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Hawke M, Considine J, Sweet L. Maternity clinician use of shared decision-making in antenatal care: A scoping review. Birth 2024; 51:475-483. [PMID: 38100235 DOI: 10.1111/birt.12805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 08/13/2024]
Abstract
BACKGROUND Implementation of shared decision-making in antenatal care has had limited exploration. OBJECTIVE To assess what is known about shared decision-making in antenatal care. SEARCH STRATEGY Five databases were searched (1997-2022) limited to English language studies from OECD countries. DATA COLLECTION AND ANALYSIS A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. MAIN RESULTS Four areas of decision-making were identified with six themes revealing enablers and barriers to shared decision-making in antenatal care. CONCLUSION Implementation of shared decision-making requires continuity, time and personalisation of care.
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Affiliation(s)
- Madeline Hawke
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine, St Albans, Victoria, Australia
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2
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Bet BB, Wielart L, Ravelli ACJ, van Wely M, van Leeuwen E, Pajkrt E. Financial contribution as reason to opt out of non-invasive prenatal testing. Eur J Obstet Gynecol Reprod Biol 2023; 287:130-136. [PMID: 37311275 DOI: 10.1016/j.ejogrb.2023.06.009] [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: 01/04/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE First trimester non-invasive prenatal testing (NIPT) provides pregnant women with a reliable, non-invasive method to screen for fetal aneuploidies. In the Netherlands, there is a nationwide prenatal screening program in which pregnant women and their partners are counseled about their options around 10 weeks of pregnancy. The first trimester and second trimester scan are fully reimbursed but the NIPT has an own financial contribution of €175 per participant, irrespective of type of insurance. The arguments for this own contribution are fear of uncritical use of NIPT or routinization. NIPT has a relatively stable uptake of 51%, against over 95% for second trimester anomaly scan. We aimed to explore the effect of this financial contribution on the decision to opt out of NIPT. STUDY DESIGN We performed a survey among 350 pregnant women undergoing a second trimester anomaly scan in our center, Amsterdam UMC, between January 2021 and April 2022. All pregnant women who declined NIPT in the first trimester, were asked to participate and answered 11-13 questions about the decision-making process, the reasons to opt out and the financial contribution. RESULTS Information about NIPT was desired in 92% of women and 96% felt sufficiently informed. Most women took the decision not to perform NIPT with their partner and did not experience difficulties in taking this decision. The most important reason to decline NIPT was: "Every child is welcome" (69%). "The test was too expensive" was answered in 12% and was significantly correlated with lower maternal age. Additionally, one in five women (19%) said they would have done NIPT if it had been for free, which was significantly higher in younger women. CONCLUSIONS The own financial contribution plays a role in the decision-making to decline NIPT and partly explains the low uptake in the Netherlands. This suggests that there is no equal access to fetal aneuploidy screening. To overcome this inequality, this own contribution should be abandoned. We speculate that this will have a positive effect on the uptake, which will increase to at least 70% and potentially 94%.
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Affiliation(s)
- Bo B Bet
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - Lot Wielart
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Centre for Reproductive Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
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Damman OC, Henneman L, IJssel DVVD, Timmermans DRM. Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study. Midwifery 2023; 119:103607. [PMID: 36753831 DOI: 10.1016/j.midw.2023.103607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process. OBJECTIVE To investigate what conditions Dutch pregnant women and professional experts consider important for autonomous reproductive decision-making in prenatal screening for fetal abnormalities, and the extent to which, according to women, those conditions are met in practice. METHODS A mixed methods study was conducted in the Netherlands in 2016-2017. A conceptual model was used to interview professional experts (n = 16) and pregnant women (n = 19). Thematic analysis was performed to identify important conditions. Subsequently, a questionnaire assessed the perceived importance of those conditions and the extent to which these were met, in the experience of pregnant women (n = 200). RESULTS Professional experts stressed the importance of information provision, and emphasized a rational decision-making model. Pregnant women differed in what information they felt was needed, and this depended on the screening decision made. Questionnaire findings showed that women prioritized discussion and consensus with partners. Information about test accuracy and miscarriage risk of invasive follow-up testing was also considered important. Two key conditions were not adequately met, in the experience of women: (1) having information about miscarriage risk; (2) not being directed by health professionals in decision-making. CONCLUSION According to women, discussion and consensus with partners was considered a highly important condition for an autonomous and meaningful decision-making process. Access to information about safety of testing and ensuring that women are not being directed in their decision-making by health professionals seem to be areas for improvement in prenatal care practice.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Section Community Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Dalisa V van den IJssel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Madeley AM, Earle S, O'Dell L. Challenging norms: Making non-normative choices in childbearing. Results of a meta ethnographic review of the literature. Midwifery 2023; 116:103532. [PMID: 36371862 DOI: 10.1016/j.midw.2022.103532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/08/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature. METHODS Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines. FINDINGS Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - 'influences and motivators', 'barriers and conflict and 'knowledge as empowerment'. Refutational translation resulted in one third order construct - 'the middle ground', which informed the line of argument synthesis and theoretical insights. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.
