Background: Tests in pregnancy such as chromosomal microarray analysis and exome sequencing are increasing diagnostic yield for fetal structural anomalies, but have greater potential to result in uncertain findings. This systematic review investigated the experiences of prospective parents about receiving uncertain results from these tests.Methods: A systematic search of three electronic databases was conducted. Data extraction was performed for studies that met the eligibility and quality criteria.Results were synthesised following the principles of thematic analysis.Results: Fourteen studies (10 qualitative, 4 quantitative) were included. Findings were grouped into three overarching themes. Sources of uncertainty included the testing procedure, the diagnosis and prognosis, and health professionals' own uncertainty. The clinical impact of the uncertainty included parents struggling to make clinical decisions with the information available, the emotional impact included decisional-regret, shock, worry and feeling overwhelmed. To manage the uncertainty, parents sought support from healthcare professionals, friends, family, the internet and other parents as well as remaining hopeful.Conclusions: Prospective parents experience a myriad of uncertainties in the prenatal setting, which must be handled sensitively. Future research should explore optimal ways of managing uncertainty to minimise harm. Recommendations are made for discussing uncertainty during pre-and post-test counseling.
| BACKGROUNDFetal anomalies occur in 2% to 5% of pregnancies and cause around 21% of perinatal deaths. 1,2,3 Initially, prenatal testing for fetal anomalies was limited to karyotyping and targeted genetic testing. 4 Chromosomal microarray analysis (CMA), which is able to evaluate the sub-microscopic structure of chromosomes is now being offered routinely in many countries, and prenatal exome sequencing (ES), which provides resolution down to the single base-pair, is beginning to be used clinically to increase diagnostic rates. 5 There are a number of benefits in getting a result from prenatal testing. This includes the potential to provide a definitive diagnosis during pregnancy which can then inform genetic counselling, pregnancy and delivery management, and pre-and post-natal care. 6,7