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Tzela P, Antsaklis P, Kanellopoulos D, Antonakopoulos N, Gourounti K. Factors Influencing the Decision-Making Process for Undergoing Invasive Prenatal Testing. Cureus 2024; 16:e58803. [PMID: 38654958 PMCID: PMC11036145 DOI: 10.7759/cureus.58803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Invasive prenatal testing, amniocentesis, and chorionic villus sampling offer insights into fetal genetic integrity and health, but carry inevitable minor risks of miscarriage and infection, thus complicating the decision-making process for parents. Previous research has revealed several factors that influence the decision to undergo invasive prenatal testing, including demographic, clinical, and psychological aspects, and attitudes towards testing. Informed choice, involving understanding options and aligning them with personal values, is crucial, with healthcare providers playing a key role in offering unbiased information. This systematic review aims to gather and synthesize literature data on the above factors to draw conclusions to aid antenatal care providers in supporting couples to make more informed decisions about their prenatal care. A systematic search was performed in PubMed and PsycInfo databases using the appropriate keywords and an in-depth evaluation of the studies retrieved followed. Finally, 17 articles were eligible for our review investigating the decision-making process of invasive prenatal testing. Factors like maternal age, education, and ethnicity are pivotal during the decision-making process. Clinical characteristics also influence decisions and women with pregnancies categorized as high-risk or those who have undergone fertility treatment display a preference for invasive testing. There seems to be a direct correlation between a woman's willingness to consider pregnancy termination, deeply rooted in psychological and moral stances, and the inclination to undergo invasive testing. In the patient decision-making process, the provision and depth of knowledge are of paramount importance. A comprehensive understanding facilitates more informed decisions. Finally, attitudes towards termination of pregnancy, as another factor influencing the decision-making process, reveal a nuanced landscape where personal beliefs, religious considerations, legal restrictions, and perspectives on disability converge. Within this complex context, religion emerges as an important determinant, shaping individuals' views on the morality of abortion. This review sheds light on the most important factors influencing the couples' consent for invasive prenatal testing. Healthcare professionals must identify which factors are critical in every specific case among several sociodemographic, clinical, emotional, and religious factors. Thus, they will be able to provide balanced and comprehensive information to help couples under this stressful procedure. We advocate for a patient-centered multidisciplinary approach while navigating couples through the intricate landscape of decision-making concerning invasive prenatal testing.
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Affiliation(s)
- Panagiota Tzela
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Panagiotis Antsaklis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Kanellopoulos
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Nikolaos Antonakopoulos
- Department of Obstetrics and Gynecology, School of Health Sciences, University of Patras, Patras, GRC
| | - Kleanthi Gourounti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
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Gerdes SMB, Ekelund CK, Rode L, Miltoft CB, Midtgaard J, Jørgensen FS, Pihl K, Tabor A, Riishede I. Motivation towards first trimester screening for preeclampsia among pregnant women in Denmark: A cross-sectional questionnaire study. Acta Obstet Gynecol Scand 2023; 102:1531-1540. [PMID: 37533170 PMCID: PMC10577627 DOI: 10.1111/aogs.14632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION The aim of this cross-sectional questionnaire study was to investigate motivation to participate in a possible new screening for preeclampsia in the first trimester of pregnancy among Danish pregnant women through a questionnaire based on Theory of Planned Behavior developed for this specific purpose. The new screening combines maternal characteristics with mean arterial pressure, uterine artery pulsatility index and biochemical markers to predict the risk of preeclampsia, whereas the current Danish screening uses maternal characteristics alone. MATERIAL AND METHODS Participation was offered to a proportion of women attending a first or a second trimester screening scan at two University Hospitals in Copenhagen. The questionnaire was set up in REDCap® and answers were entered directly into the database, which was accessed via a QR-code. RESULTS We invited 772 pregnant women to participate in the questionnaire survey between November 2021 and April 2022 at Copenhagen University Hospital Rigshospitalet (study site one) (n = 238) and Copenhagen University Hospital Hvidovre (study site two) (n = 534). The response rate was 71.8% (171/238) at study site one and 33.9% (181/534) at study site two. A total of 352 women were included in the study (total participation rate 45.6%). Most women had a positive attitude towards preeclampsia screening in pregnancy, and 99.4% said they would participate in a risk assessment for preeclampsia if given the opportunity. A total of 97.4% answered "yes" to whether a first trimester preeclampsia screening should be offered to all pregnant women in Denmark. Positive motivation to participate in preeclampsia screening was correlated with having a network with a positive attitude towards preeclampsia screening. CONCLUSIONS The results of this study indicate that Danish pregnant women have a positive attitude towards participation in a first trimester screening for preeclampsia. This observation might be useful in relation to possible future implementation in Denmark.
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Affiliation(s)
- Sandra Maria Behnke Gerdes
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Charlotte Kvist Ekelund
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Line Rode
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
- Department of Clinical BiochemistryCopenhagen University Hospital RigshospitaletGlostrupDenmark
| | - Caroline Borregaard Miltoft
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Julie Midtgaard
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Center for Applied Research in Mental Health Care (CARMEN)Mental Health Center GlostrupGlostrupDenmark
| | - Finn Stener Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Fetal Medicine Unit, Department of Obstetrics and GynecologyCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Kasper Pihl
- Fetal Medicine Unit, Department of Obstetrics and GynecologyCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Ann Tabor
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Iben Riishede
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Center of Fetal Medicine, Department of ObstetricsCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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Zhao Y, Xue Z, Geng Y, Zhu J, Hu M, Jiang M. Understanding knowledge, perception, and willingness of non-invasive prenatal testing for fetal aneuploidy: a survey among Chinese high-risk pregnant women. Front Med (Lausanne) 2023; 10:1232942. [PMID: 37908853 PMCID: PMC10613663 DOI: 10.3389/fmed.2023.1232942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Non-invasive prenatal testing (NIPT) is utilized for screening the likelihood of fetal aneuploidy, presenting the benefits of non-invasiveness, high sensitivity, and specificity. Its application in prenatal screening has become ubiquitous. The inquiry into how pregnant women comprehend and determine NIPT screening strategies is paramount. Regrettably, there has been a dearth of research on this subject in China. Consequently, this study scrutinizes pregnant women's cognizance and perspectives concerning NIPT, furnishing a foundation for advancing its judicious implementation. Methods From February 2021 to December 2022, a questionnaire survey was conducted among pregnant women receiving prenatal care and screening at the Women's Hospital, School of Medicine, Zhejiang University, who were randomly selected from a pool of individuals exhibiting a high risk of fetal aneuploidy on serological screening. The survey aimed to gather data on participant characteristics, knowledge, perception, and willingness concerning NIPT. The study employed chi-square and Kruskal Wallis tests to analyze subgroup differences. Results A total of 226 valid questionnaires were obtained. 83.2% of women pregnant women identified as high risk by serological screening would opt for NIPT, with 66.4% indicating that they would prefer NIPT for fetal aneuploidy screening in future pregnancies. These findings suggest a notable willingness among pregnant women to undergo NIPT. Additionally, the results suggest that various factors, including place of residence, educational level, family income, causes of abortion, and conception method, influence pregnant women's knowledge about NIPT Accordingly, the level of NIPT knowledge varies among pregnant women. Conclusion The survey generally revealed that pregnant women were strongly inclined to select NIPT; however, expectant Chinese mothers possess limited knowledge and perception regarding this screening method for fetal aneuploidy. Therefore, the government must implement effective measures to augment public awareness of fetal aneuploidy screening and encourage the judicious utilization of NIPT.
