Factors affecting performance of prenatal genetic testing by Israeli Jewish women

Abstract

The number of prenatal genetic tests that are being offered to women is constantly increasing. However, there is little national data as to who is performing the tests and the reasons for doing or not doing so. This study evaluated the proportion of Jewish women in Israel who perform the various prenatal genetic tests and the factors affecting the performance of these tests. It was found that 60.9% of the women performed the triple test, 50.8% of women older than 35 years performed amniocentesis, while 63.3 and 24.3% of women performed Tay-Sachs and fragile-X carrier testing respectively. Ninety-six percent of the secular women compared to only 6.7% of the ultrareligious women performed the triple test. It was also found that94.4% of the secular women, 36.4% of the religious, and none of the ultrareligious women older than 35 years performed amniocentesis. In the stepwise regression analysis, being secular, having a higher income, fewer children, and being of Ashkenazi origin remained significant factors in determining performance of Tay-Sachs carrier testing. As regards fragile-X carrier testing, being secular, having fewer than four children, and having a higher income and a supplementary medical insurance remained significant factors. The main reason reported by the women for not performing amniocentesis or the triple test was for religious or moral grounds (53.3 and 67% respectively). The main reason given for not performing Tay-Sachs or fragile-X testing was that they were not referred for the tests (76 and 82% respectively). Consideration should be given to providing first trimester prenatal diagnosis to the ultrareligious group, including state subsidized fragile-X testing and educating the primary care givers about the importance of prenatal genetic testing. The information from the present study is vital for the planning of an equitable prenatal genetic service and provides guidelines for the implementation of such services in other countries.

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“…Thus, while most western countries, have four routine health check-ups during pregnancy (measuring blood pressure, levels of haemoglobin, Hepatitis B etc.) (Haertsch et al, 1999) Israeli women have 12 procedures (State of Israel, ministry of health, 2012) including more than 8 genetic tests required for Jewish Ashkenazi women including fragile-X and Tay-Sachs (Sher et al, 2003). Moreover, as Israel is a country which suffers from continuous conflict (Meljer, A.…”

Indifferent or Uninformed? Reflections of Health Professionals on Parental Education and Consent for Expanded Newborn Screening in Israel, 2008–2016

“…Israeli society is characterized by quasi-universal utilization of ultrasound, among both Jewish and Arab women [37]. Among the key motivational factors for pregnant women in Israel to perform prenatal testing is the fear of giving birth to a severely sick or disabled child [38,39]. However, abortions are frequently performed when fetuses have mild to moderate congenital abnormalities without serious discussion of its moral appropriateness [40].…”

Different Perceptions and Attitudes regarding Prenatal Testing among Service Providers and Consumers in Israel

“…This might erroneously be interpreted as having overall higher risks than the general population; thus a woman of Ashkenazi origin might opt for more comprehensive prenatal testing, as shown by other researchers [7]. …”

“…Prenatal (and especially genetic) testing is an intricate, multidimensional issue, with cultural, social, and demographic aspects. Issues of test utilization, such as reasons for accepting or declining tests, attitudes towards the necessity and implications of tests, and ethical issues such as termination of pregnancy, have been extensively studied [4,5,6,7]. …”

“…In national surveys done in Israel around the same period as the current study, the uptake rates of maternal serum screening, Tay-Sachs disease carrier screening and amniocentesis (at age 35 years and older) among Jewish women were around 60, 63, and 50%, respectively. Uptake of US scans was very high and reached more than 95% of pregnant women [5, 7]. …”