Trends in prenatal screening and diagnostic testing among women referred for advanced maternal age

Abstract

Improved prenatal screening tests and increased availability of screening for AMA patients has led to a steady decline in uptake of invasive testing from 2001 through 2007. This trend reversed from 2007 through 2008. Possible reasons for this reversal are discussed.

Utilization of available prenatal screening and diagnosis: effects of the California screen program

“…A recent study by Nakata et al evaluated 163 756 patients referred to Genzyme Genetics for genetic counseling because of advanced maternal age, from 2001 to 2008. 6 During this period, firsttrimester screening increased from 45 to 85%; however, the authors found a decrease in amniocentesis from 56 to 31% and in CVS from 36 to 14% over the same period. The effect of large systemwide prenatal screening programs was also described by Ekelund et al 7 In their study detailing the effect of the Danish Prenatal Screening Program, the authors described a decrease in the number of prenatal diagnostic procedures performed (4202 to 1208 amniocentesis and 3322 to 2302 CVS procedures) from 2000 to 2006 while the uptake in prenatal screening reached 84% over the same period.…”

Offering prenatal diagnostic tests: European guidelines for clinical practice

“…3 In some clinical settings, amniocentesis or CVS for aneuploidy has been offered to all pregnant women of advanced maternal age. [4][5][6] In other circumstances or countries, discussion of invasive testing may be prompted by a high-risk screening result. 7 However, the opportunity to use non-invasive techniques for some conditions is now feasible 8 and these are increasingly available to women in some countries.…”

Amniocentesis Due to Advanced Maternal Age: The Role of Marital Intimacy in Couples’ Decision-Making Process

“…Despite these concerns, research has demonstrated that more than half of AMA women choose to undergo IDTs (Nakata et al, 2010). As uptake of amniocentesis seems to be higher in this group, in comparison with women with a positive screening test (Hoskovec et al, 2008), our study specifically considers the experience of women of AMA as the sole indication for genetic counseling.…”

“…Considering these implications, the study of the decision-making process regarding IDTs (i. e., how couples make a decision whether or not to undergo these tests) appears to be extremely relevant. Our study will specifically focus amniocentesis, as this is the most frequently chosen test (Nakata et al, 2010).…”

“…Due to the risk of fetal anomaly, pregnant women who are 35 years of age or older at the time of the birth are presented with the choice of whether or not to undergo prenatal invasive diagnostic tests (IDTs). Although the majority opt to undergo IDTs (Nakata, Wang, & Bhatt, 2010), little is known about the manner in which couples make this important decision, which may lead to a prenatal diagnosis of fetal anomaly and leave couples with the choice of continuing or interrupting the pregnancy.…”