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Affiliation(s)
- Yi Zhao
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhu Xue
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yarui Geng
- Department of Drug Clinical Trials, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Zhu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Maidan Hu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Minmin Jiang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
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Lust EER, Bronsgeest K, Henneman L, Crombag N, Bilardo CM, van Vliet-Lachotzki EH, Galjaard RJH, Sikkel E, Haak MC, Bekker MN. Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands. BMC Pregnancy Childbirth 2023; 23:694. [PMID: 37752446 PMCID: PMC10521538 DOI: 10.1186/s12884-023-05981-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Since 2007 all pregnant women in the Netherlands are offered the second-trimester anomaly scan (SAS) in a nationwide prenatal screening program. This study aims to assess the level of informed choice of women opting for the SAS and to evaluate the presence of routinization 16 years after its implementation. It further explores decisional conflict and women's decision making. METHODS This prospective national survey study consisted of an online questionnaire which was completed after prenatal counseling and before undergoing the SAS. Informed choice was measured by the adapted multidimensional measure of informed choice (MMIC) and was defined in case women were classified as value-consistent, if their decision for the SAS was deliberated and made with sufficient knowledge. RESULTS A total of 894/1167 (76.6%) women completed the questionnaire. Overall, 54.8% made an informed choice, 89.6% had good knowledge, 59.8% had deliberated their choice and 92.7% held a positive attitude towards the SAS. Women with low educational attainment (p=0.004) or respondents of non-Western descent (p=0.038) were less likely to make an informed choice. Decisional conflict was low, with a significantly lower decisional conflict score in women that made an informed choice (p<0.001). Most respondents (97.9%) did not perceive pressure to undergo the SAS. CONCLUSIONS Our study showed a relatively low rate of informed choice for the SAS, due to absence of deliberation. Therefore, some routinization seem to be present in the Netherlands. However, most women had sufficient knowledge, did not perceive pressure and experienced low decisional conflict.
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Affiliation(s)
- Eline E R Lust
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
| | - Kim Bronsgeest
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Neeltje Crombag
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands.
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Katada C, Ohashi K, Okada K, Sawai H. Factors related to indecisive attitudes toward non-invasive prenatal testing among women of reproductive age in Japan. J Obstet Gynaecol Res 2023; 49:794-802. [PMID: 36478626 DOI: 10.1111/jog.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to investigate the factors related to indecisive attitudes toward noninvasive prenatal testing (NIPT) among nonpregnant women of reproductive age. METHODS We conducted an online survey involving nonpregnant Japanese women aged 20-49 years. The questionnaires consisted of a hypothetical question about whether they would decide to undergo NIPT if they were to become pregnant, and responses with "unsure" were defined as indecisive attitudes. RESULTS Of 1250 participants, 412 (33%) held indecisive attitudes on whether to undergo NIPT. Multivariable logistic regression analysis demonstrated indecisive attitudes were related to a low level of knowledge about prenatal testing (adjusted odds ratio [AOR] 3.89) and preferences for family-driven decisions (AOR 1.44) instead of provider-driven. CONCLUSION Even though the NIPT is widespread, many nonpregnant women of reproductive age are unable to decide whether to undergo the NIPT or not. Hence, indecisive women toward NIPT require adequate information and communication about future NIPT among their families prior to conception. Therefore, preconception support of providing adequate information about testing and facilitating communication regarding future NIPT among women and their family members may help indecisive women make autonomous decisions on NIPT.
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Affiliation(s)
- Chihiro Katada
- Department of Nursing, Hyogo Medical University, Hyogo, Japan
| | | | - Kimie Okada
- Department of Nursing, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Hideaki Sawai
- Department of Obstetrics and Gynecology, Hyogo Medical University, Hyogo, Japan
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Sagi-Dain L, Peleg A, Sagi S, Singer A. The anxiety caused by abnormal results of Down syndrome screening tests. J OBSTET GYNAECOL 2022; 42:2893-2898. [PMID: 35993543 DOI: 10.1080/01443615.2022.2111659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The objective of our survey was to evaluate the anxiety experienced by women receiving abnormal results of prenatal Down syndrome screening by an electronic anonymous survey. Anxiety level was evaluated by a six-item Spielberger State-Trait Anxiety Inventory. Of 559 respondents, high anxiety scores were reported in the majority (86.0%). Higher anxiety scores were noted in women informed of the abnormal result by the caregiver vs. written answer. 59.1% of the respondents preferred the risk reported as percentage, while only 4.4% gave precedence to the current form (e.g. 1 in 100). The participants noted several factors which could relieve their anxiety, including an explanatory booklet (72.4%) or a website (77.9%). In conclusion, women receiving abnormal results of Down syndrome screening experience significant anxiety. Efforts should be made to relieve this distress, including changing the historical ratio risk format to percentage, adding a non-directive verbal annotation, an explanatory website and improving health professionals' understanding of the exact statistical meaning of the risk.Impact statementWhat is already known on this subject? Abnormal results of prenatal screening for Down syndrome might cause the women significant anxiety. Several simple methods are able to relieve this distress; however, they are frequently not implemented in the routine practice.What the results of this study add? We show that abnormal results of the screening tests are associated with high anxiety scores in the majority of women (86.0%). The majority of the respondents preferred the risk reported as percentage (vs. historical representation as a ratio). The participants noted several factors which could relieve their anxiety, including an explanatory booklet or a website.What the implications are of these findings for clinical practice and/or further research? Based on the results, we discuss the numerous ways able to available alleviate the distress.
