First trimester prenatal diagnosis: earlier is not necessarily better.

Abstract

In the past few years considerable attention has been given to a relatively new method of prenatal diagnosis known as chorionic villus sampling (CVS). Because CVS can be performed in the first trimester it is hailed by many as a significant advance over amniocentesis. What has not been as publicized, however, are the disadvantages of CVS and earlier prenatal diagnosis. The emotional costs of CVS in terms of the greater number of both spontaneous and selective abortions following CVS, the use of CVS for sex selection and, because of the greater social acceptability of first trimester abortion, the possibility of increased pressure on women to undergo prenatal diagnosis by health insurance companies, medical professionals and government agencies, all need to be weighed against the advantages of early prenatal diagnosis.

Prenatal and Preimplantation Diagnosis

“…The strong cultural bias in the western world toward technological control of our environment may create a confl ict when prenatal screening and diagnosis is offered to parents, as it may make quality control of offspring feel less like an option and more an obligation of responsible parenting (Boss 1999 ). Although limitless choices may be an ideal for some, for others it can feel like a burden.…”

Antenatal screening and its possible meaning from unborn baby's perspective

“…However, the present reality is that antenatal diagnosis rarely leads to fetal therapy. In fact, in many cases normal fetuses are negatively effected from the CVS procedure [31]. There is also evidence that the availability of AND may be leading scientists to leave research on cures of genetic disorders in favour of selective abortion.…”

“…The emphasis now is put on an antenatal diagnosis for Tay-Sachs disease, followed by abortion in the case of a test positive. Similarly, as soon as an antenatal diagnostic test for Huntington disease became available in the early 1980s, 'funds began to disappear for research to find a cure' [31]. Beside these trends, the greater social acceptability of abortion, and increased pressure on women to undergo AND from health insurance companies medical professionals and government agencies, are all possible negative consequences of AND.…”

Is the non‐respect of ethical principles by health professionals during first‐trimester sonographic Down syndrome screening damaging to patient autonomy?

“…concerns about possible miscarriage as a result of chorionic villus sampling (CVS), the possibility for parental selection of fetal gender), whereas others concern the professionals involved (the high level of acceptance of early termination even for small malformations, social and medical pressure and pressure from insurance companies towards ‘normality’2). In this context, we are beginning to see the emergence of studies3, 4 dealing with the new issue of truly informed consent and true autonomy in practices relating to first‐trimester ultrasound examination. In their recent study of the ethical principles involved in first‐trimester risk assessment for trisomy 21, Chervenak and McCullough6 identified the most important principle as medical competence, the second most important as respect for autonomy (respecting the beliefs and values of patients) and the third as justice (equal access for all patients to medical resources).…”

“…Some women, worried about the risk of invasive sampling techniques, prefer the use of ultrasound to evaluate the risk of Down syndrome, while others prefer to use the ultrasound scan and risk calculations for guidance in deciding which type of invasive sampling to undergo (amniocentesis or CVS)3. However, women are not always informed about these diverse approaches to the first‐trimester ultrasound exam.…”