(816) Genetic counseling practices among outpatient obstetric providers

Objective: ACOG recommends all pregnant patients be offered genetic screening and diagnostic testing. Previous studies have shown disparities in genetic testing outside of pregnancy, but little data exists about antenatal genetic counseling practices. The aim of this study is to evaluate patient, provider, and practice demographics that influence genetic counseling practices of outpatient obstetricians.

Study Design: A multi-center anonymous survey was sent through REDCap between October 2021 and March 2022. Outpatient obstetric providers were surveyed about their genetic counseling practices as well as practice demographics.

Results: 635 providers across 7 sites were sent the survey with a response rate of 66% (419/635). Diagnostic testing was offered to all patients in 37% of cases and only offered if certain patient factors were present in 44% of cases. 54.8% of attendings universally offered diagnostic testing. Residents were 82% less likely to offer diagnostic testing than attendings. Black/Non-Hispanic, Black/Hispanic, and Other/Hispanic patients were 49-69% less likely to be offered diagnostic testing compared to other patients. White/Non-Hispanic patients were 126% more likely to be offered diagnostic testing. Privately insured patients were 525% more likely to be offered diagnostic testing compared to Publicly insured patients. Those whose primary language was English were 300% more likely to be offered diagnostic testing than non-English speaking patients. Time allotted for visits, followed by personal knowledge and language barrier, were identified as significant barriers to counseling about genetic testing. Access to a genetic counselor or to a provider who performs diagnostic testing were not significant barriers.

Conclusion: Although ACOG recommends offering genetic screening and diagnostic testing to all patients, no provider group universally offers diagnostic testing. Patients from a racial/ethnic minority, those with public insurance, and those whose primary language is not English are less likely to be offered diagnostic genetic testing.