Background and Objective:
Non-invasive prenatal testing (NIPT) is an accurate and non-invasive screening test for Down’s syndrome (DS) that has been recently implemented into antenatal screening programmes worldwide. This review provides a current understanding of the extent of NIPT use in national antenatal screening pathways and its impact on the reproductive choices made during pregnancy, invasive prenatal diagnosis (IPD) and terminations, and on live births of babies with DS.

Methods:
A systematic review of studies and guidelines describing the implementation of NIPT and its impact on reproductive choices and pregnancy outcomes. Screening and data extraction was completed independently by two researchers, along with hand-searching to identify national guidelines. Narrative synthesis, descriptive analysis and meta-analysis (where possible) were used to evaluate the implementation of NIPT, its uptake, and impact on pregnancy outcomes. Quality was assessed using the Down’s and Black quality assessment tool.

Results:
In total, 27 countries or states were identified offering NIPT as part of a national screening programme (n=23 studies or national guidelines). NIPT was implemented as either a first- or second-line screening test, and was patient-funded, covered by insurance or healthcare system. Most often, NIPT was a contingent test (n=16) for higher chance of DS pregnancies. In some countries, NIPT implementation resulted in a reduction of IPD procedures. Cultural and societal attitudes to prenatal testing are often cited as an influence on the uptake of NIPT. Preliminary meta-analysis results find no significant difference in the reported terminations or live births of babies with DS following NIPT implementation.

Conclusion:
Implementation of NIPT into antenatal screening programmes is highly vairiable between countries, dependent on pre-existing prenatal testing and healthcare provisions. Further monitoring of the impact of NIPT and studies exploring the reasons behind differential uptake of screening and reduction in IPD are important to inform future public health initiatives.