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Higher incidence of birth defects may be linked to lower use of prenatal testing in black and Hispanic women

Latinas and black women are much less likely to undergo amniocentesis and chorionic villus sampling (CVS) to detect chromosomal abnormalities than white and Asian women. Latinas older than 35 years of age are three times more apt to give birth to a Down syndrome-affected infant than white women, and black women are nearly twice as likely to do so. These findings suggest a causal relationship between use of prenatal testing and the incidence of birth defects, concludes a study supported in part by the Agency for Health Care Policy and Research (HS07373).

Miriam Kuppermann, Ph.D., M.P.H., and colleagues at the University of California, San Francisco (UCSF), examined the medical charts of 238 pregnant women 35 years of age and older seen at UCSF in 1993 and 1994 to assess their use of prenatal diagnostic tests. After adjusting for socioeconomic characteristics, black women had one-third the odds of undergoing prenatal diagnosis as white women, and Latinas had one-fourth the odds. On the other hand, Asian women had nearly twice the chance of undergoing prenatal testing as white women.

Regardless of race or ethnicity, women who were professionals or students, or had partners who were professionals or students, were significantly more likely to undergo prenatal diagnosis than women who indicated that they or their partners were homemakers, unemployed, or employed in blue-collar jobs. But even after accounting for patient or partner occupation, black and Hispanic women were less likely to receive prenatal diagnosis than white or Asian women. This suggests that attitudes toward prenatal testing, pregnancy termination, and/or raising a disabled child may differ across these racial-ethnic groups, transcending socioeconomic strata. Alternatively, black and Hispanic women may not be receiving adequate, clearly understandable, and culturally sensitive information about the possible ramifications and outcomes of testing or not testing.

See "Racial-ethnic differences in prenatal diagnostic test use and outcomes: Preferences, socioeconomics, or patient knowledge?" by Dr. Kuppermann, Ph.D., M.P.H., Elena Gates, M.D., and A. Eugene Washington, M.D., M.Sc., in the May 1996 issue of Obstetrics & Gynecology 87, pp. 675-682.

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