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Affiliation(s)
- Anna-Marie Madeley
- Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom.
| | - Sarah Earle
- Graduate School: Research, Enterprise & Scholarship, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Lindsay O'Dell
- School of Nursing and Health Education, University of Bedfordshire, University Square, Luton LU1 3JU, United Kingdom
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5
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Bunnik EM. Delineating the Scope of NIPT: Ethics Meets Practice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:34-36. [PMID: 35089835 DOI: 10.1080/15265161.2021.2013984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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van der Meij KRM, Kooij C, Bekker MN, Galjaard RJH, Henneman L. Non-invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods. Prenat Diagn 2021; 41:1395-1400. [PMID: 34505288 PMCID: PMC9291196 DOI: 10.1002/pd.6043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Non-Invasive Prenatal Testing (NIPT) is increasingly being implemented worldwide. In public health programs, equitable access to healthcare is a fundamental principle which also applies to fetal aneuploidy screening. However, the out-of-pocket costs of NIPT may lead to sociodemographic disparities in uptake of screening. This study assessed whether there is a difference in the uptake of NIPT in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, where NIPT is implemented in a national screening program (TRIDENT-2 study). METHOD NIPT uptake, postal code and age of 156,562 pregnant women who received pre-test counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used as a proxy to categorize neighborhoods as being either socioeconomically disadvantaged or other. The out-of-pocket costs for NIPT were €175. RESULTS NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% whereas uptake in all other neighborhoods was 47.6% (p < 0.001). The difference in NIPT uptake between socioeconomic disadvantaged neighborhoods and other areas was smaller for the youngest maternal age-group (≤25 years) compared to other age-groups. CONCLUSION The variation in uptake suggest underlying disparities in NIPT uptake, which undermines the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access. This has ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.
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Affiliation(s)
- Karuna R M van der Meij
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Kooij
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Garcia E, Henneman L, Gitsels-van der Wal JT, Martin L, Koopmanschap I, Bekker MN, Timmermans DRM. Non-invasive prenatal testing (NIPT) and pregnant women's views on good motherhood: a qualitative study. Eur J Hum Genet 2021; 30:669-675. [PMID: 34400811 DOI: 10.1038/s41431-021-00945-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/09/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
Women's views on responsible motherhood influence decision-making regarding participation in prenatal screening. Previous studies showed that the probabilistic nature of the first-trimester combined test and the potential requirement for subsequent invasive diagnostics serve as legitimate reasons for women to exclude prenatal screening from their moral responsibilities. These moral barriers might now be less relevant with the introduction of the non-invasive prenatal test (NIPT) resulting in women feeling a moral duty to use NIPT screening as part of responsible motherhood. This qualitative study explores the impact of NIPT on women's moral beliefs about the meaning of prenatal screening in relation to responsible motherhood. We performed semi-structured interviews with 29 pregnant women who were offered NIPT as a first-tier screening test within a Dutch nationwide study (TRIDENT-2). Results show that the inherent uncertainty about the fetus's health despite improved accuracy and the lack of treatment for a detected disorder, combined with the possibility to obtain information about actionable anomalies through the fetal anomaly scan, support women's perspectives that NIPT is not an obligation of responsible motherhood. Acceptance of NIPT is considered to be a free decision related to the information each woman needs to be a good mother for her child and her family. Women's views may change when NIPT has expanded to include treatable or preventable conditions.