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Affiliation(s)
- Lena Sagi-Dain
- The Human Genetics Institute, Carmel Medical Center, Haifa, Israel
| | - Amir Peleg
- The Human Genetics Institute, Carmel Medical Center, Haifa, Israel
| | - Shlomi Sagi
- Obstetrics and Gynecology Department, Bnai Zion Medical Center, Haifa, Israel
| | - Amihood Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
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Sim WS, Yeo SH, Choi C, Yeo TW, Lee JJ, Huynh VA, Finkelstein EA, Ozdemir S. Preferences for a non‐invasive prenatal test as first‐line screening for Down Syndrome: A discrete choice experiment. Prenat Diagn 2022; 42:1368-1376. [DOI: 10.1002/pd.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Wen Shan Sim
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Seow Heong Yeo
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Christina Choi
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Tai Wai Yeo
- Department of Pathology and Laboratory Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Jia Jia Lee
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Eric Andrew Finkelstein
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Duke Global Health Institute Duke University 310 Trent Drive Durham NC USA27710
| | - Semra Ozdemir
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Saw Swee Hock School of Public Health National University of Singapore 12 Science Drive Singapore Singapore117549
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8
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Anselem O, Saurel-Cubizolles MJ, Khoshnood B, Blondel B, Sauvegrain P, Bertille N, Azria E. Does women's place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France. BMC Pregnancy Childbirth 2021; 21:590. [PMID: 34461849 PMCID: PMC8406966 DOI: 10.1186/s12884-021-04041-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women. Methods We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator. Results Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit’s level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care. Conclusions Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.
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Affiliation(s)
- Olivia Anselem
- Maternité Port-Royal, APHP.Centre-Université de Paris, FHU PREMA, 123 boulevard de Port-Royal, 75014, Paris, France.
| | - Marie-Josèphe Saurel-Cubizolles
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Babak Khoshnood
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Université Paris, Paris, France
| | - Nathalie Bertille
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternité du Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France
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Privacy Risks in Prenatal Aneuploidy and Carrier Screening: What Obstetricians and Their Patients Need to Know. Obstet Gynecol 2021; 137:1074-1079. [PMID: 33957653 DOI: 10.1097/aog.0000000000004387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Modern prenatal genetic screening techniques such as cell-free fetal DNA and expanded carrier screening genotype substantial amounts of maternal and fetoplacental DNA. Although DNA can be deidentified by stripping protected health information from genetic data, anonymized DNA can be reidentified using genetic databases, raising long-term genetic privacy concerns for both mother and fetus. In this commentary, we explore the evolution of prenatal genetic screening and how modern screening techniques may pose unanticipated privacy risks. We highlight knowledge gaps and outline steps to improve patient awareness of and control over their genetic privacy, including specific recommendations for laboratories and prenatal care practitioners who offer screening. We also encourage our colleagues who provide prenatal care to be well informed about the privacy implications of the genetic tests we order and to be vocal advocates for our patients' genetic privacy, both with the laboratories that perform these tests and in the public sphere.
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10
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Di Mattei V, Ferrari F, Perego G, Tobia V, Mauro F, Candiani M. Decision-making factors in prenatal testing: A systematic review. Health Psychol Open 2021; 8:2055102920987455. [PMID: 33489303 PMCID: PMC7809316 DOI: 10.1177/2055102920987455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This review examines the factors that affect the decision-making process of parental couples evaluating prenatal screening and diagnostic tests. A systematic search was performed using PubMed and PsycInfo databases. The 46 included studies had to: investigate the decision-making process about prenatal testing; focus on tests detecting trisomy 21, 18, 13, and abnormalities of sex chromosomes; be published in English peer-reviewed journals. The decision-making process seems composed of different levels: an individual level with demographic, clinical, and psychological aspects; a contextual level related to the technical features of the test and the information received; a relational level involving family and society.
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Affiliation(s)
- Valentina Di Mattei
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
| | | | | | | | - Fabio Mauro
- IRCCS San Raffaele Scientific Institute, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
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11
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Paz Y Miño F, Martinez-Portilla RJ, Pauta M, Borrell A. A Randomized Controlled Trial on the Influence of Prenatal Counseling on the Attitudes and Preferences Toward Invasive Prenatal Testing Among Women in Their First Trimester of Pregnancy (INVASIVE). Front Genet 2020; 11:561283. [PMID: 33240315 PMCID: PMC7682740 DOI: 10.3389/fgene.2020.561283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the impact of prenatal genetic counseling on the attitudes and preferences toward invasive testing in first-trimester pregnant women. Methods This is a randomized open-label study, of pregnant women undergoing first trimester combined screening for aneuploidies. Women were divided into the experimental or control groups in a 1:1 design. The intervention consisted of 15-min extra counseling about prenatal screening and diagnosis. The main outcome was the desire to choose an invasive testing as their first prenatal testing option which was measured as absolute risk. Results After excluding those with incomplete data, 75 women remained in the experimental group and 75 as controls. Women receiving counseling were 32% more likely to choose an invasive prenatal testing as their first-line option after extra 15-min extensive counseling, reducing the first-trimester combined screening by 20% and the cell-free DNA by 12%. If given the opportunity, 59% of the women would like to be able to choose the prenatal test that suits their needs. Conclusion Women given an extensive prenatal counseling are more likely to choose an invasive testing as their first-line test in spite of the concerning risks. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04119349.
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Affiliation(s)
- Fernanda Paz Y Miño
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Spain.,Prenatal Diagnosis Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Raigam Jafet Martinez-Portilla
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Spain.,Prenatal Diagnosis Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Clinical Research Department, National Institute of Perinatology, Mexico City, Mexico
| | - Montse Pauta
- Prenatal Diagnosis Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Borrell
- Prenatal Diagnosis Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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12
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Steffensen EH, Hyett J, Petersen OB, Vogel I. Increased prenatal detection of 22q11.2 deletion and 22q11.2 duplication after introduction of nationwide prenatal screening for trisomy 21, trisomy 13, and trisomy 18. Prenat Diagn 2020; 41:218-225. [PMID: 33080663 DOI: 10.1002/pd.5851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/09/2020] [Accepted: 10/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate time of diagnosis of 22q11.2 deletion and 22q11.2 duplication as well as trisomies 21, 13, and 18 before and after introduction of a prenatal screening program including combined first-trimester screening (cFTS) for the trisomies in Denmark in 2004. METHOD Cross-sectional, population-based register study employing The Danish Cytogenetic Central Register. Proportions of cases diagnosed 1998-2004 and 2005-2017 were compared before 14+0 and 22+0 weeks and birth (prenatal cases) or up to 1 or 10 years of age (postnatal cases). RESULTS In total, 4562 cases were included. From 1998-2004 to 2005-2017, the proportion of 22q11.2 deletion cases identified prenatally increased from 4.3% (95% CI: 0.9-12.0%) to 27.3% (21.2-34.0%), while for 22q11.2 duplication an increase from 0/6 to 26/87 (prenatal cases/all cases) was observed. Similarly, proportions of trisomies 21, 13, and 18 detected before birth increased. A greater proportion of the studied conditions was identified earlier in pregnancy, but not generally earlier in the postnatal course. CONCLUSION Proportions of 22q11.2 deletion and 22q11.2 duplication identified prenatally increased after introduction of a prenatal screening program not aimed specifically to identify these conditions,. A greater proportion of all cases were detected earlier in pregnancy, but not earlier postnatally, following introduction of screening.
