Prenatal testing for limb reduction defects. How patients' views affect their choice of CVS

To determine the effect of reports and media coverage on chorionic villus sampling (CVS) and limb reduction defects (LRD) on patients' utilization of CVS for prenatal testing for advanced maternal age and to quantitate the relation of preferences for CVS and amniocentesis (AMN) outcomes to test utilization.

We compared CVS and AMN utilization rates in two groups of women seen at one academic medical center before and after publicity concerning CVS and LRD. We measured preferences, in rating-scale units, for potential outcomes of prenatal testing in the after-publicity group. Relationships between preferences and CVS utilization were examined using multivariate methods.

The proportion of women utilizing CVS for prenatal testing declined significantly for the after-publicity group (23%) as compared with the prepublicity group (47.4%, P = .0001). Belief that the birth of a child with LRD after CVS was worse than a similar birth after AMN significantly reduced the odds of choosing CVS. A decrement in preference for a child with LRD after CVS of 5 rating-scale units reduced the likelihood of CVS by 15% (confidence interval [CI], 1-28%); a decrement of 10 units reduced the likelihood of CVS by 28% (CI, 1-48%). This effect persisted after adjustment for demographic and obstetric covariates, prior prenatal testing, locus of decision making (patient versus physician or shared) and other maternal preferences for outcomes of prenatal testing.

Lower patient preference for a child with LRD after CVS was an independent predictor of choosing AMN over CVS and was probably responsible for the significant decrease in CVS utilization at our hospital.