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Affiliation(s)
- Elisa Garcia
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,Department of Clinical Genetics, Section Community Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Linda Martin
- Department of Midwifery Science, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Isabel Koopmanschap
- Department of Clinical Genetics, Section Community Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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8
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Pop-Tudose ME, Armean P, Pop IV. Prenatal screening for Down syndrome: popularity, perceptions and factors associated with acceptance or refusal of testing. J Matern Fetal Neonatal Med 2021; 35:6505-6509. [PMID: 33910457 DOI: 10.1080/14767058.2021.1916910] [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: 10/21/2022]
Abstract
BACKGROUND Prenatal screening tests for aneuploidies have become increasingly used in maternal and fetal medicine. Given that all pregnancies associate a potential risk of Down syndrome, adequate knowledge of the tests, and their characteristics as well as facilitating decision-making autonomy are fundamental rights that must be respected. OBJECTIVES Identification of the popularity of the tests, their perception and the factors associated with the acceptance or refusal to perform them. METHODS A cross-sectional study was carried out in the South-East region of Romania, between April and September 2016. The data were collected from 275 postpartum women. The instrument used was a self-administered questionnaire and the data obtained were processed using the IBM SPSS 20.0 statistical software (IBM Corp., Armonk, NY, USA). The normality of the distribution was analyzed with Chi-square, Kolmogorov-Smirnov and Shapiro-Wilk tests. Factorial Analysis was carried out for the Principal Components of the scales for the reasons for performing and not performing. RESULTS The 2nd Trimester Morphology had the popularity as well as the highest rate of accomplishment (98.2% respectively 67.6%) among the investigated women. It is also the preferred recommendation of the specialists (81.1%). The least popular test was the TPNI, only 13.1% of the participants heard about it, as it was recommended in only 2% of the situations. Most of the participants perceived the screening tests as essential and useful, but 43.3% considered that they become mandatory if the doctor recommends them. The acceptance of the child with DS and the misperception of the risk were the main factors associated with the refusal of the test and the compliance with the recommendation of the specialist (system confidence), and social influence (non-acceptance of the Down syndrome by the society) were the main factors associated with the acceptance. CONCLUSIONS The number of women who made the decision to accept the test was greater than the ones who refused. The amendment is that acceptance was based on the custom of socio-economic-medical compliance and responsibility. For many women, the motivation of acceptance meant alignment with the normality directed by the society and the system. Even the popularity of the tests carries the imprint of the beliefs and values of the system and the specialists involved. For an adequate perception and an autonomous and informed choice of women, the screening program must include adequate information and communication services by involving specialists responsible for multidisciplinary competencies. The percentage of completion and the type of test performed almost perfectly align with the recommendations received.
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Affiliation(s)
- Melania Elena Pop-Tudose
- Department of Genetics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Petru Armean
- Specific Disciplines, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Victor Pop
- Department of Genetics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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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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10
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Bunnik EM, Kater-Kuipers A, Galjaard RJH, de Beaufort I. Why NIPT should be publicly funded. JOURNAL OF MEDICAL ETHICS 2020; 46:783-784. [PMID: 32277019 PMCID: PMC7656139 DOI: 10.1136/medethics-2020-106218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/26/2020] [Indexed: 05/16/2023]
Abstract
Asking pregnant women to (co)pay for non-invasive prenatal testing (NIPT) out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women and children, but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this is not an argument for individual women to take part in screening or to terminate an affected pregnancy. However, it is a legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women (eg, that they are not at risk), and thus to support informed consent for first-trimester prenatal screening.
