In Europe, NIPT (non-invasive prenatal testing) has been approved in almost all areas except Ireland, and many pregnant women undergo prenatal testing. NIPT (non-invasive prenatal testing) has been attracting attention in Japan in recent years, and this time we will introduce the latest (2021) situation regarding NIPT (non-invasive prenatal testing) in France.
The history of childbirth in France
Childbirth and pregnancy in France are “women’s rights”
Because France is a Catholic country, there were various legal barriers to pregnancy and childbirth being recognized as a “women’s right.”
| 1967 | Contraception is legal |
| 1975 | Abortion is permitted by law. |
| 2000 | Emergency contraception available without a prescription |
France was the first Catholic country to enact the above law, and currently, approximately 70% of women use female-led contraception (low-dose pills, intrauterine devices, etc.). Both contraception and induced abortion are covered by health insurance, and there are two types of abortion methods to choose from. Medical insurance covers abortion medication (oral or vaginal tablets) up to the 7th week of pregnancy, and surgical abortion after the 7th week. Emergency contraception (morning-after pill) is free for minors and those without health insurance, and can be purchased without a prescription for around 400-900 yen* (3 to 7 euros) from shops, pharmacies, and school doctors.
Meanwhile, in Japan, low-dose pills, intrauterine devices, and surgical abortions are not currently covered by health insurance. Although a policy has been announced that emergency contraception will be available for sale at pharmacies, abortion drugs are not yet approved.
History of prenatal testing in France
| September 1997 | Screening for chromosomal disorders using maternal serum markers begins (100% covered by medical insurance, 52% of pregnant women took the test in the first year) |
| June 2009 | Quadruple Test (combination of maternal serum markers and ultrasound examination) started |
| April 2017 | Free NIPT (new prenatal testing) at some facilities in Paris (if the quattro test indicates a risk of chromosomal disorders) |
| January 2019 | NIPT (new type prenatal testing) now available for medical insurance coverage nationwide (when the quadruple test indicates a risk of chromosomal disease) |
In France, NIPT (non-invasive prenatal testing) has been available since 2011, and the number of pregnant women taking the test at their own expense, at 390 euros (approximately 50,000 yen * ), has gradually increased. As the test became more widespread, there was a lot of backlash from women’s protection groups, who claimed that not being able to take the test due to poverty differences was discriminatory, and in 2019, NIPT (non-invasive prenatal testing) became eligible for medical insurance nationwide.
How can I get prenatal testing in France?
In France, all pregnant women, regardless of age, have the right to be screened for chromosomal abnormalities, and the government encourages them to take the tests.
When should I get prenatal testing in France?
The times when prenatal testing is available in France are as follows:
| inspection | When to Inspect | Inspection results |
| Quattro Test | Weeks 12 to 14 | About 1 week |
| NIPT (New Prenatal Testing) | Week 10 and after | About 1-3 weeks |
| Amniocentesis | Weeks 15 to 17 | About 2 weeks |
The French Quattro Test (Quattro Inspection)
Currently, the Quattro Test is a free test that is covered by medical insurance for all pregnant women. The Quattro Test is a test that combines the pregnant woman’s age, maternal serum markers, and fetal cervical thickness (NT) to determine the probability of chromosomal abnormalities such as Down syndrome. The test is optional, but 80% of pregnant women take it. If the Quattro Test is positive, the next step is NIPT (non-invasive prenatal testing) . In this case, NIPT (non-invasive prenatal testing) is also covered by medical insurance and can be tested free of charge. In France, NIPT (non-invasive prenatal testing) has been covered by medical insurance since January 2019 with the aim of reducing the number of amniocentesis tests performed and reducing fetal miscarriages due to the test.
If you are pregnant with twins, have a history of pregnancy with a chromosomal disorder, or have a family history of a chromosomal disorder, you can receive NIPT (new type prenatal testing) free of charge from the 10th week of pregnancy under medical insurance coverage. If you wish to receive NIPT (new type prenatal testing) at your own expense , it will cost 390 euros (approximately 50,000 yen * ).
NIPT (new type prenatal testing) can be done with a blood test like maternal serum markers, so there is no risk to the fetus, and it can detect chromosomal abnormalities in the fetus with high accuracy of 96.5% sensitivity and 99.9% specificity, so it seems to be used as a second choice of screening. If NIPT (new type prenatal testing) also gives a positive diagnosis, an amniocentesis test is performed as a final step to make a definitive diagnosis. In this case, the amniocentesis test is also covered by medical insurance and is free of charge.
