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Kouba I, Del Pozzo J, Alvarez A, Keller NA, Palmer A, Bracero LA, Blitz MJ. Social vulnerability and prenatal diagnosis. J Perinat Med 2024; 52:824-830. [PMID: 39155568 DOI: 10.1515/jpm-2024-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES There are limited data on how neighborhood-level risk factors affect the likelihood of having prenatal diagnosis. Neighborhood social vulnerability can be quantified and ranked using the social vulnerability index (SVI), a tool that measures the cumulative effect of external stressors in the local environment that may affect health outcomes. The objective of the study was to determine the relationship between SVI and prenatal diagnosis among pregnant patients who received genetic counseling. METHODS Retrospective cohort study of all pregnant patients who had genetic counseling at two hospitals in New York between January 2019 and December 2022. For each patient, the address of residence was linked to an SVI score (primary exposure) based on census tract. SVI scores were subdivided into fifths and analyzed categorically. The primary outcome was prenatal diagnosis (yes/no). Multivariable logistic regression was performed. RESULTS A total of 5,935 patients were included for analysis and 231 (3.9 %) had prenatal diagnosis. On regression analysis, no association between SVI and prenatal diagnosis was observed. Patients who had a diagnostic procedure were more likely to be English speaking (aOR 1.80; 95 % CI 1.13-2.87), carriers of a genetic disorder (aOR 1.94; 95 % CI 1.32-2.86), had increased NT (aOR 6.89; 95 % CI 3.65-13.00), abnormal NIPS (aOR 9.58; 95 % CI 5.81-15.80), or had fetal structural anomalies (aOR 10.60; 95 % CI 6.62-16.96). No differences were seen based on race and ethnicity group, insurance type, or marital status. CONCLUSIONS SVI score does not affect rate of prenatal diagnosis. Findings may differ in other geographic regions and populations.
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Affiliation(s)
- Insaf Kouba
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
| | - Jaclyn Del Pozzo
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
| | - Alejandro Alvarez
- Northwell, New Hyde Park, NY, USA
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, NY, USA
| | - Nathan A Keller
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
| | - Alexis Palmer
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
| | - Luis A Bracero
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
| | - Matthew J Blitz
- Northwell, New Hyde Park, NY, USA
- Department of Obstetrics and Gynecology, South Shore University Hospital, Bay Shore, NY, USA
- Zucker School of Medicine, Hempstead, NY, USA
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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Yeşilçinar İ, Seven M, Paşalak Şİ, Güvenç G. Interventions aiming to improve informed decision on prenatal screening and testing: A scoping review of the literature. J Genet Couns 2021; 30:1512-1521. [PMID: 34137487 DOI: 10.1002/jgc4.1437] [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: 07/25/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
The aim of this scoping review was to explore interventions and their effect in facilitating decision making on prenatal screening and testing among pregnant women. This review was conducted according to the Joanna Briggs Institute Methods Manual for scoping reviews. Studies published 2000-2019 that consist of interventions to facilitate pregnant women's decision making in prenatal screening and testing were specifically reviewed. A total of 27 studies are included in this scoping review. In these studies, various methods, including face-to-face individual or group interventions, e-Health interventions, video-based interventions, written educational materials, and decision aid interventions, were developed and tested for their effectiveness in facilitating informed decision making on prenatal screening and testing. While these methods appeared to be effective, further studies involving diverse populations are needed to integrate them into practice. Genetic counselors and healthcare providers working with individuals who are referred for genetic education and counseling need to work collaboratively to facilitate informed decisions on prenatal screening of women and/or their partners.