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Affiliation(s)
- Eline Maria Bunnik
- Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Inez de Beaufort
- Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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11
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Bunnik EM, Kater-Kuipers A, Galjaard RJH, de Beaufort ID. Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access. JOURNAL OF MEDICAL ETHICS 2020; 46:194-198. [PMID: 31527142 PMCID: PMC7042959 DOI: 10.1136/medethics-2019-105675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/09/2019] [Indexed: 05/28/2023]
Abstract
The introduction of non-invasive prenatal testing (NIPT) in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to (co)pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: (1) to prevent increased uptake of NIPT and (2) to promote informed choice. First, given the aim of prenatal screening (reproductive autonomy), high or low uptake rates are not intrinsically desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women's choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external (ie, financial) influences on women's personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring (substantial) copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair.
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Affiliation(s)
- Eline M Bunnik
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Crombag NMTH, Page‐Christiaens GCML, Skotko BG, Graaf G. Receiving the news of Down syndrome in the era of prenatal testing. Am J Med Genet A 2019; 182:374-385. [DOI: 10.1002/ajmg.a.61438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/06/2019] [Accepted: 11/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Neeltje MTH Crombag
- Department of Development and RegenerationCluster Woman and Child, Biomedical Sciences Leuven Belgium
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Genomics, Department of PediatricsMassachusetts General Hospital Boston Massachusetts
- Department of PediatricsHarvard Medical School Boston Massachusetts
| | - Gert Graaf
- Dutch Down Syndrome Foundation Meppel The Netherlands
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13
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Seidler Y, Mosor E, Stamm T. "No one to consult! That is the hardest part" choice-making experiences for prenatal screening tests among Japanese women and their spouses in Austria - A qualitative interview study. PATIENT EDUCATION AND COUNSELING 2019; 102:2286-2295. [PMID: 31358327 DOI: 10.1016/j.pec.2019.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Japan is the only country in the world that allows abortions due to economic reasons but illegalise them due to foetal anomaly. The objective of this study was to explore the choice-making experiences for prenatal screening among Japanese women and their spouses in Austria. METHODS We conducted a qualitative study using semi-structured face-to-face interviews with Japanese women and their spouses in Austria. Data were analysed using thematic analysis. RESULTS Twenty-five participants (14 women and 11 men) took part in the interviews. Four themes were identified: 1) Knowledge, information and memory; 2) Communication and interactions with health professionals; 3) Reasons for choice; and 4) Emotional support. Participants had limited knowledge and experienced directive counselling. Women expressed negative emotions in the choice-making processes, did not perceive husbands as a source of support and lacked a person to consult. CONCLUSION There are common characteristics among East Asian population despite different context and differences found between our Japanese participants and women in other European countries. PRACTICE IMPLICATION Proactive interventions aimed at increasing knowledge that help women to develop their preferences and reflect on their values could be further promoted among women of all socio-cultural backgrounds in Austria.
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Affiliation(s)
- Yuki Seidler
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/ 1, 1090 Vienna, Austria; Center for Health and Migration, Wasagasse 12/3/5, 1090 Vienna, Austria.
| | - Erika Mosor
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
| | - Tanja Stamm
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, BT88/E 03, 1090 Vienna, Austria.
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Nov-Klaiman T, Raz AE, Hashiloni-Dolev Y. Attitudes of Israeli parents of children with Down syndrome toward non-invasive prenatal screening and the scope of prenatal testing. J Genet Couns 2019; 28:1119-1129. [PMID: 31469214 DOI: 10.1002/jgc4.1162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 12/14/2022]
Abstract
Due to its early utilization and increasing ability to provide genetic information, non-invasive prenatal screening (NIPS) has reinforced social and bioethical quandaries concerning prenatal genetics. This paper presents exploratory findings based on 20 semi-structured interviews conducted in 2017-2019 with Israeli parents of children with Down syndrome (DS), four of whom also serving as representatives of DS organizations. Their views are presented regarding the pros and cons of NIPS; the social context of decision-making about NIPS; and views on life with DS and termination of pregnancies on that ground. While illustrating the large heterogeneity of views concerning NIPS and prenatal diagnosis (PND) amongst parents of children with DS, our respondents commonly criticized the imbalanced information provided by professionals regarding DS, seen as sending a discriminating message in line with the public ignorance surrounding DS. These views are further discussed in the multi-cultural, ableist and pro-natal context of Israeli society. We conclude by offering practical implications concerning NIPS, parental autonomy, and informed choice.
