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Tiemtore-Kambou BA, Nde-Ouedraogo N, Lamien P, Sieba IN, Kere-Nidjergou L, Bayala D, Koama A, Napon A, Diallo O, Cisse R. Epidemiological profile of congenital anomalies detected during antenatal ultrasound in three imaging centers in the city of Ouagadougou. WEST AFRICAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.4103/wajr.wajr_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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2
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The ethical landscape(s) of non-invasive prenatal testing in England, France and Germany: findings from a comparative literature review. Eur J Hum Genet 2021; 30:676-681. [PMID: 34602609 PMCID: PMC9177584 DOI: 10.1038/s41431-021-00970-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Since 2019, England, France and Germany have started offering NIPT as a publicly funded second-tier test for common chromosomal aneuploidies (trisomy 21, 18 and/or 13). Despite these benefits, the introduction of NIPT into routine prenatal care also raises a number of ethical concerns. In this paper, we analyse how these issues are discussed differently across countries, echoing the different socio-political particularities and value-systems that shape the use and regulation of NIPT in a specific country. The international comparison between England, France and Germany shows how each country defines the principle of reproductive autonomy and weighs it against other principles and values, such as, human dignity, disability rights and the duty of care of health professionals. In terms of methodology, our literature review focuses on arguments and regulations of prenatal testing and reproductive choices (specifically on NIPT), through the investigation of regulatory, parliamentary, scientific, medical, association, institutional and media sources. The comparative review helps to better understand ethical questions discussed with regard to NIPT, and, more broadly, to prenatal genomic testing, and the limits associated with reproductive autonomy in the three countries studied. Whereas reproductive autonomy is valued in each country, it is understood and implemented differently depending on the socio-cultural context, and on what other principles are evoked and how they are defined.
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Beaudoin ML, Renaud C, Boucher M, Kakkar F, Gantt S, Boucoiran I. Perspectives of women on screening and prevention of CMV in pregnancy. Eur J Obstet Gynecol Reprod Biol 2021; 258:409-413. [PMID: 33548895 DOI: 10.1016/j.ejogrb.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the choice and attitude of pregnant women regarding CMV serological screening and CMV prevention behaviors in pregnancy. STUDY DESIGN In this cross-sectional study, pregnant women were recruited in a single center during routine prenatal screening tests at 11-16 weeks. Participants filled out a questionnaire assessing knowledge about congenital CMV (cCMV) infection, risk perception and willingness to have CMV serological screening as well as their attitude toward CMV prevention behaviors. RESULTS Among 234 pregnant women, 74.4 % (95 % confidence interval: 68.8-80.0 %) wanted CMV serological screening in pregnancy. The factors significantly associated with the desire for screening were perceived risk and perceived severity of cCMV. An informed choice regarding CMV screening (value-consistent, based on good knowledge and deliberated) was performed by 54 % of women who chose the screening and 30 % of women who declined the screening (p = 0.039). The median scores regarding attitudes toward CMV prevention behaviors were 3.7/5 for avoiding sharing behaviors and 4.0/5 for not kissing a child on the lips. CONCLUSION The majority of pregnant women want to have CMV serological screening once informed about congenital CMV infection. New tools need to be developed to allow for informed choice regarding CMV serological screening in pregnancy.
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Affiliation(s)
- Meggie Lallier Beaudoin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Renaud
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Marc Boucher
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Soren Gantt
- Department of Microbiology, Infectiology & Immunology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Women and Children Infectious Diseases Centre, CHU Sainte-Justine, Montreal, Quebec, Canada; School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
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Gould JB. Culpable Ignorance, Professional Counselling, and Selective Abortion of Intellectual Disability. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:369-381. [PMID: 32696114 DOI: 10.1007/s11673-020-09984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
In this paper I argue that selective abortion for disability often involves inadequate counselling on the part of reproductive medicine professionals who advise prospective parents. I claim that prenatal disability clinicians often fail in intellectual duty-they are culpably ignorant about intellectual disability (or do not disclose known facts to parents). First, I explain why a standard motivation for selective abortion is flawed. Second, I summarize recent research on parent experience with prenatal professionals. Third, I outline the notions of epistemic excellence and deficiency. Fourth, I defend culpable ignorance as the best explanation of inadequate disability counselling. Fifth, I rebut alternative explanations. My focus is pregnancies diagnosed with mild or moderate intellectual disability.
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Affiliation(s)
- James B Gould
- Department of Philosophy, McHenry County College, 8900 Rt. 14, Crystal Lake, IL, 60110, USA.
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Stoll K, Jackson J. Supporting Patient Autonomy and Informed Decision-Making in Prenatal Genetic Testing. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036509. [PMID: 31615869 DOI: 10.1101/cshperspect.a036509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genetic counselors have both the burden and the privilege of supporting patients who are faced with making difficult decisions. In the prenatal setting, genetic counselors are responsible for reviewing a growing list of prenatal testing options for patients with the goal of helping people to anticipate the potential consequences of their decision. Prenatal genetic counselors also support patients in making decisions about the next steps after clinical evaluation has indicated a genetic condition, birth defect, or information of uncertain clinical significance in the fetus. The information provided and choices patients face in the context of prenatal and reproductive genetics can be life-altering, and decisions often must be made within a short window of time. It is imperative that the needs and preferences of each patient are considered and that individuals are empowered to make active decisions that are consistent with their needs and values. Here we will review the history of the role of the genetic counselor in the prenatal setting and will provide strategies and tools for supporting informed patient decision-making in the face of an increasingly complex reproductive genetic testing landscape.