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Affiliation(s)
- Ellen Hollands Steffensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark.,Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jonathan Hyett
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Royal Prince Alfred Hospital, Women and Babies, Sydney Institute for Women, Children and their Families, Sydney, New South Wales, Australia
| | - Olav Bjørn Petersen
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, København Ø, Denmark.,Department of Clinical Medicine, University of Copenhagen, København N, Denmark
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark.,Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Lou S, Carstensen K, Vogel I, Hvidman L, Nielsen CP, Lanther M, Petersen OB. Receiving a prenatal diagnosis of Down syndrome by phone: a qualitative study of the experiences of pregnant couples. BMJ Open 2019; 9:e026825. [PMID: 30867204 PMCID: PMC6429881 DOI: 10.1136/bmjopen-2018-026825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine how pregnant couples experience receiving a prenatal diagnosis of Down syndrome (DS) by phone-a practice that has been routine care in the Central Denmark Region for years. DESIGN Qualitative interview study. SETTING Participants were recruited from hospitals in Central Denmark Region, Denmark. PARTICIPANTS Couples who had received a prenatal diagnosis of DS by phone and decided to terminate the pregnancy. They were recruited from the obstetric department where the termination was undertaken. During the study period (February 2016 to July 2017), 21 semistructured, audio-recorded interviews were conducted by an experienced anthropologist. Interviews were conducted 4-22 weeks after the diagnosis and analysed using thematic analysis. RESULTS A prearranged phone call was considered an acceptable practice. However, the first theme 'Expected but unexpected' shows how the call often came earlier than expected. Consequently, most women were not with their partner and were thus initially alone with their grief and furthermore responsible for informing their partner, which some considered difficult. The second theme 'Now what?' shows how during the phone calls, physicians were quick to enquire about the couples' agendas. As the majority had already decided to seek termination of pregnancy, the dialogue focused on related questions and arrangements. Only half of the couples received additional counselling. CONCLUSION A prearranged phone call was considered an acceptable and appropriate practice. However, some aspects of this practice (particularly related to the context of the call) showed to be less than optimal for the couples. To make sure that a diagnostic result is delivered in accordance with the couples' needs and requests, the context of the call could be addressed and agreed on in advance by physicians and couples.
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Affiliation(s)
- Stina Lou
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus Universitetshospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
| | | | - Maja Lanther
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
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Møller A, Vogel I, Petersen OB, Lou S. Danish Sonographers' Experiences of the Introduction of "Moderate Risk" in Prenatal Screening for Down Syndrome. J Pregnancy 2018; 2018:1646035. [PMID: 30402287 PMCID: PMC6198582 DOI: 10.1155/2018/1646035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/27/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine sonographers' experiences with the introduction of an offer of noninvasive prenatal testing (NIPT) to a new moderate-risk (MR) group at the combined first-trimester prenatal screening (cFTS). STUDY DESIGN A qualitative approach consisting of seven semistructured interviews with five sonographers (midwives and nurses). Data was analyzed using thematic analysis. MAIN OUTCOME MEASURES Sonographers' perception of offering NIPT to women in MR. RESULTS The sonographers understood NIPT as a positive development in prenatal screening due to a safe procedure and high detection rates for trisomies 13, 18, and 21. Prior to the introduction of MR, the sonographers were concerned about inducing worry in pregnant women in this new risk group. However, the pregnant women responded very positively, which the sonographers attributed to several factors such as the women's overall reason for participating in prenatal screening, the simplicity of the NIPT procedure, and the communicative strategies used by the sonographers. The strategies included all sonographers using the same words and explanations, emphasizing that statistics were in the women's favor, initiating the presentation of MR with a positive message, and downplaying the MR category. CONCLUSION Sonographers' communicative strategies succeeded in limiting worry in pregnant women in MR. As such, the findings are valuable for health professionals, who are responsible for communicating about prenatal screening results and diagnostic options.
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Affiliation(s)
- Anne Møller
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
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15
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Lou S, Carstensen K, Petersen OB, Nielsen CP, Hvidman L, Lanther MR, Vogel I. Termination of pregnancy following a prenatal diagnosis of Down syndrome: A qualitative study of the decision-making process of pregnant couples. Acta Obstet Gynecol Scand 2018; 97:1228-1236. [PMID: 29791717 DOI: 10.1111/aogs.13386] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In Denmark, first trimester screening has a very high uptake (>90%). If Down syndrome is diagnosed, termination rates are high (>95%). The aim of this study was to investigate the timing of the decision to terminate pregnancy following a diagnosis of Down syndrome and the factors influencing this decision. MATERIAL AND METHODS Semi-structured, qualitative interview study with 21 couples who had received a prenatal diagnosis of Down syndrome and decided to terminate the pregnancy. Participants were recruited from obstetric departments between February 2016 and July 2017. Data were analyzed using thematic analysis. RESULTS Five themes were identified: "initial decision-making", "consolidating the decision", "reasons and concerns shaping the termination of pregnancy decision", "the right decision is also burdensome", and "perceived influences in decision-making". For most couples, the initial decision to terminate pregnancy was made before or during the diagnostic process, but it was re-addressed and consolidated following the actual diagnosis. Imagining a family future with a severely affected Down syndrome child was the main factor influencing the termination of pregnancy decision. The decision was articulated as "right" but also as existentially burdensome for some, due to fear of regret and concern about ending a potential life. The decision to terminate pregnancy was considered a private matter between the couple, but was refined through interactions with clinicians and social networks. CONCLUSION All couples made an initial decision prior to receiving the Down syndrome diagnosis. Knowledge of the couple's initial decision may facilitate patient-centered communication during and after the diagnostic process. Couples may benefit from counseling to deal with grief and existential concerns.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Maja Retpen Lanther
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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16
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Lou S, Jensen LG, Petersen OB, Vogel I, Hvidman L, Møller A, Nielsen CP. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies. Prenat Diagn 2017; 37:731-743. [DOI: 10.1002/pd.5093] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/24/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
| | - Lotte Groth Jensen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Olav Bjørn Petersen
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ida Vogel
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Møller
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Department of Public Health; Aarhus University; Aarhus Denmark
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17
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Lou S, Frumer M, Schlütter MM, Petersen OB, Vogel I, Nielsen CP. Experiences and expectations in the first trimester of pregnancy: a qualitative study. Health Expect 2017; 20:1320-1329. [PMID: 28521069 PMCID: PMC5689234 DOI: 10.1111/hex.12572] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/02/2022] Open
Abstract
Background A dominant context for pregnant women in the Western world is medical technologies such as ultrasound and screening. It has been argued that such technologies may result in tentative pregnancies, which may be particularly prominent in the first trimester. However, little is known about how women experience early pregnancy. Objective To explore the everyday experiences and expectations of first trimester pregnant women in a medicalized context of comprehensive and routine prenatal screening. Design Qualitative, semi‐structured interviews analysed using thematic analysis. Setting Between May 2015 and January 2016, participants were recruited from two general practices and one obstetric ultrasound unit in Aarhus, Denmark. Participants Twenty, first trimester pregnant women (15 primiparae, five multiparae) aged 21‐39 years. Results Early pregnancy is often kept secret in the first trimester due to a higher risk of miscarriage. However, the pregnancy is very real in the lives of the pregnant women who make it meaningful through practices of information seeking, listening to the body and anticipating the different milestones in pregnancy. First trimester screening represents one such milestone that is expected to mark a new and more certain phase in the pregnancy. A majority expects to terminate following a prenatal diagnosis, but this does not seem to influence their engagement with the pregnancy. Conclusions The pregnant women use medical technologies to mark a milestone in pregnancy but do not expect all concerns to disappear upon a normal screening result. The majority of women acknowledge that pregnancy involves simultaneous feelings of happiness and worry.
