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Provider Education · BillionToOne

UNITY Fetal Antigen Tests

The New Standard in Prenatal Care
First-and-only fetal antigen testing from cell-free DNA

RBC Fetal Antigen NIPT
Platelet Fetal Antigen NIPT

Based on clinical evidence from Pregnancy (2025) & JAMA Network Open (2025)

The Clinical Problem

Alloimmunization: Managed with Indirect Tools

🔄

Serial Titers

Indirect proxy for fetal risk; do not reflect actual fetal antigen status

🧬

Partner Testing

Incomplete; paternity uncertainty, zygosity ambiguity

⚕️

Invasive Procedures

Amniocentesis carries procedural risk; not ideal for surveillance

These methods persist not because they are ideal, but because no better option existed.

New Clinical Study · Pregnancy Journal 2025

Critical & Rising Titers in Antigen-Negative Fetuses

~70%
of alloimmunized pregnancies
reached critical titers

Titers escalated to critical thresholds regardless of fetal RBC antigen status — even when the fetus carried no risk of hemolytic disease.

Ashimi Balogun O, et al. Pregnancy 1.6 (2025): e70113.

Clinical Implication: Titer thresholds alone cannot distinguish true fetal risk from maternal immune response.

New Clinical Guidance · JAMA Network Open 2025

Clinical Practice Guideline:
RBC Alloimmunization Management

"The use of cell-free fetal DNA (cffDNA) to accurately determine fetal red blood cell antigen status."
Moise KJ Jr, et al. JAMA Network Open. 2025;8(11):e2544649.
"If cffDNA testing reveals an antigen-negative fetus, no further surveillance — including repeat titers or MCA Doppler measurements — is indicated for the remainder of the pregnancy."
Moise KJ Jr, et al. JAMA Network Open. 2025;8(11):e2544649.
Clinical Decision Framework

Fetal Antigen Status Drives Surveillance

1

Maternal Antibody Screen Positive

Clinically significant alloantibody identified

2

Order UNITY Fetal Antigen NIPT (cfDNA)

Available from 9 weeks gestation via UNITY Aneuploidy Screen

Antigen-Negative Fetus

No further titers, no MCA Doppler. Routine prenatal care.

⚠️

Antigen-Positive Fetus

Focused surveillance: serial titers + MCA Doppler per protocol.

RBC Fetal Antigen NIPT

Closing Gaps in RBC Alloimmunization

Determines fetal antigen status for up to 16 RBC antigens — covering 99% of antigens associated with HDFN.

Core Panel
D
C
c
E
K
Fyᵃ
Newly Added (2026)
e
k
Fyᵇ
Jkᵃ
Jkᵇ
M*
N*
S
s
U

*M and N must be selected at time of order; cannot be added post-submission.

Pathophysiology

Hemolytic Disease of the Fetus & Newborn (HDFN)

Mechanism

Maternal IgG antibodies cross the placenta and bind to fetal RBCs bearing the target antigen, causing immune-mediated hemolysis.

Clinical Spectrum

MildNeonatal jaundice
ModerateAnemia requiring transfusion
SevereHydrops fetalis, stillbirth
~1%
of all pregnancies affected

Risk is only present when the fetus inherits the target antigen from the father. Antigen-negative fetuses carry no risk of HDFN from maternal antibody.

First-and-Only · Platelet Fetal Antigen NIPT

Creating a New Path for FNAIT

What is FNAIT?

Fetal/Neonatal Alloimmune Thrombocytopenia — maternal antibodies against fetal platelet antigens cause severe fetal thrombocytopenia.

Catastrophic Consequences

  • ⚡ Severe fetal thrombocytopenia
  • 🧠 Intracranial hemorrhage
  • 💔 Fetal loss

UNITY Platelet Fetal Antigen NIPT

The first-and-only non-invasive test to determine platelet fetal antigen status via cfDNA in the US. Designed for pregnancies at-risk or with a history of FNAIT.

cfDNA
Non-Invasive
Platelet Typing
Clinical Workflow

Seamless Integration into Prenatal Care

🗓️

As Early as 9 Weeks

Added to UNITY Aneuploidy™ Screen at any point during pregnancy

🩸

No Additional Blood Draw

Uses the same cfDNA sample collected for aneuploidy screening

📋

No Separate Order

Add-on to existing UNITY Aneuploidy Screen order

ℹ️

Available exclusively through the UNITY Aneuploidy™ Screen platform. Contact: support@unityscreen.com · 650.460.2551

Analytical Performance

Exceptional Accuracy Across Studies

>99.9%
Sensitivity
>99.9%
Specificity
100%
Concordance with
Neonatal Outcomes
Obstetrics & Gynecology · July 2024

465 neonatal outcomes collected. 100% concordance for fetal RBC antigen genotyping via cfDNA.