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Affiliation(s)
- Katie Stoll
- Genetic Support Foundation, Olympia, Washington 98502, USA
| | - Judith Jackson
- Department of Genetic Counseling, Brandeis University, Waltham, Massachusetts 02453, USA.,Department of Maternal Fetal Medicine, South Shore Health, South Weymouth, Massachusetts 02190, USA
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6
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Laberge AM, Birko S, Lemoine MÈ, Le Clerc-Blain J, Haidar H, Affdal AO, Dupras C, Ravitsky V. Canadian Pregnant Women's Preferences Regarding NIPT for Down Syndrome: The Information They Want, How They Want to Get It, and With Whom They Want to Discuss It. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:782-791. [PMID: 30738740 DOI: 10.1016/j.jogc.2018.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/22/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study sought to assess Canadian pregnant women's and their partners' preferences for information about non-invasive prenatal testing (NIPT). METHODS Pregnant women and their partners across Canada were surveyed as part of the Personalized Genomics for prenatal Aneuploidy Screening Using maternal blood (PEGASUS) study. RESULTS A total of 882 pregnant women and 395 partners participated. Women preferred being informed by a physician (77.2%). They preferred getting information ahead of time, except for information about resources for families with Down syndrome, which they preferred getting with test results. More than half thought that written consent is important (63.7%) and could decide whether to do NIPT on the day they received the information (54.9%). Women preferred to be informed of results by telephone (43.7%) or in person (28%), but they preferred in person if they were considered at high risk for Down syndrome on the basis of the results (76%). The partner was the person whose input was considered most important (62.6%). Partners' preferences were similar, except that partners tended to want information later (at the time of the test or with the results) and felt that their opinion was not considered as highly by health professionals. CONCLUSION Canadian women want information about NIPT early, in person, by a knowledgeable physician. Partners also want to be informed and involved in the decision-making process.
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Affiliation(s)
- Anne-Marie Laberge
- Department of Pediatrics, Université de Montréal, Montréal, QC; Service de génétique médicale, Centre hospitalier universitaire Sainte-Justine, Montréal, QC; Centre de recherche du Centre hospitalier universitaire Sainte-Justine, Montréal, QC.
| | - Stanislav Birko
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Marie-Ève Lemoine
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | | | - Hazar Haidar
- Institute for Health and Social Policy (IHSP), McGill University, Montréal, QC; Centre de recherche en éthique (CRÉ) de l'Université de Montréal, Montréal, QC
| | - Aliya O Affdal
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Charles Dupras
- Institute for Health and Social Policy (IHSP), McGill University, Montréal, QC; Centre de recherche en éthique (CRÉ) de l'Université de Montréal, Montréal, QC
| | - Vardit Ravitsky
- Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
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Vassy C. [Social representations of trisomy 21]. SOINS. PEDIATRIE, PUERICULTURE 2018; 39:15-18. [PMID: 29747765 DOI: 10.1016/j.spp.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Social representations of trisomy 21 have evolved considerably since its first descriptions in France in the 19th century. Today contradictory trends are at work. Some convey alarmist and stereotypical images while others favour greater understanding of life with trisomy 21.
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Affiliation(s)
- Carine Vassy
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), 74 rue Marcel-Cachin, 93017 Bobigny cedex, France.
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Oxenford K, Daley R, Lewis C, Hill M, Chitty LS. Development and evaluation of training resources to prepare health professionals for counselling pregnant women about non-invasive prenatal testing for Down syndrome: a mixed methods study. BMC Pregnancy Childbirth 2017; 17:132. [PMID: 28449648 PMCID: PMC5408404 DOI: 10.1186/s12884-017-1315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/24/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The availability of non-invasive prenatal testing (NIPT) for aneuploidies is expanding rapidly throughout the world. Training health professionals to offer NIPT in a way that supports informed choice is essential for implementation. The aim of this study was to develop and evaluate a training package for health professionals to support the introduction of NIPT into clinical practice. METHODS Training on NIPT was offered to health professionals, primarily midwives, involved in Down syndrome screening and testing in eight hospitals located in England and Scotland as part of a research study evaluating the implementation of NIPT in the UK National Health Service. Training was evaluated using a mixed methods approach that included quantitative questionnaires at three time points and post-training qualitative interviews. The questionnaires measured confidence, self-perceived knowledge and actual knowledge about NIPT for Down syndrome. Interviews explored opinions about the training and experiences of offering NIPT. RESULTS The training provided to the health professionals was found to positively impact on their confidence in discussing NIPT with women in their clinic, and both their perceived and actual knowledge and understanding of NIPT was improved. Knowledge remained weak in four areas; cell-free fetal DNA levels increase with gestation; turnaround time for NIPT results; cell-free fetal DNA is placental in origin; and NIPT false positive rate. CONCLUSIONS Training materials, including a lesson plan, PowerPoint presentation and written factsheet on NIPT, have been developed and evaluated for use in educating midwives and supporting the introduction of NIPT. Implementation of training should include a greater focus on the areas where knowledge remained low. Some groups of midwives will need additional training or support to optimise their confidence in discussing NIPT with women.
