Prenatal diagnosis of fetal abnormality: the decision to terminate the pregnancy and the psychological consequences

Abstract

In the absence of any prenatal screening, some two percent of babies will be born with a structural anomaly; a further 1 in 700–800 will be born with Down's syndrome, with similar numbers having other chromosomal and serious genetic disorders. The prevalence of abnormalities in early pregnancy is higher because abnormal fetuses are more likely to miscarry than normal ones. A small number of women enter pregnancy at increased risk of conceiving a baby with an abnormality. They may have a maternal condition such as diabetes, need medication for conditions such as epilepsy, or have a family history of a genetic disorder (www3.ncbi.nlm.nih.gov/Omim/searchomim.html). Most abnormalities, however, occur in healthy, low-risk women.

The role of attitudes towards the targets of behaviour in predicting and informing prenatal testing choices

“…In this study around one quarter of participants said they would use screening to seek reassurance about the health of their child, an interpretation of the purpose of screening that has been demonstrated in many previous studies (Green et al, 2004;Shiloh, Eini, Ben-neria, & Sagi, 2001;Statham, 2002). However, while women hope for a healthy child, not all are willing to actively take steps to avoid having a baby with a disability.…”

“…However, while there has been a significant amount of research considering women"s attitudes towards undergoing prenatal testing (for a review see (Green, Hewison, Bekker, Bryant, & Cuckle, 2004)) there has been very little which examines their attitudes toward the tested-for conditions. This is surprising as a major factor in the decision to terminate a pregnancy for abnormality is known to be the perceived severity of the condition diagnosed (Evans et al, 1996;Statham, 2002). In a study which investigated women"s (hypothetical) prenatal diagnosis and termination intentions for 30 different conditions, perceived severity of the condition predicted these intentions but a considerable amount of individual variation was identified .…”

Decision to abort after a prenatal diagnosis of sex chromosome abnormality: a systematic review of the literature

“…Nondirective counseling leads to better-informed decision making and should be emphasized in the training for those providing genetic counseling and education. 35 Another identified factor amenable to change is parents' fear/ anxiety. Parents' fear/anxiety can be managed through genetic counseling and pregenetic counseling health education.…”

“…Genetic counseling can provide parents correct information regarding SCAs and dispel misconceptions; this may lead to subsequent reduction of many of their fears and anxieties. 14,35,36 Topics to be included in the counseling process that may help alleviate parents' fear/anxiety include a discussion of potential abnormalities and possible treatment options for SCAs. Information and connection to support systems, such as health centers in local areas and support groups of families with children affected by the same or similar chromosomal abnormalities, might prove useful resources for coping with fear and anxiety.…”

Termination of Pregnancy for Fetal Abnormality: The Perspective of a Parent Support Organisation

“…14 However, some women who have had an earlier diagnosis will put pressure on themselves to make a decision in time to have a surgical termination, as the idea of a medical induction comes as a shock to most. It can be understandably hard to contemplate labouring to deliver a dead baby.…”