Use of maternal race in prenatal screens for spina bifida is needed to ensure equitable medical care

Newswise — WASHINGTON – Breaking research demonstrates that clinical labs should account for the self-reported race of pregnant individuals when screening for spina bifida and other open neural tube defects. This finding, which was presented today in the Association for Diagnostics & Laboratory Medicine’s (formerly AACC’s) Clinical Chemistry journal, could improve prenatal care for pregnant Black individuals.

View the full study here: https://academic.oup.com/clinchem/advance-article/doi/10.1093/clinchem/hvae053/7657106

In the wake of the racial reckoning that took place in 2020, the medical community has embarked on a major push to advance health equity. A significant component of this has involved reevaluating the use of race in a wide range of clinical testing algorithms. For example, research found that race-based calculations for estimated glomerular filtration rate (eGFR) — a test for kidney function — were actually leading to delayed diagnosis and poorer outcomes for Black patients with kidney disease. Clinical labs are therefore now excluding race from their eGFR calculations.

The medical community has also been questioning the use of race in the test for alpha-fetoprotein (AFP), which is used to diagnose open neural tube defects such as spina bifida during pregnancy. Current testing algorithms for AFP account for race because self-reported Black individuals on average have higher AFP levels than White individuals. However, recent studies have recommended omitting race when screening for these birth defects.

A team of researchers led by Glenn E. Palomaki, PhD, of Women & Infant’s Hospital in Providence, Rhode Island, set out to determine the clinical impact of omitting race from AFP testing. Palomaki’s team first separately compared the AFP levels of pregnant White individuals and those of pregnant Black individuals against the median AFP level of pregnant individuals. Maternal weight, which is also higher on average in self-reported Black individuals, was also considered. They then used the same statistical analysis but eliminated self-reported race from the algorithm.

When self-reported race was used, the positivity rate of the screen was roughly equivalent among Black and White individuals. However, when self-reported race and maternal weight were not accounted for in the analysis, 1.49% of those identifying as Black were positive for open neural tube defects, while only 0.63% of those identifying as White were positive, a 2.36-fold difference. This discrepancy does not reflect the real-life disparity in open neural tube defect prevalence and would create inequitable burdens for Black individuals, including additional diagnostic testing that may be costly and invasive, as well as maternal anxiety.

“Accounting for maternal race and weight, as well as other possible covariates such as smoking status, plays a critical role in ensuring reliability and equity in various prenatal screening programs,” the study’s authors wrote. “Our results, together with existing professional recommendations and other current publications, endorse the use of self-reported race in prenatal serum screening.”

About the Association for Diagnostics & Laboratory Medicine (ADLM)

Dedicated to achieving better health through laboratory medicine, ADLM (formerly AACC) brings together more than 70,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, ADLM has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit www.myadlm.org.

Clinical Chemistry (clinchem.org) is the leading international journal of laboratory medicine, featuring nearly 400 peer-reviewed studies every year that help patients get accurate diagnoses and essential care. This vital research is advancing areas of healthcare ranging from genetic testing and drug monitoring to pediatrics and appropriate test utilization.