Nipt-aid: navigating prenatal testing - advancing informed decision-making

The National Institute of Child Health and Human Development awarded Harvard Pilgrim Health Care, Inc. $126,881 on September 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to develop and evaluate a decision support tool that facilitates informed, shared decision-making regarding prenatal cell-free DNA screening.

The project, titled NIPT-AID: Navigating Prenatal Testing—Advancing Informed Decision-Making, addresses gaps between professional guidelines and clinical practice in prenatal counseling. Though current American College of Obstetricians and Gynecologists guidelines recommend cell-free DNA screening as a first-line prenatal option for all pregnant patients, pregnant women report dissatisfaction with their counseling experiences and providers report feeling ill-equipped to discuss the complexities of the screening. The project aims to assess current prescreen counseling practices and the decision-making process from both provider and patient perspectives, identify unmet decisional needs, and develop a decision support tool to facilitate informed choices about prenatal screening.

Performance occurs in Boston, Massachusetts, with a period of performance from September 1, 2026, through August 31, 2028. Harvard Pilgrim Health Care, Inc., through its Office of Sponsored Programs division, is the recipient.

Abstract

Nearly four million women receive prenatal care each year in the united states. Prenatal cell-free DNA (cfdna) screening has revolutionized the prenatal care landscape since its introduction into clinical practice in 2011. Its superior sensitivity and specificity for detecting common fetal aneuploidies, coupled with the simplicity of the procedure, has led to rapid and widespread uptake. Updated 2020 guidelines from the american college of obstetricians and gynecologists now recommend this screening test as a first-line option in routine prenatal care for all pregnant patients regardless of maternal age or baseline risk. However, the rapid diffusion of prenatal cfdna screening has raised concerns that its routinization may erode informed choice for pregnant women. Though professional guidelines emphasize the importance of prescreen counseling to facilitate informed, shared decision-making, pregnant patients are generally dissatisfied with their counseling experiences. Prenatal care providers, in turn, report feeling ILL-equipped to discuss the complexities of prenatal cfdna screening. Moreover, expert opinion-based guidelines rarely incorporate the decisional needs and preferences of pregnant women, and IT is often infeasible for providers to cover all possible counseling topics due to time constraints. To address these challenges, the overall goal of my project-nipt-aid: navigating prenatal testing - advancing informed decision-making-is to develop and evaluate a decision support tool that facilitates informed, shared decision-making to support informed choices about prenatal cfdna screening. Specifically, my project aims to: 1) assess current prenatal cfdna prescreen counseling practices and the decision-making process to evaluate which decisional needs are being met and which remain unmet from the perspectives of both providers and pregnant patients; 2) identify pregnant women's priorities in addressing decisional needs to facilitate informed, shared decision-making about prenatal cfdna screening; and 3) develop and pilot a decision support tool to improve decision-making about prenatal cfdna screening. This research is significant because IT will empower pregnant women to make informed choices. Further, this award will build on my strong foundation in evaluating population-level decision-making by expanding my skills as a decision scientist to better inform individual-level decisions and more directly influence clinical care. Through training in qualitative research methods, psychology of shared decision-making, and healthcare intervention development and evaluation, i will enhance my ability to design and evaluate patient-centered tools. Combined with the support from my interdisciplinary mentorship team, my proposed research and training will enable my successful transition to independence and lay the groundwork for my research program focused on improving decision-making-from individual-level clinical encounters to population-level policy-to guide the responsible use of emerging genomic technologies and promote the health and well-being of children and families.