Overview:
Health disparities for Black infants begin before birth and continue long after. Now, doctors and researchers are looking at whether early prenatal testing could help close the gaps.
For Black families, the dangers facing newborns often begin long before delivery.
Black infants are still twice as likely as white infants to be born prematurely, and they face significantly higher risk of dying before their first birthday. Yet many Black parents decline prenatal tests that could help doctors identify serious health problems months before a baby is born.
That reluctance is rooted in a complicated mix of medical mistrust, uneven access to care, and a widespread misconception about the reasons prenatal screening exists.
Yet doctors say the tests can help families and hospitals prepare for high-risk births and for managing potentially life-threatening conditions.
As racial disparities in maternal and infant health continue to widen, some physicians and researchers argue that newer forms of non-invasive prenatal testing could become another tool in the effort to improve outcomes for Black mothers and babies.
Myths About Prenatal Testing
Dr. Naima Bridges, an obstetrician-gynecologist in the Dallas area and a medical advisor for BillionToOne, says one of the biggest barriers is knowing the purpose behind the benefits of non-invasive prenatal tests, or NIPTs.
“I think the most common misconception is that prenatal testing is used so that people can determine whether or not they want to continue with their current pregnancy,” Bridges says. “And so in cases where we offer prenatal testing at about nine to 12 weeks of gestation for pregnant patients, oftentimes we’ll get the response, ‘Nope, I don’t want to test. I don’t want to know what’s going on.’”
But the flip side is that “there are so many things we can do in utero and to prepare for delivery if we were better prepared to know what kind of baby we’re delivering,” she says.
Done between nine and twelve weeks of pregnancy, NIPTs can help determine whether a mother should deliver her baby at a hospital with specialists or whether certain treatments could begin even before birth.
“I strongly believe prenatal testing should be for every pregnant patient, no matter what their belief system is regarding continuing with a pregnancy,” she said. “It is to help guide you in your pregnancy and guide you to the best experts.”
The data is clear. As recently as 2019, a Black baby was more than twice as likely to die before reaching his or her first birthday. At the same time, preterm births among babies born to Black moms climbed to 14.7% in 2025 — almost 1.5 times higher than the rate for babies overall.
Rates of prenatal care improved between 2016 and 2021 but then reversed course — and Black women experienced the steepest decline.
By 2021, almost 80% of pregnant women in the general population were receiving prenatal care in the first trimester. But in 2024, the percentage dropped to around 75%, and for Black women, the rate fell from almost 7 in 10 to just over 65% over the same period.
“While the exact reasons for the recent declines in early prenatal care use are not known, disparities in maternal and infant health reflect underlying inequities in insurance coverage, access to care, and social and economic factors,” analysis from KFF found.
This means attempts to increase prenatal screening for sickle cell disease and other disorders remain low. It doesn’t help that non-invasive prenatal testing technology has been developed with predominantly white patients being involved in the research and clinical trials.
And the disparities that begin before birth also persist into childhood. Black premature babies in the newborn intensive care unit face higher rates of serious problems. These include a dangerous gut illness called necrotizing enterocolitis, along with early infections, eye damage from prematurity, and bleeding in the brain.
Streamlined Testing
BillionToOne is a molecular diagnostics company based in California. The company’s Unity Complete product line features non-invasive prenatal tests that require just one blood draw from pregnant mothers and do not rely on genetic information from fathers. The company also produces non-invasive oncology blood tests.
The UNITY carrier screening looks for inherited conditions such as sickle cell disease, cystic fibrosis, and several others. Many people carry these traits without knowing it. A child can be affected only if both parents are carriers.
In the past, if a mother tested positive for one of these diseases, doctors had to test the father as well. That was not always possible.
What makes UNITY different, Bridges said, is that it can study fetal cells found in the mother’s blood, with no sample needed from the father. The test can then tell a family whether their baby is at high risk for conditions like cystic fibrosis, which can be treated in the womb.
Bridges said the company reports a 99% positive predictive value for its screening for chromosomal conditions, and above 95% for conditions carried genetically, though she encouraged families to check the company’s published fact sheets.
Reaching more families
The test is also showing up in places where care is hardest to find.
In January 2025, the magazine Femtech Insider reported on UNITY’s Fetal Antigen test being used in rural “maternity deserts,” calling it a health equity story for mothers far from specialists. Last month, Contemporary OB/GYN reported on the launch of an expanded 14-gene fetal risk panel, describing it as a “category-defining test.”
NIPTs from other companies have studied larger patient populations and have stronger track records for detecting chromosomal problems like Down syndrome, which may give some doctors more confidence in those results.
Unity also has a narrower scope when it comes to twin pregnancies, while rivals offer broader screening options for prenatal testing of twins. But it’s likely that for a family whose biggest concern is chromosomal conditions like Down syndrome, they may want to use tests that have been researched most often.
But if sickle cell disease, thalassemia or other inherited blood disorders are a concern, Unity may be the best option.
While NIPT won’t erase the disparities Black families face, Bridges argues that having more information gives mothers more awareness, more tools to ask questions, and more power over their own care.
“The more we can empower them with data that can help them through their pregnancy, the better their outcomes will be,” she said.
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