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Affiliation(s)
- Tamar Nov-Klaiman
- Department of Sociology & Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad E Raz
- Department of Sociology & Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Hashiloni-Dolev
- Department of Sociology & Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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15
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Kater-Kuipers A, de Beaufort ID, Galjaard RJH, Bunnik EM. Ethics of routine: a critical analysis of the concept of 'routinisation' in prenatal screening. JOURNAL OF MEDICAL ETHICS 2018; 44:626-631. [PMID: 29695408 DOI: 10.1136/medethics-2017-104729] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
In the debate surrounding the introduction of non-invasive prenatal testing (NIPT) in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: (1) informed choice, (2) freedom to choose and (3) consequences for people with a disability. Three of the strongest arguments raised under the flag of routinisation are assessed for their validity: the threat that NIPT poses to informed choice, the potential increase in uptake of first-trimester prenatal screening and its consequences for social pressure to participate in screening or terminate affected pregnancies, and the negative consequences for disabled people. These routinisation arguments lack empirical or normative ground. However, the results of this analysis do not imply that no attention should be paid to possible problems surrounding the introduction of NIPT. At least two problems remain and should be addressed: there should be an ongoing debate about the requirements of informed choice, particularly related to an expanded scope of prenatal screening. Also, reproductive autonomy can only be achieved when expecting parents' options are variegated, real and valuable, so that they can continue to choose whether or not to screen or to terminate a pregnancy.
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Affiliation(s)
- Adriana Kater-Kuipers
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Inez D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Eline M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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16
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van Bruggen MJ, Henneman L, Timmermans DRM. Women's decision making regarding prenatal screening for fetal aneuploidy: A qualitative comparison between 2003 and 2016. Midwifery 2018; 64:93-100. [PMID: 29990629 DOI: 10.1016/j.midw.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Situational factors of prenatal screening have changed in recent decades. To explore the effect of a changing context on women's decision making, differences and similarities in the decision-making process of pregnant women regarding prenatal screening for fetal aneuploidy between two periods in time were studied. DESIGN A qualitative comparison was made between a dataset of 22 semi-structured interviews with pregnant women from 2003 and a newly collected dataset with 19 semi-structured interviews from 2016. FINDINGS Overall, women reported similar considerations in their decision-making process in 2003 and 2016, suggesting that decision making has not essentially changed. In 2016, women were still making a deliberate decision, however for some women costs and societal views as to what is acceptable did appear to impact the decision-making process. Moreover, new screening possibilities (e.g. improved test characteristics and including more conditions to be screened) seemed to impact the decision outcome. CONCLUSIONS Since most women based their decisions mainly on their personal values and personal experiences rather than on situational factors, the results suggest that the changing context with regard to prenatal screening had no major effect on women's decision making. It therefore seems unlikely that future changes in the field of prenatal screening will drastically change the decision-making process of pregnant women as long as informed and deliberate decision making is safeguarded.
