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OBJECTIVE Chromosomal microarray (CMA) increases the diagnostic yield of prenatal genetic diagnostic testing but is not universally performed. Our objective was to identify provider and patient characteristics associated with the acceptance of CMA at the time of prenatal genetic diagnostic testing. METHODS Retrospective cohort study of patients undergoing prenatal genetic diagnostic testing (chorionic villus sampling or amniocentesis) at a single institution between 2014 and 2020. Primary outcome was the acceptance of CMA based on the genetic counselor who saw the patient. Secondary analyses assessed patient characteristics associated with the acceptance of CMA. RESULTS 2372 participants were included. Fifty-eight percent of participants accepted CMA. Acceptance of CMA varied significantly by genetic counselor, ranging from 31% to 90%. Patients with public insurance were less likely to have CMA performed (aOR 0.29, 95% CI 0.23-0.35). Even among those with with a structural anomaly present, public insurance was associated with significantly lower odds of CMA being performed (aOR 0.38, 95% CI 0.25-0.59). CONCLUSIONS Acceptance of CMA at the time of prenatal genetic diagnostic testing varied based on the genetic counselor performing the counseling. Public insurance was associated with lower frequency of accepting CMA. This article is protected by copyright. All rights reserved. What is already known about this topic? Chromosomal microarray significantly increases the diagnostic yield of prenatal diagnostic genetic testing, but is not uniformly performed. What does this study add? This study suggests that insurance status as well as genetic counselor are associated with uptake of chromosomal microarray at the time of prenatal genetic diagnostic testing.