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Affiliation(s)
- Kerry Oxenford
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Daley
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Celine Lewis
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Lyn S Chitty
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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9
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Shea TL. Prenatal paradox: an integrative review of women’s experiences with prenatal screening for fetal aneuploidy and neural tube defects. Contemp Nurse 2016; 53:235-261. [DOI: 10.1080/10376178.2016.1269609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tamra L. Shea
- School of Nursing, The University of North Carolina at Greensboro, 101 McIver House, North Drive Extension, Greensboro, NC 27412, USA
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10
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Lewis C, Hill M, Chitty LS. Women's Experiences and Preferences for Service Delivery of Non-Invasive Prenatal Testing for Aneuploidy in a Public Health Setting: A Mixed Methods Study. PLoS One 2016; 11:e0153147. [PMID: 27045195 PMCID: PMC4821600 DOI: 10.1371/journal.pone.0153147] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy is currently only available in the UK through the private sector outside of the research arena. As part of an implementation study in the UK National Health Service we conducted a mixed methods study to assess women’s experience of being offered NIPT using validated measures of decisional conflict, decisional regret and anxiety. Clinical service preferences were also explored. Women with a Down syndrome screening risk >1:1000 were invited to take part in the study and offered NIPT, NIPT and invasive testing (for women with a risk above 1:150) or no further testing. A cross-sectional survey and semi-structured interviews were conducted at two time points; at the time of testing and one month following receipt of results (or equivalent for NIPT decliners). In total, 845 questionnaires and 81 interviews were analysed. The main motivation to accept NIPT was for reassurance (30.8%). Decisional conflict occurred in a minimal number of cases (3.8%), however, none of the participants experienced decisional regret. Around a third (29.9%) of women had elevated anxiety at the time of testing, including intermediate risk women who traditionally would not be offered further testing (54.4% high risk; 20.1% medium risk), a finding supported through the qualitative interviews where prolonged or additional anxiety was found to occur in some medium risk cases. Women were overwhelmingly positive about the opportunity to have a test that was procedurally safe, accurate, reduced the need for invasive testing and identified cases of Down syndrome that might otherwise have been missed. Reassurance was identified as the main motivator for accepting NIPT, particularly amongst medium risk women, with high risk women inclined to accept NIPT to inform decisions around invasive testing. The current turnaround time for test result was identified as a key limitation. All the women interviewed thought NIPT should be adopted as part of NHS clinical practice, with the majority favouring NIPT offered as a first-line test. Our study highlights the potential that NIPT has to positively impact women’s experience of prenatal testing for aneuploidy.
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Affiliation(s)
- Celine Lewis
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- * E-mail:
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
| | - Lyn S. Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
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11
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Vos FI, de Jong-Pleij EAP, Bakker M, Tromp E, Manten GTR, Bilardo CM. Facial profile markers in second- and third-trimester fetuses with trisomy 18. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:66-72. [PMID: 25196037 DOI: 10.1002/uog.14662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 08/23/2014] [Accepted: 08/29/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate nasal bone length (NBL), maxilla-nasion-mandible (MNM) angle, fetal profile (FP) line, prenasal thickness (PT), prenasal thickness to nasal bone length (PT:NBL) ratio and prefrontal space ratio (PFSR) as markers of trisomy 18 in the second and third trimesters of pregnancy. METHODS The NBL, MNM angle, FP line, PT, PT:NBL ratio and PFSR were measured retrospectively from stored two-dimensional images or three-dimensional volumes of trisomy-18 fetuses, and were compared with our previously reported normal ranges for euploid fetuses. Additional ultrasound findings were noted at initial routine second-trimester scan and at subsequent advanced ultrasound examination performed after referral for karyotyping. RESULTS A total of 43 trisomy-18 fetuses were included in the analysis. At initial examination, median gestational age was 21 + 2 weeks. NBL and PT were correlated with gestational age (P < 0.001), but the other markers were not. Mean NBL, MNM angle, PT, PT:NBL ratio and PFSR were 3.76 mm, 16.67°, 4.25 mm, 1.39 and 0.87, respectively. The FP line was zero (normal) in 53.7% of cases and negative (abnormal) in 46.3%. All markers were significantly associated with trisomy 18, with the PT:NBL ratio yielding the highest detection rate (88.4%) followed by NBL (83.7%), MNM angle (56.4%), FP line (46.3%), PT (27.9%) and the PFSR (20.5%) (for a 5% false-positive rate for the continuous variables). Various combinations of the four best markers (NBL, FP line, MNM angle and PT:NBL ratio) yielded detection rates of between 72% and 95%. Structural anomalies were not detected in 22% of fetuses at the initial scan and in 2% at the advanced scan. CONCLUSIONS The PT:NBL ratio and NBL are robust second- and third-trimester markers for trisomy 18. A negative FP line has a 0% false-positive rate and the potential to differentiate between trisomy 18 and Down syndrome, as in the latter the FP line is often positive. No major anomaly was observed at the initial scan in about a quarter of trisomy-18 fetuses, underlining the role of second-trimester facial marker evaluation.
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Affiliation(s)
- F I Vos
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E A P de Jong-Pleij
- Department of Obstetrics and Gynecology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M Bakker
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E Tromp
- Department of Statistics, St Antonius Hospital, Nieuwegein, The Netherlands
| | - G T R Manten
- Fetal Medicine Unit, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C M Bilardo
- Fetal Medicine Unit, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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12
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Allyse M, Sayres LC, Goodspeed T, Michie M, Cho MK. "Don't Want No Risk and Don't Want No Problems": Public Understandings of the Risks and Benefits of Non-Invasive Prenatal Testing in the United States. AJOB Empir Bioeth 2015; 6:5-20. [PMID: 25932463 DOI: 10.1080/23294515.2014.994722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The recent availability of new non-invasive prenatal genetic tests for fetal aneuploidy has raised questions concerning whether and how these new tests will be integrated into prenatal medical care. Among the many factors to be considered are public understandings and preferences about prenatal testing mechanisms and the prospect of fetal aneuploidy. METHODS To address these issues, we conducted a nation-wide mixed-method survey of 2,960 adults in the United States to explore justifications for choices among prenatal testing mechanisms. Open responses were qualitatively coded and grouped by theme. RESULTS Respondents cited accuracy, followed by cost, as the most significant aspects of prenatal testing. Acceptance of testing was predicated on differing valuations of knowledge and on personal and religious beliefs. Trust in the medical establishment, attitudes towards risk, and beliefs about health and illness were also considered relevant. CONCLUSIONS Although a significant portion of the sample population valued the additional accuracy provided by the new non-invasive tests, they nevertheless expressed concerns over high costs. Furthermore, participants continued to express reservations about the value of prenatal genetic information per se, regardless of how it was obtained.
