Inclusion of adoption as a pregnancy management option in prenatal genetic counseling practice

The current study assessed prenatal genetic counselors' experiences, comfort levels, and preparedness in discussing adoption as a pregnancy management option following a prenatal diagnosis of a non-life-limiting anomaly and/or genetic condition. This study also evaluated factors influencing adoption counseling and characterized adoption-specific education in genetic counseling program (GCP) curricula, serving as an updated review since the landscape of adoption education in GC practice was last characterized over a decade ago, which revealed substantial variability in both adoption-specific education in genetic counseling program (GCP) curricula and the discussion of pregnancy management options with patients in prenatal practice. An anonymous online survey was distributed to board-certified/eligible genetic counselors with prenatal experience in the U.S. and Canada (N = 148). Quantitative and qualitative data were analyzed using descriptive statistics, and statistical tests including Mann-Whitney U, Kruskal-Wallis, Fisher's exact, and multivariable ordinal logistic models (StataCorp, 2021) to determine statistical significance (p < 0.05). Only 32% of participants reported adoption-specific education in their GCP curriculum. Counselors were least comfortable discussing adoption (80% somewhat/very comfortable) compared to abortion (94%) and parenting (97%). Comfort levels increased with years of experience (OR = 1.12, 95% CI [1.06-1.19]) and when certain adoption resources were identified in prenatal practice (e.g., agencies, support groups). Key factors influencing frequency of adoption discussions included direct patient inquiries (91%) and abortion restrictions in restrictive U.S. states (p < 0.001). The study's findings highlighted a persistent lack of adoption-specific educational opportunities and discomfort with counseling on adoption as a pregnancy management option. Therefore, targeted training, particularly experiential learning (e.g., patient panels, guest lecturers), and identification of adoption resources that were associated with higher comfort levels counseling on adoption should be implemented to improve balanced options counseling for patients following prenatal detection of a non-life-limiting anomaly or genetic diagnosis.