
3. Specific Laboratory and Test
   Different labs may have varying prices, and more comprehensive tests (that screen for a wider range of conditions) might be more expensive.
4. Type of NIPT test
   As mentioned earlier, there are different versions of the NIPT, and some tests that screen for additional conditions might cost more.

Limitation

1. Screening, not Diagnostic
   NIPT is a screening test, which means it estimates the risk of the fetus having certain conditions. It does not definitively diagnose them. If a NIPT result indicates a high risk, follow-up diagnostic tests such as amniocentesis or chorionic villus sampling (CVS) are usually recommended.
2. False Positives and Negatives
   NIPT can occasionally yield false positive results, where the test suggests a genetic abnormality even though the fetus is healthy. There can also be false negatives, where the test doesn’t detect an actual abnormality.⁴
3. Not Comprehensive
   While NIPT screens for several of the most common chromosomal abnormalities, it doesn’t cover all genetic disorders or potential birth defects.
4. Twin or Multiple Pregnancies
   The accuracy of NIPT might be reduced in twin or multiple pregnancies. It can also be challenging to determine which fetus is affected if an abnormality is detected.
5. Mosaicism
   Mosaic results, where some cells have a chromosomal variation while others do not, can complicate the interpretation of NIPT results. The test might detect an abnormality in the placental DNA (which the test analyzes) that isn’t present in the fetus.
6. Maternal Conditions
   The presence of maternal chromosomal abnormalities, cancers, or previous organ transplants can influence the results.
7. Cost and Accessibility
   NIPT is more expensive than some other prenatal screening tests. Depending on the location and insurance coverage, it might not be accessible or affordable for all expectant parents.
8. Doesn’t Replace Standard Prenatal Screening
   Despite its benefits, NIPT doesn’t replace the need for other standard prenatal screenings and ultrasounds, which can detect a variety of conditions and physical abnormalities not covered by NIPT.

In conclusion, while NIPT provides valuable information with high accuracy rates for specific conditions, it’s essential for expectant parents to be aware of its limitations and to work closely with healthcare providers when interpreting and making decisions based on the results.

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•  https://medlineplus.gov/geneti…
• https://www.nhsinform.scot/hea…
• https://www.pregnancybirthbaby…
• https://www.nytimes.com/2022/0…