In the future , it seems that there are plans to move towards a system where NIPT (non-invasive prenatal testing) can be used from the initial screening stage, rather than the quadruple test using maternal serum markers; however, NIPT (non-invasive prenatal testing) is extremely costly compared to maternal serum markers, so this is not currently possible.
Quatro test results and confirmatory tests
In France, depending on the results of the quadruple test, the confirmatory test will proceed as follows:
| Test results | What happens next? | remarks |
| Risk is less than 1/1000 | Screening Completed | NIPT (new prenatal testing) screening is available for a self-pay fee of approximately 390 euros (50,000 yen * ) . |
| Risk is between 1/1000 and 1/51 | NIPT (new prenatal screening) screening (optional) | Since this is optional, you can choose to end it here. |
| Risk is 1/50 or higher | Direct amniocentesis (optional) or NIPT (non-invasive prenatal testing) screening (optional) | This is optional, so it ends here. You also have the option of undergoing NIPT (non-invasive prenatal testing). |
French NIPT (new prenatal testing)
What does France’s NIPT (new type prenatal testing) involve?
In France, NIPT (non-invasive prenatal testing) only tests for trisomies 13, 18, and 21, and does not appear to include full chromosome testing.
The use of tests for sex selection is banned in many European countries, including France.
Where can I get NIPT (non-invasive prenatal testing) in France?
In France, due to the division of labor in the medical field, there is no system of blood sampling at clinics or hospitals like in Japan. To receive NIPT (non-invasive prenatal testing) , you will receive a prescription from your obstetrician-gynecologist and have your blood sample taken at the nearest blood sampling laboratory.
The results of the Quad Test are available in about one week, and the results of the NIPT (New Prenatal Test) are available in one to three weeks, but because it is a sensitive issue, the test results are sent directly to the obstetrician-gynecologist in charge. If there are any problems, the obstetrician-gynecologist will contact the pregnant woman and encourage her to come in for an appointment as soon as possible. If there are no problems, the test results will be given to the pregnant woman at the next outpatient clinic.
In France, NIPT (non-invasive prenatal testing) can be taken at a nearby blood testing center as long as you have a prescription, rather than at a designated facility like in Japan, but the test results take longer to come than in Japan.
What if the test is positive?
If the quadruple test is positive and the NIPT (non-innovative prenatal testing) is also positive, amniocentesis will be performed to definitively diagnose whether or not there is a chromosomal disorder.
If the amniocentesis finally confirms the diagnosis of a chromosomal disorder, the obstetrician-gynecologist will tell you that you have the option of continuing or terminating the pregnancy. The doctor will then refer you to a counselor, who will provide you with expert genetic counseling. Many couples become mentally unstable when the test results continue to be positive, so many couples start receiving genetic counseling around the time they receive a positive result from NIPT (non-invasive prenatal testing) .
Data shows that in France, 95% of pregnant women who receive a positive amniocentesis choose to terminate the pregnancy, a result that is similar to that in Western countries where prenatal testing is widely available.
French people’s attitudes towards NIPT (new prenatal testing)
Like other developed countries, France is also seeing an increase in older women getting pregnant due to the increasing rate of women entering the workforce and the development of assisted reproductive technology. As in Japan, the average age at first pregnancy in France is now around 30 years old, which is higher than 40 years ago. In addition, infertility treatment is covered by medical insurance and can be received free of charge, so the number of pregnant women becoming pregnant at an older age is increasing. Since older pregnancies increase the risk of chromosomal disorders, miscarriage, gestational diabetes, and pregnancy-induced hypertension, which can have a significant impact on both mothers and babies, many couples decide to undergo prenatal testing out of concern for their baby. Couples who are older and have financial means often undergo NIPT (non-invasive prenatal testing) at their own expense from the very beginning.
As mentioned above, 80% of pregnant women in France undergo prenatal testing, so it can be said that awareness of testing is very high.
Government policy is to encourage prenatal testing, but there are also some concerns that undergoing the tests may increase anxiety for many couples.
Conclusion
Systems and ways of thinking regarding prenatal testing vary from country to country. Comparing these systems may lead to new discoveries and clarify your thoughts. France has overcome various legal barriers among Catholic countries and is now one of the countries where women’s rights are recognized. I think it can be said that the country provides thorough perinatal care, including medical insurance coverage for prenatal testing.
*As of March 2021, 1 euro = 129 yen
Article Editorial Supervisor
Dr Hiroshi Oka
NIPT specialist clinic, MD
Graduated from Keio University, School of Medicine