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Affiliation(s)
- Megan Allyse
- Institute for Health and Aging, University of California San Francisco
| | | | | | - Marsha Michie
- Institute for Health and Aging, University of California San Francisco
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics and Department of Pediatrics, Stanford Medical School
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13
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Gitsels-van der Wal JT, Martin L, Manniën J, Verhoeven P, Hutton EK, Reinders HS. A qualitative study on how Muslim women of Moroccan descent approach antenatal anomaly screening. Midwifery 2015; 31:e43-9. [DOI: 10.1016/j.midw.2014.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/20/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022]
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14
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Vos FI, De Jong-Pleij EAP, Bakker M, Tromp E, Pajkrt E, Kagan KO, Bilardo CM. Nasal bone length, prenasal thickness, prenasal thickness-to-nasal bone length ratio and prefrontal space ratio in second- and third-trimester fetuses with Down syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:211-216. [PMID: 24753093 DOI: 10.1002/uog.13391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/21/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate nasal bone length (NBL), prenasal thickness (PT), prenasal thickness-to-nasal bone length (PT-NBL) ratio and prefrontal space ratio (PFSR) as markers for Down syndrome in the second and third trimesters. METHODS NBL, PT, PT-NBL ratio and PFSR were measured retrospectively in stored two-dimensional images or three-dimensional volumes (corrected to the mid-sagittal plane) of fetuses with Down syndrome, which were retrieved from the digital databases of participating units. Measurements were performed on the stored images and volumes by two experienced operators, and the values obtained were compared to our previously reported normal ranges for euploid fetuses in order to assess the detection rates for Down syndrome. RESULTS A total of 159 fetuses with Down syndrome were included in the analysis, six of which were excluded because of inadequate available images. Median maternal age was 36.0 years and median gestational age was 23 + 1 weeks. NBL and PT were correlated with gestational age (P < 0.001), but the PT-NBL ratio and PFSR were not. Mean NBL, PT, PT-NBL ratio and PFSR were 4.42 mm, 5.56 mm, 1.26 and 0.34, respectively. The nasal bone was absent in 23 (15.4%) cases. As a marker for Down syndrome, the PT-NBL ratio yielded the highest detection rate (86.2%), followed by PFSR (79.7%), PT (63.4%) and NBL (61.9%). All markers were abnormal in 33.6% of cases, whilst all were normal in 4.7%. At least one of the four markers was abnormal in 95.3%, and either the PT-NBL ratio or PFSR was abnormal in 93.8%. Detection rates were not related to gestational age. CONCLUSIONS The PT-NBL ratio and PFSR are robust second- and third-trimester markers for Down syndrome. Both provide high detection rates and are easy to use, as the cut-off for normality is constant throughout gestation. Ltd.
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Affiliation(s)
- F I Vos
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, The Netherlands
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15
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Gitsels - van der Wal JT, Verhoeven PS, Manniën J, Martin L, Reinders HS, Spelten E, Hutton EK. Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study. BMC Pregnancy Childbirth 2014; 14:264. [PMID: 25106057 PMCID: PMC4137078 DOI: 10.1186/1471-2393-14-264] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 08/05/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Two prenatal screening tests for congenital anomalies are offered to all pregnant women in the Netherlands on an opt-in basis: the Combined Test (CT) for Down syndrome at twelve weeks, and the Fetal Anomaly Scan (FAS) at around twenty weeks. The CT is free for women who are 36 or older; the FAS is free for all women. We investigated factors associated with the CT and FAS uptake. METHOD This study is part of the DELIVER study that evaluated primary care midwifery in the Netherlands. Associations between the women's characteristics and the CT and FAS uptake were measured using multivariate and multilevel logistic regression analyses. RESULTS Of 5216 participants, 23% had the CT and 90% had the FAS, with uptake rates ranging from 4% to 48% and 62% to 98% respectively between practices. Age (OR: 2.71), income (OR: 1.38), ethnicity (OR: 1.37), being Protestant (OR: 0.25), multiparous (OR: 0.64) and living in the east of the country (OR: 0.31) were associated with CT uptake; education (OR: 1.26), income (OR: 1.66), being Protestant (OR: 0.37) or Muslim (OR: 0.31) and being multiparous (OR: 0.74) were associated with FAS uptake. Among western women with a non-Dutch background, first generation (OR: 2.91), age (OR: 2.00), income (OR: 1.97), being Protestant (OR: 0.32) and living in the east (OR: 0.44) were associated with CT uptake; being Catholic (OR: 0.27), Protestant (OR: 0.13) were associated with FAS uptake. Among non- western women with a non-Dutch background, age (OR: 1.73), income (OR: 1.97) and lacking proficiency in Dutch (OR: 2.18) were associated with CT uptake; higher education (OR: 1.47), being Muslim (OR: 0.37) and first generation (OR: 0.27) were associated with FAS uptake. CONCLUSION The uptake of the CT and FAS varied widely between practices. Income, parity and being Protestant were associated with uptake of both tests; ethnicity, age and living in the east were associated with CT uptake, and education and being Muslim with FAS uptake. These findings help to explain some differences between women choosing or declining early and late screening, but not the large variation in test uptake among practices, nor between the Netherlands and other countries.
