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Clinical Decisionmaking

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Women's preferences for prenatal testing depend more on their attitudes toward pregnancy outcomes than their age

A pregnant woman's attitude toward miscarriage, pregnancy termination, and the possibility of giving birth to a baby with Down syndrome are more important than her age in determining her preferences for prenatal testing to detect fetal chromosomal abnormalities such as Down syndrome. Current age- and risk-based guidelines for prenatal testing should account for women's different preferences, according to Miriam Kuppermann, Ph.D., M.P.H., of the University of California, San Francisco.

In a study that was supported in part by the Agency for Healthcare Research and Quality (HS07373 and HS10214), Dr. Kuppermann and her colleagues assessed the preferences for 12 potential prenatal testing outcomes of 584 racially/ethnically and socioeconomically diverse pregnant women recruited from 23 San Francisco Bay Area practices.

Researchers asked the women about their preferences using a time trade-off metric (how many life months they were willing to give up for a certain outcome) and standard gamble metric (how much they were willing to risk for a certain outcome). They calculated preferences on a scale of 0 (death) to 1 (perfect health). Women also completed a sociodemographic and attitude survey.

Women gave the highest preference scores to outcomes resulting in the birth of a chromosomally normal infant (mean of 0.91-0.93) and less for pregnancy loss (mean of 0.69 to 0.87). Women gave the lowest preference scores to Down syndrome-affected births (mean 0.67-0.69).

The scores were correlated with attitudes toward miscarriage, pregnancy termination, and Down syndrome. White women tended to value unaffected births higher than blacks, Asians, and Latinos, and Asians had lower preference scores for Down syndrome births. The researchers did not find a significant relationship between women's preference scores and their age.

See "How do women of diverse backgrounds value prenatal testing outcomes?" by Dr. Kuppermann, Robert F. Nease Jr., Ph.D., Elena Gates, M.D., and others, in Prenatal Diagnosis 24, pp. 424-429, 2004.

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