Socio-demographic disparities in the uptake of prenatal screening and diagnosis in Western Australia

Maxwell, Susannah; Brameld, Kate; Bower, Carol; Dickinson, Jan E.; Goldblatt, Jack; Hadlow, Narelle; Hewitt, Bev; Murch, Ashleigh; Murphy, Anthony; Stock, Roseanne; O’Leary, Peter

doi:10.1111/j.1479-828x.2010.01250.x

Cited by 59 publications

(78 citation statements)

References 30 publications

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“…Our study confirms earlier findings that women who were older than 30 were significantly more likely to have a CT [8, 10, 15] and is likely to reflect increased concerns about Down syndrome among older pregnant women. As is well known, the probability of bearing a child with Down Syndrome increases with the age of the mother [27].…”

Section: Discussionsupporting

confidence: 91%

Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study

Wal

Verhoeven

Manniën

et al. 2014

BMC Pregnancy Childbirth

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BackgroundTwo prenatal screening tests for congenital anomalies are offered to all pregnant women in the Netherlands on an opt-in basis: the Combined Test (CT) for Down syndrome at twelve weeks, and the Fetal Anomaly Scan (FAS) at around twenty weeks. The CT is free for women who are 36 or older; the FAS is free for all women. We investigated factors associated with the CT and FAS uptake.MethodThis study is part of the DELIVER study that evaluated primary care midwifery in the Netherlands. Associations between the women’s characteristics and the CT and FAS uptake were measured using multivariate and multilevel logistic regression analyses.ResultsOf 5216 participants, 23% had the CT and 90% had the FAS, with uptake rates ranging from 4% to 48% and 62% to 98% respectively between practices. Age (OR: 2.71), income (OR: 1.38), ethnicity (OR: 1.37), being Protestant (OR: 0.25), multiparous (OR: 0.64) and living in the east of the country (OR: 0.31) were associated with CT uptake; education (OR: 1.26), income (OR: 1.66), being Protestant (OR: 0.37) or Muslim (OR: 0.31) and being multiparous (OR: 0.74) were associated with FAS uptake. Among western women with a non-Dutch background, first generation (OR: 2.91), age (OR: 2.00), income (OR: 1.97), being Protestant (OR: 0.32) and living in the east (OR: 0.44) were associated with CT uptake; being Catholic (OR: 0.27), Protestant (OR: 0.13) were associated with FAS uptake. Among non- western women with a non-Dutch background, age (OR: 1.73), income (OR: 1.97) and lacking proficiency in Dutch (OR: 2.18) were associated with CT uptake; higher education (OR: 1.47), being Muslim (OR: 0.37) and first generation (OR: 0.27) were associated with FAS uptake.ConclusionThe uptake of the CT and FAS varied widely between practices. Income, parity and being Protestant were associated with uptake of both tests; ethnicity, age and living in the east were associated with CT uptake, and education and being Muslim with FAS uptake. These findings help to explain some differences between women choosing or declining early and late screening, but not the large variation in test uptake among practices, nor between the Netherlands and other countries.

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Section: Discussionsupporting

confidence: 91%

Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study

Wal

Verhoeven

Manniën

et al. 2014

BMC Pregnancy Childbirth

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“…The association between low screening rates and living in remote areas is consistent with findings from other populationbased studies 28,31,32 and from survey reports of reduced rates of offered screening among rural providers. [21][22][23]25 Reasons associated with low rates of offered screening included maternal age less than 35 years, lack of relevant family history and lack of patient request.…”

Section: Discussionsupporting

confidence: 80%

“…[28][29][30]32 Although predictors may differ across jurisdictions, age and income may have revealed stronger effects elsewhere because provider and regional effects were untested. Multiparity is often associated with older age and increased risk of aneuploidy; however, we found reduced screening uptake among multiparous women.…”

Section: Discussionmentioning

confidence: 99%

“…17,20,26,[28][29][30][31][32] We categorized maternal age at delivery or abortion into 3 groups (≤ 20 yr, 21-34 yr or ≥ 35 yr). 28 We linked all women to previous hospital admissions for delivery to determine maternal age at the time of first childbirth (≤ 20 yr, 21-34 yr or ≥ 35 yr). Age of 20 years or less at first delivery has been shown to be a strong indicator of social marginalization.…”

Section: Other Covariatesmentioning

confidence: 99%

“…[26][27][28][29][30][31][32] In light of the shifting and increasingly market-driven landscape of prenatal screening in Canada, 33 we examined the screening rates for publicly insured tests across health care regions in the province of Ontario. We also determined maternal, provider and regional factors associated with screening uptake.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study

Hayeems

Campitelli

et al. 2015

CMAJ Open

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First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening

Alldred

Takwoingi

Guo

et al. 2017

Cochrane Database of Systematic Reviews

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Test strategies that combine ultrasound markers with serum markers, especially PAPP-A and free ßhCG, and maternal age were significantly better than those involving only ultrasound markers (with or without maternal age) except nasal bone. They detect about nine out of 10 Down's affected pregnancies for a fixed 5% FPR. Although the absence of nasal bone appeared to have a high diagnostic accuracy, only five out of 10 affected Down's pregnancies were detected at a 1% FPR.

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Socio-demographic disparities in the uptake of prenatal screening and diagnosis in Western Australia

Cited by 59 publications

References 30 publications

Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study

Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study

Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study

First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening

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