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Affiliation(s)
- Metje J van Bruggen
- Department of Clinical Genetics, Section of Community Genetics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Daniëlle R M Timmermans
- Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands; Department of Public and Occupational Health, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
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17
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Kenkhuis MJA, Bakker M, Bardi F, Fontanella F, Bakker MK, Fleurke-Rozema JH, Bilardo CM. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:463-469. [PMID: 28397377 DOI: 10.1002/uog.17487] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The main aim of this study was to assess the proportion and type of congenital anomalies, both structural and chromosomal, that can be detected at an early scan performed at 12-13 weeks' gestation, compared with at the 20-week structural anomaly scan offered under the present screening policy. Secondary aims were to evaluate the incidence of false-positive findings and ultrasound markers at both scans, and parental choice regarding termination of pregnancy (TOP). METHODS Sonographers accredited for nuchal translucency (NT) measurement were asked to participate in the study after undergoing additional training to improve their skills in late first-trimester fetal anatomy examination. The early scans were performed according to a structured protocol, in six ultrasound practices and two referral centers in the north-east of The Netherlands. All women opting for the combined test (CT) or with an increased a-priori risk of fetal anomalies were offered a scan at 12-13 weeks' gestation (study group). All women with a continuing pregnancy were offered, as part of the 'usual care', a 20-week anomaly scan. RESULTS The study group consisted of 5237 women opting for the CT and 297 women with an increased a-priori risk of anomalies (total, 5534). In total, 51 structural and 34 chromosomal anomalies were detected prenatally in the study population, and 18 additional structural anomalies were detected after birth. Overall, 54/85 (63.5%) anomalies were detected at the early scan (23/51 (45.1%) structural and all chromosomal anomalies presenting with either an increased risk at first-trimester screening or structural anomalies (31/34)). All particularly severe anomalies were detected at the early scan (all cases of neural tube defect, omphalocele, megacystis, and multiple severe congenital and severe skeletal anomalies). NT was increased in 12/23 (52.2%) cases of structural anomaly detected at the early scan. Of the 12 cases of heart defects, four (33.3%) were detected at the early scan, five (41.7%) at the 20-week scan and three (25.0%) after birth. False-positive diagnoses at the early scan and at the 20-week scan occurred in 0.1% and 0.6% of cases, respectively, whereas ultrasound markers were detected in 1.4% and 3.0% of cases, respectively. After first- or second-trimester diagnosis of an anomaly, parents elected TOP in 83.3% and 25.8% of cases, respectively. CONCLUSIONS An early scan performed at 12-13 weeks' gestation by a competent sonographer can detect about half of the prenatally detectable structural anomalies and 100% of those expected to be detected at this stage. Particularly severe anomalies, often causing parents to choose TOP, are amenable to early diagnosis. The early scan is an essential part of modern pregnancy care. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M J A Kenkhuis
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M Bakker
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Bardi
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Fontanella
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M K Bakker
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J H Fleurke-Rozema
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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18
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Hill M, Barrett A, Choolani M, Lewis C, Fisher J, Chitty LS. Has noninvasive prenatal testing impacted termination of pregnancy and live birth rates of infants with Down syndrome? Prenat Diagn 2017; 37:1281-1290. [PMID: 29111614 PMCID: PMC5767768 DOI: 10.1002/pd.5182] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Implementation of noninvasive prenatal testing (NIPT) as a highly accurate aneuploidy screening test has raised questions around whether the high uptake may result in more terminations of pregnancies and fewer births of children with Down syndrome (DS). AIM The aim of the study was to investigate the impact of NIPT on termination and live birth rates for DS. METHODS Literature reporting pregnancy outcomes following NIPT was reviewed. Termination rates were calculated for women with a high-risk NIPT result for DS. Two audits of pregnancy outcomes where NIPT indicated DS were conducted in the United Kingdom and Singapore. RESULTS Fourteen studies from the United States, Asia, Europe, and the United Kingdom were included in the review. Live births of children with DS were reported in 8 studies. Termination rates following NIPT were unchanged or decreased when compared to termination rates prior to the introduction of NIPT. Audits found 15 of 43 women in the United Kingdom and 2 of 6 in Singapore continued pregnancies following a high-risk NIPT result. CONCLUSIONS Termination rates following the detection of DS by NIPT are unchanged or decreased compared to historical termination rates. Impact on live birth rates may be minimal in settings where termination rates fall. Population-based studies are required to determine the true impact.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Angela Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Celine Lewis
