Elective amniocentesis in low-risk pregnancies: decision making in the era of information and uncertainty

Lesser, Yael; Rabinowitz, J G

doi:10.2105/ajph.91.4.639

Cited by 14 publications

(3 citation statements)

References 18 publications

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“…This finding is in agreement with an earlier report in which preliminary knowledge about prenatal testing was associated with increased test rates [12]. The authors of that study found that women who underwent elective amniocentesis were more knowledgeable about prenatal diagnostics and the risks and probability of abnormality than those who were referred for but did not undergo medically indicated amniocentesis.…”

Section: Discussionsupporting

confidence: 92%

Increasing Rates of Prenatal Testing among Jewish and Arab Women in Israel over One Decade

Romano-Zelekha

Ostrovsky

Shohat

2014

Public Health Genomics

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Background/Aims/Objective: This study compared data on the use of prenatal tests offered to pregnant women in Israel as reported in a national survey conducted by the Israel Center for Disease Control in 2001 to data from 2010. Methods: Mothers of newborns were interviewed 8-72 h after delivery in 29 maternity wards in Israel on May 31, 2010. Results: A total of 768 women were interviewed, 569 (72.3%) were Jewish and 197 (25.7%) were Arabs. Nuchal translucency screening and early ultrasound level 2 were significantly more frequently done in both Jewish and Arab women in 2010 than in 2001. The use of the biochemical triple marker test and amniocentesis did not change. The increased rate of nuchal translucency screening and early ultrasound level 2 was significantly higher among the Jewish women compared to the Arabs (21.5 and 28.0% vs. 2.9 and 13.7% in 2001; 62.0 and 65.6% vs. 30.1 and 30.9% in 2010, respectively). The rates of amniocentesis in the Jewish women aged ≥35 years were 47.6 and 47.5% in 2001 and 2010, respectively; they are significantly higher than among the Arabs (18.5 and 28.5%, respectively). The factors associated with making more use of different prenatal tests were: secularity, a higher income, and supplementary medical insurance for the Jewish women, and supplementary medical insurance and printed information on prenatal testing for the Arabs. Conclusions: The prenatal testing rates have risen over the last decade in both population groups, but there are still significant gaps. We suggest that public funding of additional prenatal tests may increase their use in both population groups.

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Section: Discussionsupporting

confidence: 92%

Increasing Rates of Prenatal Testing among Jewish and Arab Women in Israel over One Decade

Romano-Zelekha

Ostrovsky

Shohat

2014

Public Health Genomics

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“…Previous work has suggested several factors that predict test uptake: positive attitudes toward prenatal diagnostic tests, perception of prenatal diagnostic tests as reliable, and requests for more scientific information [ 25 ]. A study conducted in Israel found that use of amniocentesis by low risk women was associated with older age and receipt of more information about the test [ 26 ]. Others have shown that negative perceptions of having a child with DS had a more significant influence on decisions than the numeric probability of having such a child, as indicated by screening results [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

The limited effect of information on Israeli pregnant women at advanced maternal age who decide to undergo amniocentesis

Grinshpun‐Cohen

Miron‐Shatz

Berkenstet

et al. 2015

Isr J Health Policy Res

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BackgroundA primary goal of amniocentesis is the detection of trisomy 21 (Down syndrome- DS) in the fetus. This procedure involves a small risk of miscarriage. As the risk of DS increases with maternal age, screening tests (maternal serum triple test and others) and age are used to generate a risk assessment, and amniocentesis is offered to women with high risk. In Israel, amniocentesis is government funded for women of advanced maternal age (AMA, i.e., ≥35 years), even if their risk assessment is low.The purpose of this study was to explore the reasons AMA women undergo amniocentesis, their knowledge about risk estimates, and to evaluate whether their decision is informed.MethodsShortly after undergoing amniocentesis, 42 consecutive women without a medical indication for amniocentesis other than age, completed a questionnaire that assessed their knowledge and opinions regarding screening tests, pregnancy termination, amniocentesis risks and the factors that affected their decision.ResultsWomen rarely deliberated before undergoing amniocentesis. One third of those who had the screening test did not wait for the results before undergoing amniocentesis. Only one third of those who received the screening results remembered their risk estimation before going ahead with amniocentesis. Almost half (41 %) cited “age” as their main reason for undergoing amniocentesis, though only 44 % of these women could recall their age related DS risk. Sixty percent estimated their DS risk as low or very low but still had amniocentesis. Most participants (74 %) stated that they would consider termination of the pregnancy if the fetus was diagnosed with an intellectual deficit.ConclusionsThese results cast doubt on whether AMA women’s decision to undergo amniocentesis is based on risk estimates, as women seem to disregard risk estimates, and sometimes not even wait for them when making the decision. The policy of funding amniocentesis solely on the basis of age may have led to the conception that being over 35 alone is sufficient reason to undergo amniocentesis. This finding should inform policy makers, as it raises questions about the link between public funding and the choices of individual women, and has implications for healthcare expenditures.

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“…Patient-level factors such as preferences [52, 53], health literacy [54], medical/psychological conditions [55, 56], and wealth [57, 58] are likely to have broad effects on overuse, as are differences in providers’ skills [59, 60], financial interests [61], and other cultural factors [59, 62–65]. Measuring systematic overuse would also provide insight on the role of tort litigation and the practice of defensive medicine [66], and would elucidate industry’s function in resource utilization [67].…”

Section: How Can Measuring Systematic Overuse Have An Impact?mentioning

confidence: 99%

Systematic Overuse of Healthcare Services: A Conceptual Model

Nassery

Segal

Chang

et al. 2014

Appl Health Econ Health Policy

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A perfect storm of factors influences the overuse of healthcare services in the USA. Considerable attention has been placed on geographic variation in utilization; however, empiric data has shown that geographic variation in utilization is not associated with overuse. While there has been renewed interest in overuse in recent years, much of the focus has been on the overuse of individual procedures. In this paper we argue that overuse should be thought of as a widespread and pervasive phenomenon that we coin as systematic overuse. While not directly observable (i.e., a latent phenomenon), we suggest that systematic overuse could be identified by tracking a portfolio of overused procedures. Such a portfolio would reflect systematic overuse if it is associated with higher healthcare costs and no health benefit (including worse health outcomes) across a healthcare system. In this report we define and conceptualize systematic overuse and illustrate how it can be identified and validated via a simple empirical example using several Choosing Wisely indicators. The concept of systematic overuse requires further development and empirical verification, and this paper provides an important first step, a conceptual framework, to that end.

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Elective amniocentesis in low-risk pregnancies: decision making in the era of information and uncertainty

Cited by 14 publications

References 18 publications

Increasing Rates of Prenatal Testing among Jewish and Arab Women in Israel over One Decade

Increasing Rates of Prenatal Testing among Jewish and Arab Women in Israel over One Decade

The limited effect of information on Israeli pregnant women at advanced maternal age who decide to undergo amniocentesis

Systematic Overuse of Healthcare Services: A Conceptual Model

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