Countrywide Variables Associated With the Reduction of Fetuses With Down Syndrome

Area of Science:

• Public Health
• Genetics
• Health Economics

Background:

• Prenatal screening for Down syndrome (DS) has become more accessible globally.
• Macroeconomic policies influence healthcare access and outcomes, including reproductive health choices.
• Understanding the impact of policy on DS birth rates is crucial for public health planning.

Purpose of the Study:

• To analyze the association between macroeconomic policy decisions and live births with Down syndrome (DS).
• To model the impact of prenatal screening availability and reimbursement on the DS reduction percentage.
• To identify factors influencing the rate of selective termination for DS pregnancies.

Main Methods:

• Log-odds of DS live birth reduction were estimated using maternal age-based prevalence models and birth data.
• Regression analysis predicted log-odds using variables: screening availability/reimbursement, maternal age, Gross National Income (GNI) per capita, and country effects.
• Least squares regression with robust standard errors and model validation were employed.

Main Results:

• A significant increase in the DS reduction percentage (OR=3.24, p=0.0001) was observed when moving from no screening to available and reimbursed serum screening.
• Policy shifts could increase DS reduction rates from 5% to 15%, 25% to 52%, and 50% to 76%.
• Higher maternal age and GNI per capita were associated with increased DS reduction percentages.

Conclusions:

• Expanding prenatal screening availability and reimbursement policies demonstrably reduces live births with Down syndrome.
• Macroeconomic factors, including national income, play a role in the effectiveness of DS screening programs.
• Policy interventions aimed at increasing prenatal screening access can lead to fewer live births with DS.