Views of the obstetric profession on non‐invasive prenatal testing in Aotearoa New Zealand: A national survey

Filoche, Sara; Lawton, Beverley; Beard, Angela; Stone, Peter

doi:10.1111/ajo.12656

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…Our survey response rate was 30.7%. This compares favourably to previously published surveys of healthcare professionals, which have response rates varying from 15.9 to 36.5% [9,[15][16][17], but may limit the generalizability of the results. Non-specialists and consultants practising in public hospitals were also overrepresented.…”

Section: Limitationssupporting

confidence: 65%

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Prenatal screening in the era of non-invasive prenatal testing: a Nationwide cross-sectional survey of obstetrician knowledge, attitudes and clinical practice

Yang

Tan

2020

BMC Pregnancy Childbirth

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Background Non-invasive prenatal testing (NIPT) has revolutionized the prenatal screening landscape with its high accuracy and low false positive rate for detecting Trisomy 21, 18 and 13. Good understanding of its benefits and limitations is crucial for obstetricians to provide effective counselling and make informed decisions about its use. This study aimed to evaluate obstetrician knowledge and attitudes regarding NIPT for screening for the common trisomies, explore how obstetricians integrated NIPT into first-line and contingent screening, and determine whether expanded use of NIPT to screen for sex chromosome aneuploidies (SCAs) and microdeletion/microduplication syndromes (CNVs) was widespread. Methods A questionnaire was designed and administered with reference to the CHERRIES criteria for online surveys. Doctors on the Obstetrics & Gynaecology trainee and specialist registers were invited to participate. Medians and 95% confidence intervals (CI) were reported for confidence and knowledge scores. Results 94/306 (30.7%) doctors responded to the survey. First trimester screening (FTS) remained the main method offered to screen for the common trisomies. 45.7% (43/94) offered NIPT as an alternative first-line screen for singletons and 30.9% (29/94) for monochorionic diamniotic twins. A significant proportion offered concurrent NT and NIPT (25/94, 26.6%), or FTS and NIPT (33/94, 35.1%) in singletons. Varying follow up strategies were offered at intermediate, high and very-high FTS risk cut-offs for Trisomy 21. Respondents were likely to offer screening for SCAs and CNVs to give patients autonomy of choice (53/94, 56.4% SCAs, 47/94, 50% CNVs) at no additional cost (52/94, 55.3% SCAs, 39/94, 41.5% CNVs). Median clinical knowledge scores were high (10/12) and did not differ significantly between specialists (95% CI 10–11) and non-specialists (95% CI 9.89–11). Lower scores were observed for scenarios in which NIPT would be more likely to fail. Conclusions Our findings show the diversity of clinical practice with regard to the incorporation of NIPT into prenatal screening algorithms, and suggest that the use of NIPT both as a first-line screening tool in the general obstetric population, and to screen for SCAs and CNVs, is becoming increasingly prevalent. Clear guidance and continuing educational support are essential for providers in this rapidly evolving field.

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Section: Limitationssupporting

confidence: 65%

“…Median total confidence scores were higher among MFM specialists (19/20, 95% CI 18-19.29) versus non-MFM specialists (17/20, 95% CI [16][17], and specialists felt more confident providing pre and post-test counselling (18/20, 95% CI 17.7-19) than non-specialists (16/20, 95% CI 15-16.1).…”

Section: Confidence In Providing Pre and Post-test Counsellingmentioning

confidence: 98%

Prenatal screening in the era of non-invasive prenatal testing: a Nationwide cross-sectional survey of obstetrician knowledge, attitudes and clinical practice

Yang

Tan

2020

BMC Pregnancy Childbirth

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“…Time mentioned above counted the consultation time by physicians only, and not the nurse-counseling time. One national survey reported that 45.8% of respondents answered that about 15 minutes is appropriate amount of time for pretest counseling [14]. Our survey shows that amount of time for pretest counseling by physician was shorter compared to above ideal time.…”

