Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and...

Area of Science:

• Medical Ethics
• Obstetrics and Gynecology
• Public Health Policy

Background:

• Physicians' clinical decisions are influenced by funding policies and medico-legal environments.
• Maternal age is a key factor in Down syndrome (DS) risk assessment during prenatal screening.

Purpose of the Study:

• To evaluate how maternal age and government funding affect obstetrician/gynecologist recommendations for invasive prenatal testing (amniocentesis) for Down syndrome (DS).
• To assess the association between these recommendations and physicians' perceived risk of medical malpractice liability.

Main Methods:

• A questionnaire was completed by 171 Israeli physicians.
• Physicians provided amniocentesis recommendations for two identical scenarios of women at 18 weeks gestation with normal preliminary screening results, differing only in maternal age (28 vs. 37 years).

Main Results:

• Amniocentesis recommendations significantly differed based on maternal age: 6.4% recommended for the 28-year-old vs. 40.9% for the 37-year-old. Conversely, 31.6% declined for the younger woman versus 7.0% for the older.
• Approximately half of physicians varied their recommendations between scenarios, with 65.6% recommending amniocentesis for the 37-year-old regardless of test results.
• Physicians with higher perceived malpractice liability risk were more likely to vary recommendations based on maternal age.

Conclusions:

• Physician recommendations for amniocentesis are influenced by maternal age, even when age is already factored into Down syndrome risk calculations.
• The perceived risk of malpractice liability may introduce a spurious influence on physicians' recommendations for invasive prenatal testing.
• Clinical decision-making in prenatal diagnostics is potentially skewed by medico-legal considerations beyond established risk factors.