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2

Making the right choices for them

Appropriate prenatal testing is a crucial part of caring for your patients who are expecting. To make it

easier to give them the right tests at the right time throughout their pregnancy, we’ve designed this guide

based on recommendations from the American Congress of Obstetricians and Gynecologists (ACOG).

ACOG recommendations —

the 1ST Trimester

Recommended Laboratory Screening1 Corresponding Quest Test(s) Test Code(s)*

Can be ordered as a group panel or individually†

Cervical cytology screening, if indicated‡

OB Panel

Additional First Trimester Tests

Urinalysis

Obstetric Panel‡

Individual components:

CBC (includes Differential and Platelet

Count);

Antibody screen, RBC with Refl ex to ID

and Titer, and Androgen Typing§;

ABO group and Rh type;

RPR refl ex to Titer and Confi rmatory

Testing§;

Hepatitis B Surface Antigen (HBsAG)

with refl ex Confi rmation§;

Rubella Virus IgG Antibody

20210,

6399,

795,

7788,

36126,

498,

802

Image-Guided Pap with Age-Based

Screening Protocols;

Image-Guided Pap with Age-Based

Screening, Plus CT/NG;

Image-Guided Pap with Age-Based

Screening, Plus CT/NG/Trich;

Pap alone

91384‡,

91385‡,

91386‡,

See note below‡

Urinalysis, with Refl ex to Microscopic§;

Urinalysis, Macroscopic

7909(X),

6448(X)

Some patients may require additional screening to see if they are carriers for certain hereditary conditions. For more information, please see page 8.

3

Recommended Laboratory Screening1 (cont’d)

Maternal Serum Screen (part 1)

Noninvasive prenatal screening

TB, if indicatedıı

Chlamydia¶

HIV testing

Gonorrhea, if indicated¶

Chlamydia and gonorrhea

Additional infectious diseases

Hepatitis C testing

One or both of the following screens for fetal

aneuploidy should be offered

First trimester screen, hCG (includes

PAPP-A, hCG, NT, Down syndrome risk

and interpretation);

Serum Integrated Screen, Part 1 (includes

PAPP-A);

Sequential Integrated Screen, Part 1

(includes PAPP-A, hCG, NT, Down

syndrome and trisomy 18 risk and

interpretation);

Integrated Screen, Part 1 (includes

PAPP-A and NT)

QNatal® Advanced

Corresponding Quest Test(s) (cont’d)

QuantiFERON®-TB Gold

Chlamydia trachomatis RNA, TMA

HIV-1/2 Antigen and Antibodies, Fourth

Generation, with Refl exes§

Neisseria gonorrhoeae RNA, TMA

Chlamydia trachomatis/Neisseria

gonorrhoeae RNA, TMA

Hepatitis C Antibody with refl ex

to HCV RNA§

92777(X)

16145,

16165,

16131,

16148

Test Code(s)* (cont’d)

11361(X)

11362(X)

11363(X)

91431(X)

19453(X),

16603(X) draw site incubated

8472(X)

*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/Test Center for more information. † If Antibody Screen is positive, Antibody Identifi cation, Titer, and Antigen Typing will be performed at an additional charge. If RPR screen is reactive, RPR Titer and FTA

Confi rmatory testing will be performed at an additional charge. When only a single test, Hepatitis B Surface Antigen, is ordered to diagnose Hepatitis B in a pregnant woman, additional tests such as liver enzymes should be ordered to confi rm the diagnosis.

‡ The age-based offerings are based on ACOG recommendations and include image-guided Pap tests. Non-imaged Paps as well as conventional Paps are also available at Quest Diagnostics. Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.

§ Refl ex testing may be performed at an additional charge.|| Risk factors include known HIV infection; close contact with individuals known or suspected to have TB; medical risk factors such as diabetes, lupus, cancer,

alcoholism, and drug addiction; birth in or emigration from countries with high prevalence; being medically underserved; homelessness; living or working in long-term care facilities, such as correctional institutions, mental health institutions, and nursing homes.

¶ If positive, test-of-cure should be performed within 3-4 weeks post-treatment.

1ST

Trimester

4

2ND

Trimester

Special considerations2-4

Obesity in pregnancy

More than half of pregnant women in the United States are overweight or obese, putting them at greater

risk of pregnancy complications, such as gestational diabetes, preeclampsia, cesarean delivery, and giving

birth to an infant with congenital anomalies.

ACOG recommendations for counseling obese patients include:

• Discussing the increased risks to their baby

• Measuring their height and weight at their initial prenatal visit

– ACOG guidelines recommend a total weight gain of 15-25lbs for overweight women (BMI=25-29.9) and

11-20lbs for obese women (BMI≥30)

• Providing information on diet and exercise

Zika virus and pregnancy

Zika virus is a growing public health concern that has been associated with serious birth defects such as

microcephaly. Recommendations include:

• PCR and/or antibody testing for all pregnant women who have traveled to or live in an affected area

• Counseling for women of reproductive age who have traveled to or live in an affected area on potential risks

associated with infection

This is an evolving area of practice, and information may change. Visit cdc.gov/zika/pregnancy and

QuestDiagnostics.com/Zika for the most up-to-date information.