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Affiliation(s)
- İlknur Yeşilçinar
- Nursing Department, Health Science Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Memnun Seven
- College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Gülten Güvenç
- Gülhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
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Stock NM, Costa B, Williams JR, Martindale A. Breaking the News: Parents’ Experiences of Receiving an Antenatal Diagnosis of Cleft Lip. Cleft Palate Craniofac J 2019; 56:1149-1156. [DOI: 10.1177/1055665619830884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective:In high-income countries, many cases of cleft lip are now identified at the 18- to 21-week pregnancy scan. The manner in which a diagnosis is communicated is vital for long-term parental well-being, yet previous studies have been indicative of parental dissatisfaction. The aims of the present study were to examine the experiences of parents who received an antenatal diagnosis of cleft lip in their unborn child and to offer pragmatic suggestions for improving the diagnostic experience in practice.Design:An online, mixed-methods survey was designed and distributed by the Cleft Lip and Palate Association. Data from 574 eligible parents were analyzed using descriptive statistics and inductive content analysis.Results:Although survey responses indicated positive diagnostic experiences overall, respondents perceived a lack of sensitivity among sonographers, long waiting times between referrals, and a lack of appropriate and reliable information. Respondents also reported a number of misconceptions about cleft lip and/or palate and its prognosis, as well as a variety of initial concerns about their own ability to cope with the anticipated challenges.Conclusion:Findings emphasize the importance of providing accurate and individualized information to prospective parents, in a sensitive manner, so they can adjust to their child’s diagnosis and prepare for the birth appropriately. Given that antenatal screening for cleft lip is becoming more fully integrated into routine practice, more training for health-care professionals, improved access to reliable information in a variety of formats, and stronger links between local hospitals and specialist cleft services may be needed.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Costa B, Williams J, Martindale A, At The Centre For Appearance Research TVFRT. Parental views of antenatal testing and termination following a diagnosis of cleft lip. PSYCHOL HEALTH MED 2018; 24:456-469. [PMID: 30280914 DOI: 10.1080/13548506.2018.1529328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Fetal anomaly screening at 18-21 weeks now routinely includes cleft lip. If detected, the manner in which the diagnosis is communicated can considerably influence prospective parents' decision-making in regard to further testing and termination of pregnancy (TOP). Given the known psychological impact of an antenatal diagnosis of cleft lip on prospective parents, this study aimed to explore the decision-making process from the parents' perspective, in order to evaluate how well current practice is meeting guidelines. Data from 217 parents of children born with cleft lip (with or without cleft palate) were collected using a mixed-methods online survey. Respondents reported feeling upset, offended and/or anxious following the diagnosis, due to unsatisfactory information and a perceived lack of empathy from health professionals. Some respondents had felt under pressure to make a decision quickly, with a minority having regretted undergoing amniocentesis, and/or experiencing significant distress at having come close to TOP unnecessarily. A number of suggestions are made as to how the discussion between parents and health professionals could be improved, to ensure that the information and support needs of families affected by cleft lip are fully addressed.
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Affiliation(s)
- Nicola Marie Stock
- a Centre for Appearance Research , University of the West of England , Bristol , UK
| | - Bruna Costa
- a Centre for Appearance Research , University of the West of England , Bristol , UK
| | - Jenny Williams
- b South Thames Cleft Service, St Thomas' Hospital , London , UK
| | - Anna Martindale
- c Communications and Information , Cleft Lip and Palate Association , London , UK
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Nationwide survey for current clinical status of amniocentesis and maternal serum marker test in Japan. J Hum Genet 2016; 61:879-884. [DOI: 10.1038/jhg.2016.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/18/2016] [Accepted: 05/10/2016] [Indexed: 11/08/2022]
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Brajenović-Milić B, Dorčić TM. Men’s Knowledge About Maternal Serum Screening for Down Syndrome and their Attitude Towards Amniocentesis. J Genet Couns 2016; 26:141-149. [DOI: 10.1007/s10897-016-9989-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
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Canbulat N, Demirgöz Bal M, Çoplu M. Emotional reactions of mothers who have babies who are diagnosed with Down syndrome. Int J Nurs Knowl 2014; 25:147-53. [PMID: 24602179 DOI: 10.1111/2047-3095.12026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to explore a deeper insight into experiences of Turkish mothers living with/diagnosed with Down syndrome (DS) baby. METHODS Individual and audiotaped interviews were carried out with 11 women after amniocentesis in Karaman city of Turkey between August 2012 and February 2013. Transcribed semistructured interviews were qualitatively and analyzed using a thematic analysis approach to code and categorize emerging themes. RESULTS Three principal themes emerged from the study: mothers' emotional reaction after diagnosed DS, mother and healthcare professional interactions, and mother's coping with diagnosed DS. CONCLUSIONS Understanding the experiences of women living with/diagnosed with DS baby enables nurses to devise appropriate strategies to provide better support at every stage and thus helping them to cope with daily life.