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Affiliation(s)
- Janneke T Gitsels - van der Wal
- />Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7 (D4.44), 1081 HV Amsterdam, Netherlands
- />Faculty of Theology, VU University Amsterdam, Amsterdam, Netherlands
| | | | - Judith Manniën
- />Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7 (D4.44), 1081 HV Amsterdam, Netherlands
| | - Linda Martin
- />Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7 (D4.44), 1081 HV Amsterdam, Netherlands
| | - Hans S Reinders
- />Faculty of Theology, VU University Amsterdam, Amsterdam, Netherlands
| | - Evelien Spelten
- />Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | - Eileen K Hutton
- />Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7 (D4.44), 1081 HV Amsterdam, Netherlands
- />Department Midwifery Education Program, McMaster University, Hamilton, Canada
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Bakker M, Pajkrt E, Bilardo CM. Increased nuchal translucency with normal karyotype and anomaly scan: What next? Best Pract Res Clin Obstet Gynaecol 2014; 28:355-66. [DOI: 10.1016/j.bpobgyn.2013.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/23/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
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17
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Vassy C, Rosman S, Rousseau B. From policy making to service use. Down's syndrome antenatal screening in England, France and the Netherlands. Soc Sci Med 2014; 106:67-74. [DOI: 10.1016/j.socscimed.2014.01.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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18
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Canbulat N, Demirgöz Bal M, Çoplu M. Emotional reactions of mothers who have babies who are diagnosed with Down syndrome. Int J Nurs Knowl 2014; 25:147-53. [PMID: 24602179 DOI: 10.1111/2047-3095.12026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to explore a deeper insight into experiences of Turkish mothers living with/diagnosed with Down syndrome (DS) baby. METHODS Individual and audiotaped interviews were carried out with 11 women after amniocentesis in Karaman city of Turkey between August 2012 and February 2013. Transcribed semistructured interviews were qualitatively and analyzed using a thematic analysis approach to code and categorize emerging themes. RESULTS Three principal themes emerged from the study: mothers' emotional reaction after diagnosed DS, mother and healthcare professional interactions, and mother's coping with diagnosed DS. CONCLUSIONS Understanding the experiences of women living with/diagnosed with DS baby enables nurses to devise appropriate strategies to provide better support at every stage and thus helping them to cope with daily life.
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Affiliation(s)
- Nejla Canbulat
- Department of Pediatric Nursing, School of Health, Karamanoglu Mehmetbey University, Karaman, Turkey
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19
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Daley R, Hill M, Lewis C, Chitty L. Non-invasive prenatal testing for Down's syndrome—Where are we now? ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Daley
- Research Midwife, Great Ormond Street Hospital for Children NHS Foundation Trust; University College London Hospital NHS Foundation Trust
| | - Melissa Hill
- RAPID Project Coordinator, Great Ormond Street Hospital for Children NHS Foundation Trust
| | - Celine Lewis
- Research Psychologist, Great Ormond Street Hospital for Children NHS Foundation Trust; UCL Institute of Child Health
| | - Lyn Chitty
- Professor, Genetics and Fetal Medicine Great Ormond Street Hospital for Children NHS Foundation Trust; UCL Institute of Child Health
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20
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Constantine ML, Allyse M, Wall M, Vries RD, Rockwood TH. Imperfect informed consent for prenatal screening: Lessons from the Quad screen. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1477750913511339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The study evaluated patient informed consent (IC) for the Quad screen and examined differences in IC between test acceptors and test refusers. A multidimensional model of IC was used. Methods Women seeking prenatal care at nine obstetrics clinics in a large Midwestern city completed surveys between February and December 2006. Surveys contained measures for three dimensions of IC: intention, understanding and controlling influence. Results 56.2% of women did not meet criteria for all three of our dimensions of IC and therefore failed to give it. The failure rate was higher among women who choose to screen (72.6%) than women who choose not screen (50%) (p < 0.001). Women who met all criteria for IC were over three times less likley to choose to screen (or = 0.32, CI 0.17–0.62 ( p < 0.01)) than women who did not meet criteria for IC. Conclusion The decision to screen for fetal anomalies is less of a deliberated action than the decision not to screen. Women who lack a fundamental understanding of the purpose and nature of the screen may be operating on the belief that the screen is part of standard care and presents no need to deliberate.
