First‐trimester screening and its impact on uptake of diagnostic testing

Abstract

ObjectiveTo determine the influence of first‐trimester screening (FTS) on a patient's decision regarding prenatal diagnostic testing (PDT) and if the uptake rate of PDT has changed among women with advanced maternal age (AMA) following the January 2007 American College of Obstetricians and Gynecologists statement regarding FTS.MethodsA database review was performed for the 2 years before and the 2 years after the January statement. A total of 7424 patient records were evaluated to determine the number of AMA women who obtained PDT, the number of positive and negative FTS results, and how many of those women had PDT. We then surveyed 53 patients and 23 referring physicians to determine what the patient understands about FTS, how patients utilize their FTS results, and how physicians educate their patients about FTS.ResultsWe determined that there was a 19.6% decrease in the uptake of PDT since that statement. Prior to their counseling session (2009–2010), 43% of those surveyed were against having PDT. After counseling, only 9% were against PDT. Overall, 91% were either open to or wanted PDT after counseling.ConclusionsIn addition to FTS results, we found that genetic counseling may be an influential factor in the patient's decision regarding PDT. Copyright © 2011 John Wiley & Sons, Ltd.

Non-invasive prenatal screening versus prenatal diagnosis by array comparative genomic hybridization: a comparative retrospective study

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A qualitative investigation of the decision‐making process of couples considering prenatal screening for Down syndrome

“…Work with larger samples could usefully be conducted to investigate the extent to which healthcare professionals are seen purely as information givers rather than being directly involved in decision making . It could be that prenatal screening differs in some way from other healthcare decisions, leading expectant mothers to seek information from her healthcare professional, but not their involvement with making the decision. Furthermore, exploring the decision‐making process of single women without a partner and any conditions under which couples do not desire joint decision making might shed further light on our understanding of decision making in pregnancy.…”

Change in rates of prenatal tests for chromosomal abnormality over a 12-year period in women of advanced maternal age

“…Their study included patients screened up to 2 years after the ACOG statement, whereas our study evaluated the mean rate in a 9-year period from 2007 to 2016. Thus, the decrease in amniocentesis in this study is greater than that reported by Darnes et al [ 6 ] Although the ACOG statement about screening for aneuploidy regardless of maternal age was introduced in 2007, all clinicians at our institution did not immediately began to offer invasive testing based on maternal age. Over time, the proportion of clinicians at our institution who offered screening or diagnostic tests regardless of maternal age increased gradually, and the rate of amniocentesis decreased.…”

“…In our study, there was a 32.1% decrease in the mean rate of amniocentesis and a 38.7% increase in serum screening since the 2007 ACOG statement. Darnes et al [ 6 ] reported a 19.6% decrease in prenatal diagnostic testing after the 2007 ACOG statement. Their study included patients screened up to 2 years after the ACOG statement, whereas our study evaluated the mean rate in a 9-year period from 2007 to 2016.…”

“…With the development of second-trimester serum screening and the more efficient first-trimester serum screening tests, the American College of Obstetricians and Gynecologists (ACOG) recommended in 2007 that all pregnant women be offered screening and invasive diagnostic testing for aneuploidy regardless of their age [ 4 ]. This statement brought about a change in the mode of counseling by health-care providers in prenatal care, and influenced the rates of serum screening and invasive prenatal diagnosis [ 5 6 ].…”