Section: Discussionmentioning

confidence: 59%

Korean physicians’ attitudes toward the prenatal screening for fetal aneuploidy and implementation of non-invasive prenatal testing with cell-free fetal DNA

Kim

Kim²,

Han

et al. 2018

J Genet Med

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Physicians' attitudes may have a strong influence on women's decision regarding prenatal screening options. The aim of this study is to assess the physicians' attitudes toward prenatal screening for fetal aneuploidy including non-invasive prenatal testing (NIPT) in South Korea. Materials and Methods: Questionnaires were distributed and collected at several obstetrics-gynecological conferences and meetings. The questionnaire included 31 multiple choice and 5 fill-in-the-blank questions. Seven questions requested physicians' demographic information, 17 questions requested information about the NIPT with cell-free fetal DNA, and 12 questions requested information about general prenatal screening practices. Results: Of the 203 obstetricians that completed the survey. In contrast with professional guidelines recommending the universal offering of aneuploidy screening, only 53.7% answered that prenatal aneuploidy testing (screening and/or invasive diagnostic testing) should be offered to all pregnant women. Physicians tended to have positive attitudes toward the clinical application of NIPT as both primary and secondary screening methods for patients at high-risk for fetal trisomy. However, for patients at average-risk for fetal trisomy, physicians tended to have positive attitudes only as a secondary screening method. Physicians with more knowledge about NIPT were found to tend to inform their patients that the detection rate of NIPT is higher. Conclusion: This is the first study to investigate expert opinion on prenatal screening in South Korea. Education of physicians is essential to ensure responsible patient counseling, informed consent, and appropriate management after NIPT.

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“…However, 31% would offer this, despite recognising a strong son preference, with participants suggesting the illegal status of abortion for social reasons in Pakistan as sufficient protection against sex‐selective TOP . A 2017 survey of obstetric professionals in New Zealand found that 37% had been asked about using NIPT for sex determination, and 33% supported the public funding of NIPT sex determination …”

Section: Nipt Sex Determination and Sex Selectionmentioning

confidence: 99%

Sex selection and non‐invasive prenatal testing: A review of current practices, evidence, and ethical issues

et al. 2019

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Non‐invasive prenatal testing (NIPT) can determine the sex of the fetus very accurately and very early in gestation. There are concerns that the ease, timing, and accuracy of NIPT sex determination will facilitate sex‐selective termination of pregnancy (TOP). Here, we review current practices, the evidence for a link between NIPT and sex‐selective TOP, and associated ethical issues. Sex‐selective TOP, usually motivated by son preference, has had serious demographic consequences in countries such as India and China. Currently, ultrasound is the primary method by which parents determine the sex of the fetus. The diffusion of ultrasound technology has had a direct impact on the rates of sex‐selective TOP. Although NIPT is currently more costly, it is feasible that increased uptake of this technology could have a similar effect. Partly because NIPT is a relatively recent development in prenatal screening, there is little data on the impact of NIPT on sex selection practices. Evidence that NIPT is playing a role in sex‐selective TOP remains largely anecdotal. Further research is required to assess and quantify TOP resulting from NIPT sex determination. The use of these technologies for sex selection raises a number of ethical issues, in addition to practical demographic consequences.

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Views of the obstetric profession on non‐invasive prenatal testing in Aotearoa New Zealand: A national survey

Abstract: There was strong support for public funding of NIPT, and for NIPT capability to be developed in NZ. The call for more training, education and support needs to be actioned in order to facilitate the introduction of NIPT into screening services.

Cited by 8 publications

References 29 publications

Prenatal screening in the era of non-invasive prenatal testing: a Nationwide cross-sectional survey of obstetrician knowledge, attitudes and clinical practice

Prenatal screening in the era of non-invasive prenatal testing: a Nationwide cross-sectional survey of obstetrician knowledge, attitudes and clinical practice

Korean physicians’ attitudes toward the prenatal screening for fetal aneuploidy and implementation of non-invasive prenatal testing with cell-free fetal DNA

Sex selection and non‐invasive prenatal testing: A review of current practices, evidence, and ethical issues

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