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Affiliation(s)
- ML Constantine
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M Allyse
- Center for Biomedical Ethics, Stanford University, Stanford, CA, USA
| | - M Wall
- Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY, USA
| | - R De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Medical Education/Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
- Academie Verloskunde Maastricht/Zuyd University; CAPHRI School for Public Health and Primary Care/Maastricht University, Maastricht, NL
| | - TH Rockwood
- Department of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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21
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Horsch A, Brooks C, Fletcher H. Maternal coping, appraisals and adjustment following diagnosis of fetal anomaly. Prenat Diagn 2013; 33:1137-45. [DOI: 10.1002/pd.4207] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/18/2013] [Accepted: 07/20/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Antje Horsch
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA); Unité de Recherche, Université de Lausanne Lausanne Switzerland
- Service de Néonatologie; Université de Lausanne, Lausanne Switzerland
| | - Chloe Brooks
- Children and Young People Learning Disability Service; Evergreen House Cheltenham UK
| | - Helen Fletcher
- Southern Health NHS Foundation Trust; Psychology Services, South Bucks Community Learning Disabilities Team; High Wycombe UK
- North Learning Disability Team; Aylesbury UK
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22
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Farrimond HR, Kelly SE. Public viewpoints on new non-invasive prenatal genetic tests. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2013; 22:730-44. [PMID: 23885055 DOI: 10.1177/0963662511424359] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Prenatal screening programmes have been critiqued for their routine implementation according to clinical rationale without public debate. A new approach, non-invasive prenatal diagnosis (NIPD), promises diagnosis of fetal genetic disorders from a sample of maternal blood without the miscarriage risk of current invasive prenatal tests (e.g. amniocentesis). Little research has investigated the attitudes of wider publics to NIPD. This study used Q-methodology, which combines factor analysis with qualitative comments, to identify four distinct "viewpoints" amongst 71 UK men and women: 1. NIPD as a new tool in the ongoing societal discrimination against the disabled; 2. NIPD as a positive clinical application offering peace of mind in pregnancy; 3. NIPD as a medical option justified for severe disorders only; and 4. NIPD as a valid expansion of personal choice. Concerns included the "trivialisation of testing" and the implications of commercial/direct-to-consumer tests. Q-methodology has considerable potential to identify viewpoints and frame public debate about new technologies.
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23
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Lewis C, Silcock C, Chitty LS. Non-invasive prenatal testing for Down's syndrome: pregnant women's views and likely uptake. Public Health Genomics 2013; 16:223-32. [PMID: 23886854 DOI: 10.1159/000353523] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The introduction of non-invasive prenatal testing (NIPT) for Down's syndrome into routine state-funded antenatal care in the UK is approaching. METHODS We conducted qualitative one-to-one interviews with 40 pregnant women to ascertain their views on using NIPT for Down's syndrome. RESULTS The overwhelming majority of women viewed NIPT as a positive advancement in prenatal care, highlighting numerous practical and psychological advantages of a safe test that was highly accurate and could be conducted early in pregnancy. Concerns raised were that testing could become routinised, and that pressure to test might occur with women feeling less justified in declining a blood test that is available and offered by trusted health professionals; the impact on the disabled community and stigma for women who decline testing was also noted. Nevertheless, the vast majority of women said they would be likely to use NIPT, including half of the women who currently decline screening. Women's preference was for pre- and post-test counselling to be delivered by a midwife. CONCLUSION The successful introduction of NIPT into routine prenatal care will require guidelines and counselling strategies which ensure women are offered this test in a way which safeguards informed consent.
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Affiliation(s)
- C Lewis
- Genetic Alliance UK, London, UK
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24
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Gitsels-van der Wal JT, Manniën J, Ghaly MM, Verhoeven PS, Hutton EK, Reinders HS. The role of religion in decision-making on antenatal screening of congenital anomalies: a qualitative study amongst Muslim Turkish origin immigrants. Midwifery 2013; 30:297-302. [PMID: 23726134 DOI: 10.1016/j.midw.2013.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE to explore what role religious beliefs of pregnant Muslim women play in their decision-making on antenatal screening, particularly regarding congenital abnormalities and termination, and whether their interpretations of the religious doctrines correspond to the main sources of Islam. DESIGN qualitative pilot study using in-depth interviews with pregnant Muslim women. SETTING one midwifery practice in a medium-sized city near Amsterdam participated in the study. PARTICIPANTS 10 pregnant Muslim women of Turkish origin who live in a high density immigrant area and who attended primary midwives for antenatal care were included in the study. DATA COLLECTION AND DATA ANALYSIS to explore the role of religion in decision-making on antenatal screening tests, a topic list was constructed, including four subjects: being a (practising) Muslim, the view on unborn life, the view on disabled life and the view on termination. To analyse the interviews, open and axial coding based on the Grounded Theory was used and descriptive and analytical themes were identified and interpreted. FINDINGS all 10 interviewees stated that their faith played a role in their decision-making on antenatal screening, specific to the combined test. They did not consider congenital anomalies as a problem and did not consider termination to be an option in case of a disabled fetus. However, the Islamic jurisprudence considers that termination is allowed if the fetus has serious abnormalities, but only before 19 weeks plus one day of gestation. KEY CONCLUSIONS religious convictions play a role regarding antenatal screening in pregnant Muslim women of Turkish origin. The interviewees did not consider a termination in case of an affected child. Women were unaware that within Islamic tradition there is the possibility of termination if a fetus has serious anomalies. Incomplete knowledge of religious doctrines may be influencing both decisions of antenatal screening and diagnostic tests uptake and of terminating a pregnancy for fetuses with serious anomalies. IMPLICATIONS FOR PRACTISE counsellors should be aware of the role of religious beliefs in the decision-making process on antenatal screening tests.
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Affiliation(s)
- Janneke T Gitsels-van der Wal
- Faculty of Theology, VU University Amsterdam, the Netherlands; Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Mohammed M Ghaly
- Islamic Studies, Faculty of Humanities, Leiden University, the Netherlands.
| | | | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; McMaster University, Department Midwifery Education Program, Hamilton, Canada.
| | - Hans S Reinders
- Faculty of Theology, VU University Amsterdam, the Netherlands.
