You will be offered screening. That is a decision, not a step.
And you can decline all of it.
Somewhere in the first trimester you will be offered screening for chromosomal conditions. It is often presented as part of the routine bloodwork. It is not.
ACOG's own guidance states that all patients should be offered both screening and diagnostic tests, and that all patients have the right to accept or decline testing after counselling.
The question worth sitting with before you agree is what you would do with the result. Some women want as much information as possible whatever they would do with it. Some want to know only about things they can act on. Some do not want to spend a pregnancy waiting for numbers. All three are legitimate, and only one of them requires the test.
Ask yourself first"If this test came back positive, what would I want to happen next?" If the answer is "nothing different," that is a complete reason to decline.
Where this comes from:
145. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics, Committee on Genetics, Society for Maternal-Fetal Medicine. Screening for fetal chromosomal abnormalities. ACOG Practice Bulletin No. 226. Obstet Gynecol. 2020;136(4):e48-e69.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.