Prenatal examinations for early intervention and counseling
Source: Bureau of Health Promotion, Department of Health
The importance of prenatal exams cannot be overemphasized. They provide for early
detection of abnormalities in the mother and fetus and increase the likelihood of
timely intervention to create the optimal chance for delivery of a healthy baby.
It is suggested that a woman receive 15 prenatal exams over the course of a normal
pregnancy (of which the National Health Insurance Program (NHIP) provides
payment for 10). That number may be increased for high risk pregnancies or
pregnancies with complications.
The Department of Health (DOH) is pushing forward with a national prenatal
congenital disorder diagnostic services network. This includes amniocentesis option
for women aged 34 and above to detect chromosomal defects and testing for a variety
of genetic disorders.
Alpha fetoprotein testing and amniocentesis
It is increasingly common to screen pregnant women by testing their blood for alpha
fetoprotein (AFP). A high level of AFP suggests a fetus with a neural tube defect
(malformation of the spinal cord or brain, such as spina bifida or anencephaly). A low
level of AFP suggests a chromosomal abnormality. Amniocentesis can help detect
neural tube defects by measuring AFP in amniotic fluid, and can diagnose most
chromosomal abnormalities.
Amniocentesis is usually performed in the second trimester of pregnancy around the
16th week. A thin, hollow needle is inserted into the uterus under guidance of
ultrasound imaging and some of the amniotic fluid that surrounds the baby is removed.
The entire procedure takes only a few minutes and results are normally available
within three weeks.
It is suggested for women aged 34 or older at higher risk of bearing children with
certain chromosomal birth disorders, such as Down syndrome, a combination of
mental and physical abnormalities. Down syndrome occurs in approximately one in
1,000 children born to women in their 20s. The chances increase to one in 300 by age
34.
Statistics for 2005 show that more than 89.8% of pregnant women aged 34 and above
opt to undergo amniocentesis with 22,378 receiving DOH subsidy for this procedure.
Cases with abnormal results are provided guidance, counseling and education via a
medical treatment and public health network that includes medical institutions and
local health departments.
Prenatal genetic diagnostic testing
To elevate the quality of prenatal clinical cytogenetic testing and congenital disorder
genetic testing, the DOH has established guidelines and evaluation standards for
testing institutions, under which it performs regular institutional inspections.
Currently, 26 cytogenetic testing institutions and 15 congenital disorder genetic
testing institutions have passed inspection.
DOH subsidies are offered for prenatal genetic testing for seven disorders, namely
thalassemia, spinocerebellar ataxis, Huntington’s disease, Duchenne muscular
dystrophy, fragile X syndrome, spinal muscular atrophy and hemophilia A &B. For
pregnant women with a family history of congenital disorder or for who prenatal
screening shows abnormal results a subsidy of NT$2,000 is available and women
from low-income families or living in remote or offshore areas can take advantage of
an additional subsidy of NT$3,500.
Information on abnormal karytopes, gathered during testing procedures, is entered
into databases and managed by professional academic institutions that have been
commissioned by the DOH.