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | | | - Lyn S. Chitty
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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19
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Holtkamp KCA, Lakeman P, Hader H, Jans SMJP, Hoenderdos M, Playfair HAM, Cornel MC, Peters M, Henneman L. Experiences of a High-Risk Population with Prenatal Hemoglobinopathy Carrier Screening in a Primary Care Setting: a Qualitative Study. J Genet Couns 2017; 27:635-646. [PMID: 28980104 PMCID: PMC5943376 DOI: 10.1007/s10897-017-0159-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/18/2017] [Indexed: 12/16/2022]
Abstract
Carrier screening for hemoglobinopathies (HbPs; sickle cell disease and thalassemia) aims to facilitate autonomous reproductive decision-making. In the absence of a Dutch national HbP carrier screening program, some primary care midwives offer screening on an ad hoc basis. This qualitative descriptive study explores how pregnant women perceive an offer of HbP carrier screening by their midwife. Semi-structured interviews (n = 26) were conducted with pregnant women at risk of being a HbP carrier, and whom were offered screening at their booking appointment in one of two midwifery practices in Amsterdam. The results showed that half of the respondents were familiar with HbPs. Generally, women perceived the offer of HbP carrier screening as positive, and most women (n = 19) accepted screening. Seven declined, of whom two already knew their carrier status. Important reasons to accept screening were to obtain knowledge about their own carrier status and health of their unborn child, and the ease of the procedure. A multistep process of decision-making was observed, as many women did not give follow-up testing (e.g. partner, invasive diagnostics) much consideration while deciding on accepting or declining HbP screening. Women experienced information overload, and preferred receiving the information at a different moment (e.g. before the intake by a leaflet, or preconceptionally). In conclusion, while prenatal HbP carrier screening is perceived as positive, informed decision-making seems to be suboptimal, and both the content and timing of the information provided needs improvement.
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Affiliation(s)
- Kim C A Holtkamp
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Hind Hader
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Suze M J P Jans
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- TNO, Quality of Life, Department of Child Health, Leiden, The Netherlands
| | | | | | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Marjolein Peters
- Department of Pediatric Hematology, Emma's Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, Amsterdam Public Health research institute, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
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20
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Posthumus AG, Peters IA, Borsboom GJ, Knapen MFCM, Bonsel GJ. Inequalities in uptake of prenatal screening according to ethnicity and socio-economic status in the four largest cities of the Netherlands (2011-2013). Prenat Diagn 2017. [PMID: 28621806 DOI: 10.1002/pd.5089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In the Netherlands, all women are claimed to have equal access to prenatal screening (PS). Prior research demonstrated substantial inequalities in PS uptake associated with socioeconomic status (SES) and ethnic background. The suggested pathway was a lack of intention to participate in PS among these subgroups. We studied the background of inequalities in PS participation, challenging intention heterogeneity as the single explanation. METHODS Multivariable logistic regression analyses of the national PS registry, focusing on the four largest cities in the Netherlands (n = 4578, years 2011-2013), stratified by SES. OUTCOME MEASURES (1) any uptake of PS (yes/no) and (2) uptake (one/two tests) for women who intended to participate in two tests. Determinants included intention, ethnicity, practice, and age. RESULTS Of non-Western women, 85.7% were screened versus 89.7% of Western women. Intention was an important explanatory factor in all models. However, after correction for intention, ethnicity remained a significant determinant for differences in uptake. Ethnicity and SES also interacted, indicating that non-Western women in low SES areas had the lowest uptake (corrected for intention). CONCLUSIONS FOR PRACTICE Socioeconomic status and ethnicity related inequalities in PS uptake are only partially explained by intention heterogeneity; other pathways, in particular provider-related determinants, may play a role. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anke G Posthumus
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ingrid A Peters
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - Gerard J Borsboom
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Utrecht Medical Centre (UMCU), Utrecht, The Netherlands
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21