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Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark.,Center for Prenatal Diagnostics, Aarhus University, Aarhus, Denmark
| | - Michal Frumer
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mette M Schlütter
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark
| | - Olav B Petersen
- Center for Prenatal Diagnostics, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Center for Prenatal Diagnostics, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla P Nielsen
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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18
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Peters IA, Posthumus AG, Reijerink-Verheij JCIY, Van Agt HME, Knapen MFCM, Denktaş S. Effect of culturally competent educational films about prenatal screening on informed decision making of pregnant women in the Netherlands. PATIENT EDUCATION AND COUNSELING 2017; 100:776-782. [PMID: 27887753 DOI: 10.1016/j.pec.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/09/2016] [Accepted: 11/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect of a culturally competent educational film (CCEF) on informed decision making (IDM) regarding prenatal screening (PS) in a study population consisting of multicultural pregnant women. METHODS A cross-sectional study with 262 women in the control group and 117 in the intervention group. All counselled participants received a self-report questionnaire to obtain data on IDM and only the intervention group received the CCEF. Twenty two percent of the study population had an ethnic minority background and 52% had a low or medium educational level. RESULTS After exposure to the CCEF, knowledge about the Fetal Anomaly Scan (FAS) was significantly increased in ethnic minority women and in 'medium' and 'highly' educated women. Among women in the intervention group who had the intention to participate in FAS, there was an increase of 11% in IDM and a decrease of 12% in uninformed decision making. CONCLUSION CCEF leads to a significant increase in the level of knowledge in medium and highly educated groups as well as non-western ethnic minority groups. The increase in IDM among intentional participants in the FAS is promising as well. CCEF's are a valuable complement to counseling about PS.
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Affiliation(s)
- I A Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands; Foundation Prenatal Screening Southwest region of the Netherlands, Rotterdam, The Netherlands.
| | - A G Posthumus
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands
| | | | - H M E Van Agt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M F C M Knapen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands; Foundation Prenatal Screening Southwest region of the Netherlands, Rotterdam, The Netherlands
| | - S Denktaş
- Department Social and Behavioural Sciences, Erasmus University College, Erasmus University Rotterdam, Rotterdam, The Netherlands
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19
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Moses RM, Brown JH, Wright DC, Diplock H, Melov SJ, McGee TM. Who is and isn't having babies with Down syndrome in western Sydney: a ten year hospital cohort study. Aust N Z J Obstet Gynaecol 2017; 57:146-151. [DOI: 10.1111/ajo.12617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/22/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Rebecca M. Moses
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - James H.W. Brown
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Dale C. Wright
- Department of Cytogenetics, Sydney Genome Diagnostics; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Hayley Diplock
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Sarah J. Melov
- Department of Obstetrics and Gynaecology, Westmead Institute for Maternal and Fetal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Therese Mary McGee
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
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20
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Lou S, Nielsen CP, Hvidman L, Petersen OB, Risør MB. Coping with worry while waiting for diagnostic results: a qualitative study of the experiences of pregnant couples following a high-risk prenatal screening result. BMC Pregnancy Childbirth 2016; 16:321. [PMID: 27769247 PMCID: PMC5073971 DOI: 10.1186/s12884-016-1114-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty. METHODS Qualitative, semi-structured interviews with 16 high-risk couples who underwent diagnostic testing. The couples were recruited at a university hospital fetal medicine unit in Denmark. Data were analysed using thematic analysis. RESULTS All couples reported feeling worried and sad upon receiving a high-risk screening result. While waiting for diagnostic results, the couples focused on coming to their own understanding of the situation and employed both social withdrawal and social engagement as strategies to prevent worry from escalating. Additionally, couples used gratitude, reassuring reasoning and selective memory as means to maintain hopes for a good outcome. Discussions about what to do in case of an abnormal test result were notably absent in the accounts of waiting. This bracketing of the potential abnormal result allowed the couples to hold on to a 'normal' pregnancy and to employ an 'innocent-till-proven-guilty' approach to their worries about the fetus's health. None of the interviewed couples regretted having prenatal screening and all of them expected to have prenatal screening in a future pregnancy. CONCLUSIONS The couples in this study did not put the pregnancy mentally 'on hold'. Worry and uncertainty must be understood as managed through a diverse range of practical and emotional strategies that change and overlap in the process of waiting. Clinicians may support appropriate ways of coping with worry and waiting through empathetic and empowering clinical communication. In addition to providing adequate information and presenting options available, clinicians may support high-risk women/couples by encouraging them to seek their own personal understandings and management strategies as a way to gain some control in an uncertain situation.
