The effectiveness of genetic counselling for neural-tube malformations

A total of 160 couples who, between 1967 and 1974, had had genetic counselling because of neural-tube malformations in a previous pregnancy were later interviewed in their homes to assess the effectiveness of the counselling. In the earlier years, few couples in which the husband was in a manual occupation came for counselling, but latterly the proportion increased. Most couples seen together for counselling acted appropriately on the risks given, but only when very high or low risks were given were these remembered accurately. Both accurate recall and appropriate action tended to be compromised by poor preparation of the couple for counselling, by too early a consultation after the birth of an abnormal child, by survival of the child, or by psychiatric illness. Before prenatal diagnostic tests became available, few couples embarked on further pregnancies, but more recently half the couples started a further pregnancy within one year and only one in five couples decided against having more children. It is concluded that couples at risk should be persuaded to seek counselling, and be better prepared for it beforehand, that counselling should not take place too soon after the birth, and that there should be later follow-up. Couples should be seen together, and a non-directive approach usually should be adapted. More public education would help to bring the service to more of the families most in need of it.