5

ACOG recommendations —

the 2ND Trimester

Recommended Laboratory Screening1

CBC

Gestational diabetes screening

Differential and platelets:

Includes WBC, RBC, hemoglobin,

hematocrit, MCV, MCH, MCHC, RDW,

platelet count, MPV, and differential

(absolute and percent neutrophils,

lymphocytes, monocytes, eosinophils,

and basophils)

H/H, RBC, Indices, WBC, Plt:

Includes WBC, RBC, Hemoglobin,

Hematocrit, MCV, MCH, MCHC, RDW,

Platelet Count

Includes AFP, unconjugated

Estriol, hCG, Dimeric Inhibin A, UE3,

DIA (hyperglycosylated hCG), and

Maternal Risk Interpretation

Includes AFP, unconjugated Estriol,

hCG, Dimeric Inhibin A, and Maternal

Risk Interpretation

6399,

1759

8477,

19833,

6745

Maternal Serum Screen (part 2)†

Maternal Serum Alpha-Fetoprotein

Diagnostic Chromosomal Analysis via

amniocentesis or chorionic villus sampling,

if indicated†

Penta screen†

Quad screen†

Integrated screen, Part 2

(includes AFP, hCG, uE3, and DIA)

Maternal Serum AFP

Chromosome Analysis, Chorionic

Villus Sample;

Chromosome Analysis, Amniotic fl uid

Glucose Gestational Screen (50g),

135 Cutoff (ACOG supported 1st step

of 2-step GDM evaluation);

Glucose Gestational Screen (50g),

140 Cutoff (ACOG supported 1st step

of 2-step GDM evaluation);

Glucose Tolerance Test, Gestational,

4 specimens (100g) (ACOG supported

2nd step of 2-step GDM evaluation)

15934(X)

30294

16167

5059

14592(X),

14590(X)

Corresponding Quest Test(s) Test Code(s)*

One or more of the following should be offered

as appropriate

*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.† Our genetic advisors can provide assistance with diagnostic testing recommendations. Call 1.866.GENE.INFO (1.866.436.3463) to reach our

dedicated genetics hotline.

6

ACOG recommendations —

the 3RD Trimester

Recommended Laboratory Screening1 Corresponding Quest Test(s) Test Code(s)*

CBC

H/H, RBC, Indices, WBC, Plt:

Includes WBC, RBC, Hemoglobin,

Hematocrit, MCV, MCH, MCHC, RDW,

Platelet Count

1759

Differential and platelets:

Includes WBC, RBC, hemoglobin,

hematocrit, MCV, MCH, MCHC, RDW,

platelet count, MPV, and differential

(absolute and percent neutrophils,

lymphocytes, monocytes, eosinophils,

and basophils)

6399,

D (Rh) antibody screen, if indicatedAntibody Screen, RBC with Refl ex to

Identifi cation, Titer, and Antigen Typing† 795

Group B streptococcal disease

Streptococcus Group B culture;

Streptococcus Group B with susceptibility

culture;

Streptococcus Group B DNA, PCR with

Broth Enrichment;

Streptococcus Group B DNA, PCR with

Broth Enrichment and Refl ex to

Susceptibility†

5617(X),

15090(X),

91768(X),

91770(X)

RPR (if patient tested positive or is high risk due to age

or lifestyle as indicated)

Chlamydia and gonorrhea (if patient tested positive or

high risk due to age or lifestyle)

HIV testing (if patient is high risk due to lifestyle)

Gonorrhea (if patient tested positive or

high risk due to age or lifestyle)

Chlamydia (if patient tested positive or

is high risk due to age or lifestyle)

RPR with refl ex to Titer and Confi rmatory

Testing†

Chlamydia trachomatis/Neisseria

gonorrhoeae RNA, TMA

HIV-1/2 Antigen and Antibodies,

Fourth Generation, with Refl exes†

Chlamydia trachomatis RNA, TMA

Neisseria gonorrhoeae RNA, TMA

11361(X)

11362(X)

36126

11363(X)

91431(X)

*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.†Refl ex testing may be performed at an additional charge.

3RD

Trimester

8

Genetic carrier screening for diverse patients

In addition to standard laboratory tests, additional screening may be offered for some patients based on their ethnic background to determine if they are carriers for certain hereditary conditions. This type of screening is ideally performed as part of preconception counseling but may also be done in the fi rst trimester.

Genetic Laboratory Screening1,5 Ethnic Background1,5,6 Corresponding Quest Test(s) Test Code(s)*

Cystic fi brosis

Caucasian; African descent;

Ashkenazi Jewish; Southeast

Asian; French Canadian; Cajun

Cystic Fibrosis Screen,

CFvantage® Cystic Fibrosis

Expanded Screen

10458(X),

92068(X)

Spinal Muscular Atrophy

Recommended by ACMG for

all patients who are pregnant

or planning a pregnancy,

regardless of ethnicity.

