Prenatal diagnosis for women aged 37 years and over: to have or not to have

Abstract

Forty percent of pregnant women aged 37 years and over do not have prenatal diagnosis despite being eligible for a free test. The present study aimed to determine how often, and which, untested women were making a choice about this, how many declined an offer and why. A questionnaire was given to untested women, aged 37 years and over, at no less than 24 weeks gestation. A total of 375 (81.5%) women declined, 72 (16%) were not offered a test and 13 presented too late antenatally. There was a three-fold increased likelihood (OR 3.10 95% CI 1.44, 6.65) of no offer for urban non-English speaking background women, compared with the reference group (metropolitan, English speaking). Unpartnered women were also significantly less likely to receive an offer (OR 3.18, 95% CI 1.19, 8.46). Risk to the baby was the main reason for declining. When offered non-invasive prenatal screening, most decliners of prenatal diagnosis accepted, even those who declined because they were opposed to abortion. We estimate that overall 33% of older pregnant women were being offered and declining amniocentesis and/or chorion villus sampling (CVS). Only 6% were not offered a test, but this small proportion is over-represented by minority groups who must be given equal opportunity to make this choice.

Mapping uptake of prenatal diagnosis for Down syndrome and other chromosome abnormalities across Victoria, Australia

“…[1][2][3][4][5] In Victoria, prenatal diagnosis has been widely available and utilised by pregnant women of advanced maternal age (37 years and older) since the 1970s. More recently, with the introduction of prenatal screening for Down syndrome in 1996, an increasing number of younger women are making use of the diagnostic service.…”

Laughter as Medical Providers' Resource: Negotiating Informed Choice in Prenatal Genetic Counseling

“…However, patients may preempt the information delivery process by refusing to undergo any tests at the first mention. Only very few studies have focused on the issue of why patients choose not to have prenatal genetic counseling (see, for example, Rapp, 1999;Halliday et al, 2001), yet in our data there is abundant evidence of patients who at least initially resisted undergoing prenatal diagnosis.…”

Prenatal diagnostic testing and Down syndrome in Victoria 1992–2002

“…9 It has been suggested that women have safety concerns when deciding on a prenatal diagnostic test and a study undertaken in 1998/99 in Victoria has shown that the main reason for declining was the risk to the baby. In addition, 82% of women who declined a diagnostic procedure accepted non-invasive prenatal screening, 10 leaving only a small population of women who would not have had any testing at all. Our study shows that 10 years ago almost two-thirds of Victorian women who had a prenatal diagnostic test did so because they were 37 years of age or older, whereas in 2002 less than 50% had a diagnostic test for this reason alone.…”