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Affiliation(s)
- Stina Lou
- DEFACTUM -Public Health & Health Services Research, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. .,Institute of Public Health, Aarhus University, Aarhus, Denmark.
| | - Camilla P Nielsen
- DEFACTUM -Public Health & Health Services Research, Olof Palmes Alle 15, 8200, Aarhus N, Denmark.,Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Mette B Risør
- General Practice Research Unit, Institute of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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21
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Lewis C, Hill M, Chitty LS. A qualitative study looking at informed choice in the context of non-invasive prenatal testing for aneuploidy. Prenat Diagn 2016; 36:875-81. [PMID: 27477537 PMCID: PMC5053255 DOI: 10.1002/pd.4879] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022]
Abstract
Objective To explore women's attitudes towards non‐invasive prenatal testing (NIPT) and determine factors influencing their decisions around uptake of NIPT. Method We conducted qualitative interviews to assess knowledge, attitude and deliberation amongst women offered NIPT in a public health service. In total, 45 women took part in telephone interviews (79% participation rate). Results Most women could recount the key aspects of NIPT discussed during pre‐test counselling but had variable knowledge about Down syndrome. Analysis of women's attitudes towards undergoing NIPT revealed three dominant factors they considered when reflecting on the test: (1) how NIPT compared with alternative testing options, (2) reflections on coping and (3) moral or religious values. Exploring the deliberative process revealed the different paths women take when making decisions. For some, it was an extension of the decision to have Down syndrome screening; some considered it early on following the booking‐in appointment; others made step‐wise decisions about NIPT when it became relevant to them. Conclusion Our findings support the importance of personalised counselling, whereby women and their partners have the opportunity to reflect on the implications of the test results in the context of their own lives and values. Our data highlight the influence of personal circumstances on decision‐making. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's Already Known About This Topic?Non‐invasive prenatal testing (NIPT) for aneuploidies has entered clinical practice, although concerns exist around the potential for routinisation and erosion of informed choice. Research into informed decision‐making for NIPT is now beginning to emerge, although these are predominantly quantitative studies.
What Does This Study Add?Participants frequently used a combination of clinical information, personal experiences and moral values to guide action. For many participants, decision‐making was a multistep deliberative process which occurred as and when new information became available.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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22
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Smith SK, Sousa MS, Essink-Bot ML, Halliday J, Peate M, Fransen M. Socioeconomic Differences in Informed Decisions About Down Syndrome Screening: A Systematic Review and Research Agenda. JOURNAL OF HEALTH COMMUNICATION 2016; 21:868-907. [PMID: 27410478 DOI: 10.1080/10810730.2016.1177145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.
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Affiliation(s)
- Sian K Smith
- a Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine , University of New South Wales , Sydney , New South Wales , Australia
| | - Mariana S Sousa
- b Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
- c Prince of Wales Clinical School , University of New South Wales , Sydney , New South Wales , Australia
| | - Marie-Louise Essink-Bot
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
| | - Jane Halliday
- e Murdoch Children's Research Institute , Royal Children's Hospital , Melbourne , Victoria , Australia
- f Department of Paediatrics , University of Melbourne , Parkville , Victoria , Australia
| | - Michelle Peate
- g Department of Obstetrics and Gynaecology, Royal Women's Hospital , University of Melbourne , Parkville , Victoria , Australia
| | - Mirjam Fransen
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
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Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review. Med Decis Making 2016; 36:777-90. [PMID: 26975351 DOI: 10.1177/0272989x16636113] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND People often face difficult decisions about their health and may later regret the choice that they made. However, little is known about the extent of decision regret in health care or its predictors. We systematically reviewed evidence about the extent of decision regret and its risk factors among individuals making health decisions. METHODS The data sources were Medline, Embase, and reverse citation searches in Google Scholar and Web of Science. Studies using the Decision Regret Scale (DRS) to measure decision regret among individuals making nonhypothetical health decisions were included. There were no restrictions on study design, setting, or language. We extracted characteristics of included studies, measures of central tendency for DRS scores (0 = no regret, 100 = high regret), and all risk factors from published analyses. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was performed owing to the heterogeneity of studies. RESULTS The initial search yielded 372 unique titles, and 59 studies were included. The overall mean DRS score across studies was 16.5, and the median of the mean scores was 14.3 (standard deviation range = 2.2-34.5) (n = 44 studies). The risk factors most frequently reported to be associated with decision regret in multivariate analyses included higher decisional conflict, lower satisfaction with the decision, adverse physical health outcomes, and greater anxiety levels. CONCLUSIONS The extent of decision regret as assessed with the DRS in nonhypothetical health decisions was often low but reached high levels for some decisions. Several risk factors related to the decision-making process significantly predicted decision regret. Additional research into the psychometrics of the DRS and the relevance of scores for clinicians and patients would increase the validity of decision regret as a patient-reported outcome.
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Affiliation(s)
| | - Matthew Menear
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada (JB),School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada (JB)
| | - France Légaré
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
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Lou S, Nielsen CP, Hvidman L, Petersen OB, Risør MB. 'What do you think?' the collaborative practices of choice and care in a Danish obstetric ultrasound unit. Anthropol Med 2015; 23:86-101. [PMID: 26431350 DOI: 10.1080/13648470.2015.1087966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper is based on ethnographic fieldwork at an obstetric ultrasound unit in Denmark and explores the few, intense minutes of clinical interaction following a high-risk screening result for Down's syndrome. The category of high-risk transforms the routine ultrasound into a situation of inescapable choice, where the health of the foetus is questioned and decisions must be made. The clinical interactions following a high-risk result are investigated as processes of production, and the concepts of logic of choice and the logic of care are employed as analytical tools for identifying different rationales at play in the situation. The analysis shows that sonographers and women/couples collaboratively engage in logics of choice and care. Their mutual aim is to make the high-risk results meaningful and manageable so that a decision can be made. In this process initiative is shifted back and forth. Through a logic of care, complexity is reduced and statistics transformed by emphasising certain interpretations and leaving others unspoken. However, the logic of choice is also collectively maintained by positioning the women/couples as decision-makers. It is argued that in the obstetric ultrasound unit, the logic of choice provides a powerful frame, with the logic of care filling in the gaps and discontinuities to facilitate decisions. In this context, the logics are complementary rather than competing, and thus the analysis add new perspectives to the original concepts. In sum, the logics of choice and care provide a valuable analytical tool for interpreting and understanding the complex and collaborative practices of clinical interaction.