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Affiliation(s)
- Nejla Canbulat
- Department of Pediatric Nursing, School of Health, Karamanoglu Mehmetbey University, Karaman, Turkey
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Shalaby HAR, Elhady RA, Gamal AM, Badry AA. Prenatal diagnosis in low resource setting: is it acceptable? J Obstet Gynaecol India 2013; 62:515-9. [PMID: 24082550 DOI: 10.1007/s13224-012-0185-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 11/13/2011] [Indexed: 11/24/2022] Open
Abstract
AIM This study aimed to explore knowledge and acceptability of prenatal procedures both non-invasive prenatal screening tests and invasive procedures among Egyptian women in childbearing age and to assess their attitude toward such procedures. Also to examine confounding factors affecting women's attitude toward prenatal procedures. STUDY DESIGN A cross-sectional study on a representative sample of women in childbearing age attending Obstetrics & Gynecology outpatient clinic at Mansoura University Hospital, Egypt. An anonymous questionnaire was supplemented by voluntary interviewers for women in childbearing age. RESULTS 465 women were included in the study. The mean age ± SD was 27 ± 6 years. About 44 % of women were knowledgeable about non-invasive prenatal screening procedure, and only 25.5 % had heard about invasive prenatal procedures. 88.8 % express positive attitude regarding performance of the screening tests. Forty-one percent of the group agreed to perform invasive prenatal procedures during their pregnancy. Educational level and family history of congenital anomalies significantly affected attitudes toward testing during future pregnancy. The cost of procedure affected the decision to perform in 56.7 % of women. CONCLUSION Egyptian women express positive attitude toward non-invasive prenatal screening but showed poor knowledge. Their attitude toward invasive procedure is guarded by the risk of abortion. Education and family history of fetal anomalies are the factors that affect attitudes. The cost of the prenatal test affects the decision made by the women to participate in testing.
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Nakić Radoš S, Košec V, Gall V. The psychological effects of prenatal diagnostic procedures: maternal anxiety before and after invasive and noninvasive procedures. Prenat Diagn 2013; 33:1194-200. [PMID: 23966135 DOI: 10.1002/pd.4223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES (1) To examine the change in anxiety before and after prenatal diagnostic procedures in women undergoing invasive (amniocentesis) and noninvasive (ultrasound) procedures; and (2) to examine predictors of anxiety before the diagnostic procedure. METHODS A short-term follow-up study was conducted on a sample of pregnant women in the second trimester. Questionnaires were administered to women scheduled for amniocentesis (n = 37) and ultrasonography (n = 37) before and immediately after the procedure. The following questionnaires were administered: the State-Trait Anxiety Inventory, the Affect Intensity Measure, the COPE inventory, and the Optimism-Pessimism Scale. RESULTS Prior to the administration of the prenatal diagnostic procedure, measured anxiety levels were the same in both groups of women (p > 0.05). An interaction effect of a two-way ANOVA revealed that anxiety decreased after the procedure in the ultrasound but not the amniocentesis group (F(1, 72) = 5.01, p = 0.028). Although coping styles and affect intensity were found to be related to anxiety (p < 0.05), they were not significant predictors of anxiety before the diagnostic procedure when controlling for trait anxiety and procedure type. CONCLUSION Anxiety levels associated with noninvasive but not after invasive, prenatal diagnostics tests decrease immediately following the procedure.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Obstetrics and Gynecology, University Hospital Center Sisters of Mercy, Zagreb, Croatia
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Choi H, Van Riper M, Thoyre S. Decision making following a prenatal diagnosis of Down syndrome: an integrative review. J Midwifery Womens Health 2012; 57:156-64. [PMID: 22432488 DOI: 10.1111/j.1542-2011.2011.00109.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prenatal screening for Down syndrome (DS) is a routine part of prenatal care in many countries, and there is growing interest in the choices women make following a prenatal diagnosis of DS. This review describes what is known about actual and hypothetical decision making following a prenatal diagnosis of DS and adds understanding about the factors that influence women's decision making. METHODS A search of empirical studies was conducted through electronic databases, major journals, and reference lists that were published in English between January 1999 and September 2010. Inclusion criteria were that the research explored attitudes toward continuation of pregnancy or induced abortion for DS and included at least 1 variable that explored factors influencing women's decision making following a prenatal diagnosis of DS. Studies that did not specify DS, unpublished manuscripts, review articles, and book chapters were excluded. RESULTS A total of 11 studies were identified that met the inclusion criteria. The decision to undergo an induced abortion varied depending on whether participants were prospective parents recruited from the general population (23%-33% would terminate), pregnant women at increased risk for having a child with DS (46%-86% would terminate), or women who received a positive diagnosis of DS during the prenatal period (89%-97% terminated). Multiple factors influence women's decision making following a diagnosis of DS, including demographic factors such as religion, maternal age, gestational age, number of existing children, and history of induced abortion. Psychosocial factors including perceived parenting burden/reward, quality of life for a child with DS, attitudes toward and comfort with individuals with disabilities, and support from others also are important influences. DISCUSSION Multiple factors influence the decisions pregnant women make following the diagnosis of fetal DS. Therefore, it is critical that health care providers who work with pregnant women are aware of these factors.
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Affiliation(s)
- Hyunkyung Choi
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460, USA.
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