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25
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Carroll FE, Al-Janabi H, Flynn T, Montgomery AA. Women and their partners' preferences for Down's syndrome screening tests: a discrete choice experiment. Prenat Diagn 2013; 33:449-56. [DOI: 10.1002/pd.4086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Fran E. Carroll
- School of Social and Community Medicine; University of Bristol; England UK
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences; University of Birmingham; England UK
| | - Terry Flynn
- Centre for the Study of Choice; University of Technology; Sydney Australia
| | - Alan A. Montgomery
- School of Social and Community Medicine; University of Bristol; England UK
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26
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Bakker M, Birnie E, Pajkrt E, Bilardo CM, Snijders RJM. Low uptake of the combined test in the Netherlands - which factors contribute? Prenat Diagn 2012; 32:1305-12. [DOI: 10.1002/pd.4001] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Merel Bakker
- Department of Obstetrics and Gynecology, Fetal Medicine Unit; University Medical Centre; Groningen The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, Fetal Medicine Unit; University Medical Centre; Groningen The Netherlands
- Department of Genetics, University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Fetal Medicine Unit; Academic Medical Centre; Amsterdam The Netherlands
| | - Caterina Maddalena Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit; University Medical Centre; Groningen The Netherlands
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Allyse M, Sayres LC, King JS, Norton ME, Cho MK. Cell-free fetal DNA testing for fetal aneuploidy and beyond: clinical integration challenges in the US context. Hum Reprod 2012; 27:3123-31. [PMID: 22863603 PMCID: PMC3472618 DOI: 10.1093/humrep/des286] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The recent release of new, non-invasive prenatal tests for fetal aneuploidy using cell-free fetal DNA (cffDNA) has been hailed as a revolution in prenatal testing and has triggered significant commercial interest in the field. Ongoing research portends the arrival of a wide range of cffDNA tests. However, it is not yet clear how these tests will be integrated into well-established prenatal testing strategies in the USA, as the timing of such testing and the degree to which new non-invasive tests will supplement or replace existing screening and diagnostic tools remain uncertain. We argue that there is an urgent need for policy-makers, regulators and professional societies to provide guidance on the most efficient and ethical manner for such tests to be introduced into clinical practice in the USA.
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Affiliation(s)
- Megan Allyse
- Stanford Center for Biomedical Ethics, Stanford, CA 94305-5417, USA.
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28
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Schoonen M, Wildschut H, Essink-Bot ML, Peters I, Steegers E, de Koning H. The provision of information and informed decision-making on prenatal screening for Down syndrome: a questionnaire- and register-based survey in a non-selected population. PATIENT EDUCATION AND COUNSELING 2012; 87:351-359. [PMID: 22030253 DOI: 10.1016/j.pec.2011.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 09/27/2011] [Accepted: 10/04/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Evaluating the information provision procedure about prenatal screening for Down syndrome, using informed decision-making as a quality-indicator. METHODS Questionnaire- and register-based surveys. Midwives associated with 59 midwifery practices completed process data for 6435 pregnancies. Pregnant women (n=510) completed questionnaires on informed decision-making. RESULTS Midwives offered information to 98.5% of women; 62.6% of them wished to receive information, of these, 81.9% actually received information. Decision-relevant knowledge was adequate in 89.0% of responding women. Knowledge about Down syndrome was less adequate than knowledge about the screening program. Participants in the screening program had higher knowledge scores on Down syndrome and on the screening program than non-participants. Of the women who intended to participate (35.8%), 3.1% had inadequate knowledge. A total of 75.5% of women made an informed decision; 94.3% of women participating in the screening program, and 64.9% of women not participating. CONCLUSION This quality assurance study showed high levels of informed decision-making and a relatively low participation rate in the national screening program for Down syndrome in the Netherlands. Knowledge of the Down syndrome condition needs to be improved. PRACTICE IMPLICATIONS This evaluation may serve as a pilot study for quality monitoring studies at a national level.
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Affiliation(s)
- Marleen Schoonen
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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29
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Chitty LS, Hill M, White H, Wright D, Morris S. Noninvasive prenatal testing for aneuploidy-ready for prime time? Am J Obstet Gynecol 2012; 206:269-75. [PMID: 22464064 DOI: 10.1016/j.ajog.2012.02.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
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Choi H, Van Riper M, Thoyre S. Decision making following a prenatal diagnosis of Down syndrome: an integrative review. J Midwifery Womens Health 2012; 57:156-64. [PMID: 22432488 DOI: 10.1111/j.1542-2011.2011.00109.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prenatal screening for Down syndrome (DS) is a routine part of prenatal care in many countries, and there is growing interest in the choices women make following a prenatal diagnosis of DS. This review describes what is known about actual and hypothetical decision making following a prenatal diagnosis of DS and adds understanding about the factors that influence women's decision making. METHODS A search of empirical studies was conducted through electronic databases, major journals, and reference lists that were published in English between January 1999 and September 2010. Inclusion criteria were that the research explored attitudes toward continuation of pregnancy or induced abortion for DS and included at least 1 variable that explored factors influencing women's decision making following a prenatal diagnosis of DS. Studies that did not specify DS, unpublished manuscripts, review articles, and book chapters were excluded. RESULTS A total of 11 studies were identified that met the inclusion criteria. The decision to undergo an induced abortion varied depending on whether participants were prospective parents recruited from the general population (23%-33% would terminate), pregnant women at increased risk for having a child with DS (46%-86% would terminate), or women who received a positive diagnosis of DS during the prenatal period (89%-97% terminated). Multiple factors influence women's decision making following a diagnosis of DS, including demographic factors such as religion, maternal age, gestational age, number of existing children, and history of induced abortion. Psychosocial factors including perceived parenting burden/reward, quality of life for a child with DS, attitudes toward and comfort with individuals with disabilities, and support from others also are important influences. DISCUSSION Multiple factors influence the decisions pregnant women make following the diagnosis of fetal DS. Therefore, it is critical that health care providers who work with pregnant women are aware of these factors.
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Affiliation(s)
- Hyunkyung Choi
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460, USA.
