The choices women make about prenatal diagnosis

Despite the rapid advancement and increasing utilization of prenatal diagnostic technologies, there has been a paucity of investigation into the psychological, socioeconomic, and demographic features associated with the choices women make about both the uptake of services, and the actions taken after fetal abnormalities are discovered. From 1986 through 1991 we have completed four studies initiating a proposed comprehensive evaluation of these factors. The first two studies concentrated on patient features influencing uptake of prenatal diagnostic procedures in both a priori 'high risk' pregnancies (advanced maternal age) as well as in previously 'low risk' pregnancies which had become 'high risk' by virtue of abnormal maternal alpha-fetoprotein (MSAFP) screening. The second two studies evaluated features influencing abortion decisions after the discovery of either chromosomal anomalies, or non-aneuploid ultrasonographically detected structural abnormalities. Data suggested that (1) older and more highly educated women tended to choose CVS over amniocentesis; (2) perceptions of genetic risk within couples was most influenced by attributes of their partners; (3) anxiety and perception of risk was higher in young women having abnormal screening MSAFP, than in the advanced maternal age group although this difference appeared to be commensurate with actual risks; (4) for fetal aneuploidy, the specific karyotype and, to a lesser extent, coexistent structural anomalies are the major determinants of decisions to abort; (5) for euploid fetal structural abnormalities the prognostic severity and potential for beneficial medical intervention (either antenatally or postnatally) as counselled by the physician were the principal determinants influencing abortion decisions. Further study is needed and important questions still to be addressed are discussed.