A systematic review of factors influencing uptake of invasive fetal genetic testing by pregnant women of advanced maternal age

Godino, Lea; Turchetti, Daniela; Skirton, Heather

doi:10.1016/j.midw.2012.11.009

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…A recent systematic review that attempted to identify the factors influencing the uptake of invasive pre‐natal testing by AMA women has found that it is difficult to draw firm conclusions as to the influential factors. The researchers looked at ‘external’ and ‘psychological’ factors, but did not examine women's subjective risk assessments or their main reasons for having amniocentesis.…”

Section: Discussionsupporting

confidence: 93%

Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age

Grinshpun‐Cohen

Miron‐Shatz

Ries-Levavi

et al. 2014

Health Expectations

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Background Risk for foetal Down syndrome (DS) increases as maternal age increases. Non-invasive screening (maternal serum triple test) for DS is routinely offered to pregnant women to provide risk estimates and suggest invasive amniocentesis for definitive pre-natal diagnosis to high-risk women.Objective We examined women's decision process with regard to pre-natal screening, and specifically, the degree to which they take into account triple serum screening results when considering whether or not to undergo amniocentesis.Design Semi-structured phone interviews were conducted to assess recall of DS screening results, understanding of risk estimates and their effect on women's decision whether to undergo amniocentesis. The study included 60 pregnant Israeli women (half younger than 35 and half advanced maternal age -AMA), with normal DS screening results and no known ultrasound abnormalities.Results Age appeared to determine the decision process. The vast majority of AMA women had amniocentesis, many of them before receiving their DS screening results. Most AMA participants knew that their risk estimate was 'normal', but still considered themselves at high risk due to their age. Procedure-related risk (miscarriage) and other factors only had a minor effect on their decision. A minority of younger women had amniocentesis. Younger women mentioned procedure-related risk and having normal screening results as the main factors affecting their decision not to have amniocentesis.Conclusion Age 35 is an anchor for the pre-determination regarding performing or avoiding amniocentesis. AMA women mention 'age' as their main reason to have amniocentesis and considered it an independent risk factor.

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Section: Discussionsupporting

confidence: 93%

Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age

Grinshpun‐Cohen

Miron‐Shatz

Ries-Levavi

et al. 2014

Health Expectations

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“…3,4 However, in order to pursue such a change, a better understanding of the reasons underlying the choice to undergo IPP is needed. Evidence from the literature 7 does not enable firm conclusions to be drawn as to the factors influencing the uptake of IPP by AMA women, although a correlation has been suggested with ethnicity, older age and higher education.…”

Section: Introductionmentioning

confidence: 96%

Attitudes of women of advanced maternal age undergoing invasive prenatal diagnosis and the impact of genetic counselling

et al. 2015

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Despite the increasing availability and effectiveness of non-invasive screening for foetal aneuploidies, most women of advanced maternal age (AMA) still opt for invasive tests. A retrospective cross-sectional survey was performed on women of AMA undergoing prenatal invasive procedures, in order to explore their motivations and the outcome of preliminary genetic counselling according to the approach (individual or group) adopted. Of 687 eligible women, 221 (32.2%) participated: 117 had received individual counselling, while 104 had attended group sessions. The two groups did not differ by socio-demographic features. The commonest reported reason to undergo invasive tests was AMA itself (67.4%), while only 10.4% of women mentioned the opportunity of making informed choices. The majority perceived as clear and helpful the information received at counselling, and only 12.7% had doubts left that, however, often concerned non-pertinent issues. The impact of counselling on risk perception and decisions was limited: a minority stated their perceived risk of foetal abnormalities had either increased (6.8%) or reduced (3.6%), and only one eventually declined invasive test. The 52.6% of women expressed a preference toward individual counselling, which also had a stronger impact on perceived risk reduction (P = 0.003). Nevertheless, group counselling had a more favourable impact on both clarity of understanding and helpfulness (P = 0.0497 and P = 0.035, respectively). The idea that AMA represents an absolute indication for invasive tests appears deeply rooted; promotion of non-invasive techniques may require extensive educational efforts targeted to both the general population and health professionals. INTRODUCTIONWomen of advanced maternal age (AMA) face an increased risk of having a child affected by a chromosomal disorder such as trisomy 21, 18 or 13, with the risk rising from 1 in 525 for a 20-year-old to 1 in 18 for a 45-year-old woman. 1 For this reason, in many countries women of AMA have been or still are offered invasive prenatal procedures (IPP), namely amniocentesis (AC) and chorionic villus sampling (CVS), to perform foetal karyotyping. 2 However, owing to the risk of foetal loss associated with IPP, noninvasive screening tests have been developed and proven accurate in identifying women at increased risk of foetal aneuploidies, regardless of maternal age. The combined test including sonographic measurement of foetal nuchal translucency and the biochemical assessment of free beta-hCG and PAPP-A performed at 11-13 weeks allows detection of 90-95% of affected foetuses for a false-positive rate of 5%. [3][4][5] Despite the excellent performance of the combined test in antenatal exclusion of trisomy 21, only few countries in Europe have adopted a policy of universal screening of the population and cancelled the AMA as a primary indication to foetal karyotyping. In Italy, according to the most recent guidelines, the combined test is suggested as a primary screening tool in pregnancy, irrespective of maternal age, bu...

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“…In more recent decades, women ≥ 35 years have had access to antenatal fetal screening using maternal serum tests and ultrasound before making a decision about an invasive test (Nakata et al ., ; Chitty & Bianchi, ). Despite the fact that screening and testing should be offered as options rather than routine tests, and that counselling and information affect the uptake of testing (Godino et al ., ), there is still evidence that women and their partners do not make informed choices (Barr & Skirton, ).…”

Section: Introductionmentioning

confidence: 99%

Experiences regarding maternal age‐specific risks and prenatal testing of women of advanced maternal age in Japan

Murakami

Turale

Skirton

et al. 2016

Nursing & Health Sciences

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The number of pregnant women of advanced maternal age has increased worldwide. Women in this group have an increased chance of fetal abnormality. To explore Japanese women's experiences regarding maternal age-specific risks and prenatal testing, we conducted a descriptive qualitative study. Semi-structured interviews were conducted with 16 women aged 35 years or over who had given birth within the previous three months to a healthy, term infant. Thematic analysis of transcribed interview data was performed and three major themes were identified: inadequate understanding of genetic risks; insufficiently informed choice regarding prenatal testing; and need for more information from health professionals. Some participants were not aware of maternal age-specific risks to the fetus. Many took their cues from health professionals and did not raise the topic themselves, but would have considered prenatal testing if made aware of the risks. Nurses, midwives and other health professionals need to adequately inform pregnant women about the genetic risks to the fetus and offer testing at an appropriate stage early in the pregnancy.

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A systematic review of factors influencing uptake of invasive fetal genetic testing by pregnant women of advanced maternal age

Cited by 12 publications

References 29 publications

Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age

Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age

Attitudes of women of advanced maternal age undergoing invasive prenatal diagnosis and the impact of genetic counselling

Experiences regarding maternal age‐specific risks and prenatal testing of women of advanced maternal age in Japan

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