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de Graaf G, Engelen JJM, Gijsbers ACJ, Hochstenbach R, Hoffer MJV, Kooper AJA, Sikkema-Raddatz B, Srebniak MI, van der Kevie-Kersemaekers AMF, van Zutven LJCM, Voorhoeve E. Estimates of live birth prevalence of children with Down syndrome in the period 1991-2015 in the Netherlands. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:461-470. [PMID: 28261902 DOI: 10.1111/jir.12371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND In Western countries, increasing maternal age has led to more pregnancies with a child with Down syndrome (DS). However, prenatal screening programs, diagnostic testing and termination of pregnancy influence the actual DS live birth (LB) prevalence as well. The aim of this study is to examine these factors in the Netherlands for the period 1991-2015. In our study, we establish a baseline for DS LB prevalence before non-invasive prenatal testing will be made available to all pregnant women in the Netherlands in 2017. METHODS Full nationwide data from the Dutch cytogenetic laboratories were used to evaluate the actual DS LB prevalence. In addition, nonselective DS prevalence, which is the DS LB prevalence that would be expected in absence of termination of pregnancies, was estimated on the basis of maternal age distribution in the general population. RESULTS Because of an increase in maternal age, nonselective DS prevalence increased from around 15.6 [95% confidence interval (CI) 13.9-17.4] per 10 000 LBs in 1991 (311 children in total) to around 22.6 (95% CI 20.3-24.9) per 10 000 in 2015 (385), the increase levelling off in recent years. Actual LB prevalence rose from around 11.6 (95% CI 10.9-12.2) per 10 000 in 1991 (230 children) to an estimated peak of 15.9 (95% CI 15.6-16.2) per 10 000 in 2002 (322), gradually decreasing since to 11.1 (95% CI 10.8-11.5) per 10 000 in 2015 (190). Reduction of DS LBs resulting from elective terminations had been fairly constant between 1995 and 2002 at around 28% and rose afterwards from 35% in 2003 to around 50% in 2015. CONCLUSIONS In spite of expansion of antenatal screening in the Netherlands in the 1990s and early 2000s, actual DS LB prevalence increased during this period. However, after 2002, this trend reversed, probably because of informing all pregnant women about prenatal testing since 2004 and the implementation of a national screening program in 2007.
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Affiliation(s)
- G de Graaf
- Dutch Down Syndrome Foundation, Meppel, The Netherlands
| | - J J M Engelen
- Department of Clinical Genetics, Research Institute Growth and Development (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A C J Gijsbers
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Hochstenbach
- Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A J A Kooper
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Sikkema-Raddatz
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M I Srebniak
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - E Voorhoeve
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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22
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van Schendel RV, Kater-Kuipers A, van Vliet-Lachotzki EH, Dondorp WJ, Cornel MC, Henneman L. What Do Parents of Children with Down Syndrome Think about Non-Invasive Prenatal Testing (NIPT)? J Genet Couns 2016; 26:522-531. [PMID: 27618823 PMCID: PMC5415584 DOI: 10.1007/s10897-016-0012-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
This study explores the attitudes of parents of children with Down syndrome towards non-invasive prenatal testing (NIPT) and widening the scope of prenatal screening. Three focus groups (n = 16) and eleven individual interviews with Dutch parents (and two relatives) of children with Down syndrome were conducted. Safety, accuracy and earlier testing were seen as the advantages of NIPT. Some participants were critical about the practice of screening for Down syndrome, but acknowledged that NIPT enables people to know whether the fetus is affected and to prepare without risking miscarriage. Many feared uncritical use of NIPT and more abortions for Down syndrome. Concerns included the consequences for the acceptance of and facilities for children with Down syndrome, resulting in more people deciding to screen. Participants stressed the importance of good counseling and balanced, accurate information about Down syndrome. Testing for more disorders might divert the focus away from Down syndrome, but participants worried about “where to draw the line”. They also feared a loss of diversity in society. Findings show that, while parents acknowledge that NIPT offers a better and safer option to know whether the fetus is affected, they also have concerns about NIPT’s impact on the acceptance and care of children with Down syndrome.
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Affiliation(s)
- Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Wybo J Dondorp
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Research Institutes GROW and CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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23
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Crombag NMTH, van Schendel RV, Schielen PCJI, Bensing JM, Henneman L. Present to future: what the reasons for declining first-trimester combined testing tell us about accepting or declining cell-free DNA testing. Prenat Diagn 2016; 36:587-90. [PMID: 27061402 DOI: 10.1002/pd.4824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/29/2016] [Accepted: 04/06/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel V van Schendel
- Department of Clinical Genetics, section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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