Nature Scientific Reports · August 2023

Validation for RhD, C, c, E, K, Fyᵃ antigens. >99.9% sensitivity, specificity, and reproducibility.

Guideline Recognition

ACOG & SMFM: cfDNA Now Recommended

ACOG · 2024

Two guideline updates supporting the use of cfDNA to determine fetal RhD and fetal antigen status, citing UNITY clinical data as supporting evidence.

JAMA Network Open · 2025

Clinical practice guideline recommends cfDNA for fetal antigen testing in alloimmunized pregnancies, citing UNITY data as primary evidence.

📈

UNITY has contributed evidence to three clinical guideline updates and surpassed 1,000,000 tests ordered as of 2025.

BillionToOne · Platform Evolution

A Track Record of Clinical Innovation

19
2019
UNITY Fetal Risk™ Screen — first NIPT for recessive conditions without partner testing
20
2020
UNITY Aneuploidy™ Screen & Fetal RhD™ NIPT launched
22
2022
UNITY Fetal Antigen™ NIPT — first NIPT for RBC antigen status in HDFN
24
2024
Two ACOG guideline updates cite UNITY data; 1M+ tests ordered
26
2026
Expanded RBC panel (16 antigens) + first-and-only Platelet Fetal Antigen NIPT
Comparative Overview

Traditional Monitoring vs. cfDNA-Based Testing

Parameter Traditional Approach UNITY cfDNA Testing
Fetal antigen determination Indirect (partner testing, titers) Direct from fetal cfDNA
Invasive procedure required Sometimes (amniocentesis) Never — maternal blood draw only
Gestational age at testing Variable; often delayed As early as 9 weeks
Surveillance for antigen-neg fetus Continued (titers, MCA Doppler) Discontinued per guideline
Sensitivity / Specificity Variable; not standardized >99.9% / >99.9%
Neonatal outcome concordance Not directly measured 100% (465 neonates)
Clinical Considerations

Important Limitations & Caveats

Screening, Not Diagnostic

False positive and false negative results may occur. Results must be interpreted in the full clinical context by a qualified provider.

Not FDA-Approved

Laboratory-developed test (LDT) performed in a CLIA-certified, CAP-accredited laboratory. Not an FDA-approved test.

Variable Performance Factors

Test performance may vary based on fetal fraction, maternal age, zygosity, and other clinical factors.

M & N Antigen Ordering

M and N antigens must be selected at the time of ordering. They cannot be added after the test has been submitted.

Supporting Literature

Key References

#CitationKey Finding
1 Ashimi Balogun O, et al. Pregnancy 1.6 (2025): e70113. ~70% critical titers in antigen-negative fetuses
2 Moise KJ Jr, et al. JAMA Netw Open. 2025;8(11):e2544649. CPG: cfDNA recommended; no surveillance if antigen-negative
3 Rego S, et al. Obstet Gynecol. July 2024. 465 neonates; 100% concordance for RBC antigen genotyping
4 Alford B, et al. Sci Rep. 13.1 (2023): 12786. >99.9% sensitivity, specificity; 100% concordance
5 BillionToOne. PR Newswire. December 2023. Global collaboration with J&J Phase 3 trial (Nipocalimab/HDFN)
6 BillionToOne. Internal data on file. August 2025. 1,000,000+ tests ordered
Summary

Redefining the Standard of Perinatal Care

✅ For Alloimmunized Pregnancies

Early cfDNA-based fetal antigen determination enables evidence-based de-escalation of surveillance when the fetus is antigen-negative.

✅ For FNAIT-at-Risk Pregnancies

The first non-invasive platelet antigen typing enables earlier risk stratification and management planning.

Learn More & Register for Live Webinar
try.unityscreen.com/webinar
support@unityscreen.com · 650.460.2551

UNITY Fetal Antigen NIPT is a screening test, not a diagnostic test. This is a laboratory-developed test (LDT) performed in a CLIA-certified, CAP-accredited laboratory. It is not an FDA-approved test. © 2026 BillionToOne, Inc. UN-FB-019-2601.