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31
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Tischler R, Hudgins L, Blumenfeld YJ, Greely HT, Ormond KE. Noninvasive prenatal diagnosis: pregnant women's interest and expected uptake. Prenat Diagn 2011; 31:1292-9. [PMID: 22028097 PMCID: PMC3225485 DOI: 10.1002/pd.2888] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate pregnant women's level of future interest in noninvasive prenatal diagnosis (NIPD) and what factors might affect expected uptake of this testing. METHOD Written questionnaires were administered to women in their third trimester. RESULTS One hundred fourteen women returned the questionnaire (80.9% response rate). Of these, 71.9% reported interest in NIPD, 22.7% were ambivalent, and 5.4% were uninterested. Safety of the fetus was the single most important factor in 75% of women's decisions. Factors associated with increased interest in NIPD included: older age (p = 0.036), higher education (p = 0.013), Caucasian or Asian ethnicity (p = 0.011), and higher likelihood to terminate an affected pregnancy (p = 0.002). Nearly 20% of women reported that they would do whatever their doctor recommended regarding NIPD, and 94.4% of women wished to meet with a genetic counselor at some point to discuss NIPD. CONCLUSION The majority of pregnant women report hypothetical interest in NIPD, primarily because of increased safety for the fetus, although a significant minority are uninterested or ambivalent. Discussions with healthcare providers regarding NIPD, and their recommendations, are likely to be an important factor in women's decisions about this testing. As such, adequate discussion of the implications of prenatal diagnostic testing will be critical.
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Affiliation(s)
- Reana Tischler
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Louanne Hudgins
- Department of Pediatrics, Division of Medical Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Henry T. Greely
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Law School, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Center for Biomedical Ethics, Institutions: Stanford University, Lucile Packard Children’s Hospital
| | - Kelly E. Ormond
- Department of Genetics, Institutions: Stanford University, Lucile Packard Children’s Hospital
- Stanford Center for Biomedical Ethics, Institutions: Stanford University, Lucile Packard Children’s Hospital
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Kuppermann M, Nakagawa S, Cohen SR, Dominguez-Pareto I, Shaffer BL, Holloway SD. Attitudes toward prenatal testing and pregnancy termination among a diverse population of parents of children with intellectual disabilities. Prenat Diagn 2011; 31:1251-8. [PMID: 22028300 DOI: 10.1002/pd.2880] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/03/2011] [Accepted: 08/23/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine how parents of children with intellectual disabilities view prenatal testing and pregnancy termination for their child's condition. METHOD We interviewed 201 English-speaking or Spanish-speaking caregivers of children aged 2 to 10 years. Primary outcomes were being disinclined to undergo prenatal testing or pregnancy termination for the child's condition in a future pregnancy. RESULTS While only 33% of the sample indicated they would not have prenatal testing, 75% were disinclined to terminate their pregnancy if their fetus was affected. In multivariable logistic regression analysis, Asians were significantly less likely than White participants to say they would forego prenatal testing (adjusted odds ratio (aOR) = 0.08, 95% confidence interval (CI) = 0.01-0.86, p = 0.037), while Latinos had lower odds of being disinclined to terminate (aOR = 0.27, 95% CI = 0.07-0.99, p = 0.048). Participants who felt that abortion for their child's condition should not be available were more likely to say they would forego prenatal testing (aOR = 5.10, 95% CI = 2.09-12.43, p < 0.001) and, not surprisingly, they were also at higher odds of being disinclined to terminate pregnancy for this condition (aOR = 13.63, 95% = CI 4.19-44.34, p < 0.001). Greater life satisfaction also was associated with being disinclined to terminate pregnancy (aOR = 3.40, 95% CI = 1.34-8.61, p = 0.010). CONCLUSION Although many parents of children with intellectual disabilities believe they would desire information regarding their fetus in a future pregnancy, most feel they would not opt to terminate their pregnancy. As new tests for intellectual disabilities become available, determining what would be most useful to prospective parents should become a high priority.
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Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, CA 94143-0856, USA.
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Azria E. [Statement of conscience in trisomy 21 screening: pregnant women's free will jeopardized]. ACTA ACUST UNITED AC 2010; 39:592-4. [PMID: 20926207 DOI: 10.1016/j.jgyn.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2010] [Indexed: 11/17/2022]
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Seror V, Ville Y. Women's attitudes to the successive decisions possibly involved in prenatal screening for Down syndrome: how consistent with their actual decisions? Prenat Diagn 2010; 30:1086-93. [DOI: 10.1002/pd.2616] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Leblanc P, Arduin PO. [Down syndrome screening: from medical criticism to crisis of conscience]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2010; 39:509-13. [PMID: 20692772 DOI: 10.1016/j.jgyn.2010.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/02/2010] [Indexed: 11/29/2022]
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:166-75. [PMID: 20216348 DOI: 10.1097/gco.0b013e328338c956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leblanc P, Arduin PO. [Medical ethics as tried by bioethics' law. From an obstetrician's point of view]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38:363-366. [PMID: 19467805 DOI: 10.1016/j.jgyn.2009.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 03/20/2009] [Accepted: 04/08/2009] [Indexed: 05/27/2023]
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Azria E, Schmitz T, Bourgeois-Moine A, Goffinet F, Tsatsaris V, Mahieu-Caputo D. Peut-on concilier autonomie maternelle et responsabilité médicale dans les décisions de voies d’accouchement des fœtus en siège ? Rôle de l’information. ACTA ACUST UNITED AC 2009; 37:464-9. [DOI: 10.1016/j.gyobfe.2009.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 04/01/2009] [Indexed: 11/30/2022]
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