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Affiliation(s)
- Stina Lou
- a CFK - Public Health & Quality Improvement, Central Denmark Region, Olof Palmes Alle 15 , 8200 Aarhus N, Denmark, and Institute of Public Health, Aarhus University, Olof Plames Alle 15 , 8200 Aarhus N , Denmark
| | - Camilla Palmhøj Nielsen
- a CFK - Public Health & Quality Improvement, Central Denmark Region, Olof Palmes Alle 15 , 8200 Aarhus N, Denmark, and Institute of Public Health, Aarhus University, Olof Plames Alle 15 , 8200 Aarhus N , Denmark
| | - Lone Hvidman
- b Department of Obstetrics and Gynaecology , Aarhus University Hospital Skejby , Skejbygaardvej 100, 8200 Aarhus N , Denmark
| | - Olav Bjørn Petersen
- b Department of Obstetrics and Gynaecology , Aarhus University Hospital Skejby , Skejbygaardvej 100, 8200 Aarhus N , Denmark
| | - Mette Bech Risør
- c General Practice Research Unit , Institute of Community Medicine, University of Tromsø , 9037 Tromsø , Norway
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Skjøth MM, Draborg E, Lamont RF, Pedersen CD, Hansen HP, Ekstrøm CT, Jørgensen JS. Informed choice about Down syndrome screening - effect of an eHealth tool: a randomized controlled trial. Acta Obstet Gynecol Scand 2015; 94:1327-36. [PMID: 26332592 DOI: 10.1111/aogs.12758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/16/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effect of an eHealth intervention (interactive website) on pregnant women's ability to make an informed choice about Down syndrome screening. MATERIAL AND METHODS The study was designed as a randomized controlled trial with allocation to an intervention group and a control group in a ratio of 1:1. Subsequent subgroup analysis was conducted. Participants were recruited from 5 August 2013 to 25 April 2014 at Odense University Hospital, Denmark. Inclusion criteria were: pregnant women aged ≥18 years who were invited to participate in Down syndrome screening. Exclusion criteria were: high risk of abortion, psycho-socially vulnerable women, late referral, inability to speak Danish and women declining to participate. The primary outcome was informed choice about Down syndrome screening. The Multidimensional Measure of Informed Choice was used to assess whether the choice was informed or uninformed. RESULTS A total of 1150 participants were included in the study, of which 910 (79%) completed the questionnaire. Only a minority (30% of the women in the intervention group) actually used the website. There was no significant difference in the groups with respect to making an informed choice. The mean knowledge scores were significantly higher for those in the intervention group who used the intervention. CONCLUSIONS An interactive website with information about Down syndrome screening had no direct effect on making an informed choice. However, the majority of the pregnant women who used the website were satisfied with the website and would recommend it to others.
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Affiliation(s)
- Mette M Skjøth
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Eva Draborg
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ronald F Lamont
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK
| | - Claus D Pedersen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Helle P Hansen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Claus T Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jan S Jørgensen
- Department of Gynecology and Obstetrics, Institute of Clinical Research, Research Unit of Gynecology and Obstetrics, University of Southern Denmark, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Kou KO, Poon CF, Tse WC, Mak SL, Leung KY. Knowledge and future preference of Chinese women in a major public hospital in Hong Kong after undergoing non-invasive prenatal testing for positive aneuploidy screening: a questionnaire survey. BMC Pregnancy Childbirth 2015; 15:199. [PMID: 26330276 PMCID: PMC4557816 DOI: 10.1186/s12884-015-0636-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/24/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the non-invasive nature of non-invasive prenatal testing (NIPT), there is still a need for a separate informed consent process before testing. The objectives of this study are to assess (a) knowledge and preferences of Chinese women in a major public hospital in Hong Kong who underwent NIPT, and (b) whether their knowledge and preferences differ depending on womens' characteristics and sources of information. METHODS Setting: Prenatal diagnosis and counselling clinic. Between February 2012 and September 2013, a questionnaire survey was distributed to all women who underwent NIPT after positive aneuploidy screening. As a pilot study, ten knowledge questions were designed based on the rapid response statement on Prenatal Detection of Down Syndrome using Massively Parallel Sequencing from the International Society for Prenatal Diagnosis in 2011. The source of women's knowledge and their preferences were also evaluated. While conventional screening was publicly funded, NIPT was not. Differences between subgroups were compared using chi square tests and logistic regression analysis. RESULTS Of 152 women who underwent NIPT, 135 (88.8%) completed their questionnaires. More than 90% of women recognised the possibility of false positive and false negative results. Slightly more than 70% of women knew the inferior sensitivity of NIPT compared to an invasive test, and the possibility of an uninformative test result, but were not aware of the complicated aspects of NIPT. Pregnant women with an advanced level of education or those who underwent NIPT before 15 weeks provided answers that was more accurate by around 10-20% in two to three knowledge questions than those without. These associations were confirmed by multivariate logistic regression analysis. The women received information on NIPT largely from their private doctors (47.4%) and web (41.5%). In their future pregnancies, more women would opt for NIPT (a self-financed item) after positive screening ('free' in a public hospital) (57.8%) than as a primary screening (30.4%). CONCLUSIONS It is feasible to use a questionnaire based on the ISPD statement on NIPT to assess women's knowledge of the test. The Chinese women who underwent NIPT recognised the limitations, but did not understand the complicated aspects. More information should be provided by health care professionals in order to facilitate an informed choice by patients. More women preferred NIPT as a contingent test than as a primary screening probably because of its high cost.
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Affiliation(s)
- Kam On Kou
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Chung Fan Poon
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Wai Ching Tse
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
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Gundlund A, Hansen AV, Pedersen GS, Villadsen SF, Mortensen LH, Brøndum-Nielsen K, Andersen AMN. A Register-Based Study of Diseases With an Autosomal Recessive Origin in Small Children in Denmark According to Maternal Country of Origin. Paediatr Perinat Epidemiol 2015; 29:351-9. [PMID: 25970349 DOI: 10.1111/ppe.12195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Compared with children born of Danish mothers, the mortality of children, born and living in Denmark, is significantly increased in those with a mother from Afghanistan, Iraq, Pakistan, Somalia, and Turkey. Consanguinity has been suggested to account for part of this disparity. Since information on consanguinity is lacking, this suggestion is difficult to test. With an indirect approach, we addressed this question by comparing the risk of diseases with autosomal recessive inheritance in children born in Denmark of Danish-born women and of women born in these five countries, respectively. METHODS All children born in Denmark (1994-2010) were followed until 5 years of age or end-of-study period for the risk of hospitalisation with diseases of autosomal recessive aetiology, and therefore considered consanguinity-related. Diagnoses of autosomal recessive diseases were identified using two different methods: a literature review of consanguinity-associated diseases and a search in the Online Catalogue of Human Genes and Genetic Disorders. Risks were also calculated for diseases with known non-autosomal recessive aetiology (considered non-consanguinity-related). We estimated adjusted hazard ratios for the diseases in children of foreign-born women compared with children of Danish-born women. RESULTS Compared with offspring of Danish-born women, the risk of a consanguinity-related disease was significantly increased in children of foreign-born women, although the absolute risk was low. The risk of non-consanguinity-related diseases did not differ between the groups compared. CONCLUSIONS The findings support the hypothesis that consanguinity accounts for some, however a minor part, of the disparity in child mortality among migrants in Denmark.