Recommended by ACOG for

patients with a family history

of SMA

SMA Carrier Screen 18041

Fragile X

Recommended by ACOG for

women with a family history

of fragile X-related disorders,

unexplained mental

retardation or developmental

delay, autism, or premature

ovarian insuffi ciency

XSense® Fragile X with Refl ex and

Chromosome Analysis, Blood† 16326(X)

Sickle hemoglobinopathies African descent

Sickle Cell Screen,

Sickle Cell Screen with Refl ex to

Hemoglobinopathy Evaluation

(includes Hemoglobin A1, Fetal

Hemoglobin, Hemoglobin A2 and

any hemoglobin variants)†

825,

37679

Tay-Sachs disease

Familial dysautonomia

Ashkenazi Jewish;

French Canadian; CajunTay Sachs Mutation

Ashkenazi Jewish Familial dysautonomia mutation

90903(X)

90912(X)

ACMG = American College of Medical Genetics and Genomics

*Test codes may vary by location. Please contact your local laboratory or go to QuestDiagnostics.com/TestCenter for more information.† Refl ex testing may be performed at an additional charge.‡ All diseases within this panel can also be ordered individually: Cystic Fibrosis 92068(X), Canavan Disease 90905(X), Gaucher Disease 90907(X),

Fanconi Anemia 90897(X), Bloom Syndrome 90872(X), Tay-Sachs Mutation 90903(X), Familial Dysautonomia 90912(X), Nieman-Pick Disease 90893(X), Mucolipidosis Type IV 90899(X), Glycogen Storage Disease 90915(X), and MSUD Mutation 90909(X).

9

Visit the Genetics section within QuestDiagnostics.com for

more information about our genetic testing offerings, including

our selection of over 700 tests.

Genetic Laboratory Screening1,5

(cont’d)

Ethnic Background1,5,6

(cont’d)

Corresponding Quest Test(s)

(cont’d)

Test Code(s)*

(cont’d)

Canavan disease Ashkenazi Jewish Canavan disease mutation 90905(X)

Ashkenazi JewishExpanded Ashkenazi Jewish Panel

Ashkenazi Jewish Panel (includes

Cystic Fibrosis, Canavan Disease,

Gaucher Disease, Fanconi Anemia,

Bloom Syndrome, Tay-Sachs

Mutation, Familial Dysautonomia,

Niemann-Pick Disease,

Mucolipidosis Type IV, Glycogen

Storage Disease, and MSUD

Mutation)‡

90891(X)

Beta-thalassemia, alpha-thalassemia

African descent; Southeast

Asian (if microcytic anemia);

Mediterranean

Thalassemia and

Hemoglobinopathy

Comprehensive, includes

Hemoglobin A2 and any

hemoglobin variants, Hemoglobin

F, Ferritin, Hemogram (WBC, RBC,

Hemoglobin, Hematocrit, MCV,

MCH, MCHC, RDW)

17365

10

Delivering support

across every stage of pregnancy

Quest Diagnostics is committed to helping you ensure the healthiest possible outcomes for both mother and baby.

With our broad range of tests, as well as an extensive array of tools and educational materials for both you and your

patients, you can manage their care more effectively.

Comprehensive test menu

We provide a wide range of prenatal testing options backed by proven science, from routine to

highly specialized, including over 700 genetic tests—more than any other laboratory.

Expert review and consultation

We offer one-on-one consultations and professional reviews with our team of medical

experts, including highly trained genetic counselors, geneticists, and toxicologists, to

support your decision-making when you need it—no matter what the case.

Tools for your practice and your patients

With offerings such as QuestConnect™, you can add or cancel tests and request test information,

as well as pay invoices and order supplies—anytime, anywhere you’re online.

Resources for her

Help her stay informed

We offer educational content in multiple languages—both online and in printed materials—for patients on a

wide range of topics. Encourage them to take advantage of these resources and stay informed throughout their

pregnancy by visiting QuestDiagnostics.com/Patients.

Give her the tools to make better health decisions

MyQuest™ by Care360® helps patients to become advocates for their own care. In addition to getting test

results anytime, anywhere on their computer, tablet, or smartphone, they can share information with healthcare

providers, schedule testing appointments, and track their health conditions.

Your patients can sign up at QuestDiagnostics.com/MyQuest.

References: 1. Riley L, Stark A, eds. Guidelines for Perinatal Care. 7th ed. Elk Grove Village, IL/Washington, DC: American Academy of Pediatrics and The American

College of Obstetricians and Gynecologists; 2012:129-139; 483-484. 2. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109:419-433.

3. The American College of Obstetricians and Gynecologists. ACOG committee opinion No. 548: Weight gain during pregnancy. Obstet Gynecol. 2013;121:210-212.

4. The American College of Obstetricians and Gynecologists. Practice advisory: updated interim guidance for care of obstetric patients and women of reproductive

age during a Zika virus outbreak. http://www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-

Patients-During-a-Zika-Virus-Outbreak. Accessed March 14, 2016. 5. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 432:

Spinal muscular atrophy. Obstet Gynecol. 2009;113:1194-1196. 6. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 469:

Carrier screening for fragile X syndrome. Obstet Gynecol. 2010;116:1008–1010.

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