​PAs first trimester screening has assumed an increasingly dominant role in the obstetric care of prospective parents, the need for genetic counseling has also increased. There are several challenges related to first trimester screening; foremost among them is the need to distinguish between screening and diagnosis. Additional challenges include the need to discuss not only Down syndrome but cardiac defects, developmental/genetic syndromes, adverse pregnancy outcomes, and preeclampsia. In the future, counseling will involve specific risk assessment for a broad range of chromosome abnormalities. This article provides a framework for providing genetic counseling to prospective parents undergoing first trimester screening. However, the counseling session has to be individualized based on the counselor's approach and unique issues and concerns related to the pregnancy.