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Affiliation(s)
- Anna Gundlund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Vinkel Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ternby E, Ingvoldstad C, Annerén G, Lindgren P, Axelsson O. Information and knowledge about Down syndrome among women and partners after first trimester combined testing. Acta Obstet Gynecol Scand 2015; 94:329-32. [PMID: 25582972 DOI: 10.1111/aogs.12560] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Abstract
We assessed reasons among women and partners for choosing combined ultrasound-biochemistry testing, information and knowledge about Down syndrome and decisions concerning invasive procedures and termination of pregnancy in a prospective cohort study in Uppsala County. In all 105 pregnant women and 104 partners coming for a combined ultrasound-biochemistry test answered a questionnaire. The most common reason for a combined ultrasound-biochemistry test was "to perform all tests possible to make sure the baby is healthy". Internet and midwives were the most common sources of information. Seventy-two percent had not received information on what it means to live with a child with Down syndrome. Many expectant parents perceived information as insufficient. Both women and partners had varying or low levels of knowledge about medical, cognitive and social consequences of Down syndrome. Twenty-five percent had not decided on an invasive test if indicated and only 42% would consider termination of pregnancy with a Down syndrome diagnosis.
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Affiliation(s)
- Ellen Ternby
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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29
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Skjøth MM, Draborg E, Pedersen CD, Hansen HP, Lamont RF, Jørgensen JS. Providing information about prenatal screening for Down syndrome: a systematic review. Acta Obstet Gynecol Scand 2014; 94:125-32. [DOI: 10.1111/aogs.12543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Mette M. Skjøth
- Research Unit of Gynecology and Obstetrics; Department of Gynecology and Obstetrics; Institute of Clinical Research; University of Southern Denmark; Odense University Hospital; Odense Denmark
| | - Eva Draborg
- Institute of Public Health; University of Southern Denmark; Odense Denmark
| | - Claus D. Pedersen
- Centre for Innovative Medical Technology; Odense University Hospital; Odense Denmark
| | - Helle P. Hansen
- Institute of Public Health; University of Southern Denmark; Odense Denmark
| | - Ronald F. Lamont
- Research Unit of Gynecology and Obstetrics; Department of Gynecology and Obstetrics; Institute of Clinical Research; University of Southern Denmark; Odense University Hospital; Odense Denmark
- Division of Surgery; Northwick Park Institute for Medical Research; University College London; London UK
| | - Jan S. Jørgensen
- Research Unit of Gynecology and Obstetrics; Department of Gynecology and Obstetrics; Institute of Clinical Research; University of Southern Denmark; Odense University Hospital; Odense Denmark
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Simeone S, Lojo C, Garcia-Esteve L, Triunfo S, Crovetto F, Arranz A, Gratacós E, Figueras F. Psychological impact of first-trimester prevention for preeclampsia on anxiety. Prenat Diagn 2014; 35:60-4. [PMID: 25156501 DOI: 10.1002/pd.4485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/13/2014] [Accepted: 08/16/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aims to examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women. METHODS The anxiety levels of a cohort of women screened for preeclampsia at first trimester were measured by the Spielberg State-Trait Anxiety Inventory (STAI-S) and compared between women screened as low and high risk. In a subgroup of women, the anxiety levels were additionally measured at second and third trimester. A General Linear Model (GLM) for repeated measurements was performed to adjust for potential confounders (age, nulliparity and socio-economic level). RESULTS A total of 255 women (135 low-risk and 120 high-risk) were evaluated. No differences were found in the mean STAI-S scores between low-risk and high-risk women: 35 (SD 9.9) and 34.6 (SD 10.1); p = 0.77. The proportion of women with high anxiety was not significantly different between groups (28/134 [20.7%] vs 24/120 [20%]; p = 0.88). No differences were found in the subgroups (51 low-risk and 50 high-risk) in which the anxiety levels were also measured at second and third trimester: 35.8 (SD 8.8) vs 35.2 (SD 9.7), p = 0.74, and 37.2 (SD 9.4) vs 35.3 (SD 8.6), p = 0.3. These differences remained non-significant after adjustment for potential confounders. CONCLUSION A strategy of first-trimester screening for preeclampsia does not increase maternal anxiety.
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Affiliation(s)
- Serena Simeone
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; High Risk Pregnancy Unit, Department of Child and Women's Health, Careggi University Hospital, Florence, Italy
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Gregg AR, Van den Veyver IB, Gross SJ, Madankumar R, Rink BD, Norton ME. Noninvasive prenatal screening by next-generation sequencing. Annu Rev Genomics Hum Genet 2014; 15:327-47. [PMID: 24849140 DOI: 10.1146/annurev-genom-090413-025341] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Noninvasive prenatal screening (NIPS) has emerged as a highly accurate method of screening for fetal Down syndrome, with a detection rate and specificity approaching 100%. Challenging the widespread use of this technology are cost and the paradigm shift in counseling that accompanies any emerging technology. The expense of the test is expected to decrease with increased utilization, and well beyond the current NIPS technology, its components (fetal genome measurements, sequencing technology, and bioinformatics) will be utilized alone or in combinations to interrogate the fetal genome. The end goal is simple: to offer patients information early in pregnancy about fetal genomes without incurring procedural risks. This will allow patients an opportunity to make informed reproductive and pregnancy management decisions based on precise fetal genomic information.
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Affiliation(s)
- Anthony R Gregg
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida 32610;
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Ekelund CK, Jørgensen FS, Petersen OB, Sundberg K, Tabor A. Impact of a new national screening policy for Down's syndrome in Denmark: population based cohort study. BMJ 2008; 337:a2547. [PMID: 19039015 PMCID: PMC2590884 DOI: 10.1136/bmj.a2547] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the impact of a screening strategy in the first trimester, introduced in Denmark during 2004-6, on the number of infants born with Down's syndrome and the number of chorionic villus samplings and amniocenteses, and to determine detection and false positive rates in the screened population in 2005 and 2006. DESIGN Population based cohort study. SETTING 19 Danish departments of gynaecology and obstetrics and a central cytogenetic registry 2000-7. PARTICIPANTS 65 000 pregnancies per year. MAIN OUTCOME MEASURES The primary outcomes measured were number of fetuses and newborn infants with Down's syndrome diagnosed prenatally and postnatally and number of chorionic villus samplings and amniocenteses carried out. Secondary outcomes measured were number of women screened in 2005 and 2006, screen positive rate, and information on screening in 2005 and 2006 for infants with a postnatal diagnosis of Down's syndrome. RESULTS The number of infants born with Down's syndrome decreased from 55-65 per year during 2000-4 to 31 in 2005 and 32 in 2006. The total number of chorionic villus samplings and amniocenteses carried out decreased from 7524 in 2000 to 3510 in 2006. The detection rate in the screened population in 2005 was 86% (95% confidence interval 79% to 92%) and in 2006 was 93% (87% to 97%). The corresponding false positive rates were 3.9% (3.7% to 4.1%) and 3.3% (3.1% to 3.4%). CONCLUSION The introduction of a combined risk assessment during the first trimester at a national level in Denmark halved the number of infants born with Down's syndrome. The strategy also resulted in a sharp decline in the number of chorionic villus samplings and amniocenteses carried out, even before full implementation of the policy.
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Affiliation(s)
- Charlotte K Ekelund
- Department of Fetal Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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