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UW study urges labs to reconsider race-based adjustment in prenatal test

Researchers examined data evaluating alpha-fetoprotein levels and found "no clinical measurable difference" between Black and non-Black patients, the study says.

SEATTLE — A new study conducted by University of Washington School of Medicine researchers and published in the journal Obstetrics & Gynecology argues labs should stop adjusting test results from a common prenatal screening based on race. 

The study examined patient records for tests of alpha-fetoprotein levels, which can be used to assess the potential for spina bifida and other characteristics in an infant, UW Medicine says

Dr. Shani Delaney is an obstetrician who specializes in high-risk pregnancies and an associate professor at the University of Washington School of Medicine who worked on the study.

"There has been a call to action across medicine for the past several years to re-evaluate how we use race in all fields of medicine," Dr. Delaney said. "We know there are differences in outcomes by different racial groups and different racial categories, but how do we use that information to take care of our patients and understand what causes the differences in outcome based on race?"

Delaney says past recommendations for AFP tests used data from decades ago.

"Who defines race, and how is race defined, is one big part of this, and then the other part of that is- we cannot use the color of someone's skin as a substitute for genetics," Delaney said. "It doesn't replace where their geographic ancestry comes from across the globe, so we wanted to be able to take care of all our prenatal pregnant patients and say 'Are we running this lab test correctly?' so we can give them the most accurate information."

Researchers looked at more than 27,000 medical records from UW Medicine hospitals and say they found "no clinical measurable difference" between AFP levels for Black and non-Black patients. Dr. Delaney says she hopes findings like this one help all fields of medicine re-evaluate policy, procedures and investments related to providing quality care.

"We need to do better about understanding the differences in outcomes by race, but really what is the reason for why those differences exist?" Delaney said. "We need to look at racism and we need to look at socioeconomic and other societal factors that make those outcomes for Black and brown patients, and so this directly affects pregnant patients but I hope this will move forward the broader conversation we need to have nationally and internationally in the medical field as well."

Dr. Delaney says factors that do appear to impact patients include transportation options to attend prenatal appointments, access to tests based on available funds, adequate support during their labor and delivery experience to help them through the birthing process, and representation in the medical field. 

"It's much easier for someone to say, I can make a laboratory adjustment on the computer- that's easy to do," Dr. Delaney said. "It's harder to tackle racism, and providers' perceptions of patients, but those are the areas we need to tackle."

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