Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age

• Published in: Health expectations : an international journal of public participation in health care and health policy Vol. 18; no. 6; pp. 2306 - 2317
• Main Authors: Grinshpun‐Cohen, Julia, Miron‐Shatz, Talya, Ries‐Levavi, Liat, Pras, Elon
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.12.2015; John Wiley and Sons Inc
• Subjects: Abnormalities; Adult; advanced maternal age; Age; Amniocentesis; Amniocentesis - psychology; Amniocentesis - utilization; Clinical trials; Decision Making; Down syndrome; Down Syndrome - diagnosis; Down's syndrome; Estimates; Female; Genetic counseling; Genetic testing; Genetics; Gynecology; High risk; Humans; Israel; Maternal Age; Maternal serum; Medical diagnosis; Medical screening; Obstetrics; Original; Original Research Papers; Pregnancy; Prenatal diagnosis; Risk Assessment; Risk Factors; Screening; Serum; statistical risk estimates; Womens health; Young women; amniocentesis; screening; Down syndrome; advanced maternal age; statistical risk estimates; decision making
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/hex.12200

Background Risk for foetal Down syndrome (DS) increases as maternal age increases. Non‐invasive screening (maternal serum triple test) for DS is routinely offered to pregnant women to provide risk estimates and suggest invasive amniocentesis for definitive pre‐natal diagnosis to high‐risk women. Objective We examined women's decision process with regard to pre‐natal screening, and specifically, the degree to which they take into account triple serum screening results when considering whether or not to undergo amniocentesis. Design Semi‐structured phone interviews were conducted to assess recall of DS screening results, understanding of risk estimates and their effect on women's decision whether to undergo amniocentesis. The study included 60 pregnant Israeli women (half younger than 35 and half advanced maternal age – AMA), with normal DS screening results and no known ultrasound abnormalities. Results Age appeared to determine the decision process. The vast majority of AMA women had amniocentesis, many of them before receiving their DS screening results. Most AMA participants knew that their risk estimate was ‘normal’, but still considered themselves at high risk due to their age. Procedure‐related risk (miscarriage) and other factors only had a minor effect on their decision. A minority of younger women had amniocentesis. Younger women mentioned procedure‐related risk and having normal screening results as the main factors affecting their decision not to have amniocentesis. Conclusion Age 35 is an anchor for the pre‐determination regarding performing or avoiding amniocentesis. AMA women mention ‘age’ as their main reason to have amniocentesis and considered it an independent risk factor.