title: Parent preferences and prenatal testing for neural tube defects.
abstract: Previous analyses of prenatal screening for neural tube defects have generally found benefits to exceed costs. The usual screening battery follows an elevated maternal serum alpha-fetoprotein level with high-resolution ultrasound and/or amniocentesis. Current thinking focuses on weighing the risk of a false-negative (an abnormality missed) against the risk of an amniocentesis-induced fetal loss. This thinking neglects the risk of a false-positive (an unaffected fetus labeled abnormal) and individual parents' preferences concerning a false-negative vs a fetal loss. With these risks included, we find that high-resolution ultrasound is appropriate for all women with elevated serum alpha-fetoprotein. Women with moderately elevated serum alpha-fetoprotein who have negative ultrasound scans need no further testing, nor do women with highly elevated serum alpha-fetoprotein and positive ultrasound scans. Further testing using amniocentesis to confirm the ultrasound result is appropriate for women with moderately elevated serum alpha-fetoprotein and positive ultrasound scans, and for women with highly elevated serum alpha-fetoprotein and negative ultrasound scans. The actual cutoffs defining normal, moderately elevated, and highly elevated serum alpha-fetoprotein depend on several parameters, particularly the underlying prevalence of neural tube defects and the parents' preferences.
authors.affiliation: Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1063.
authors.forename: F K
authors.initials: FK
authors.lastname: Ennever
authors.forename: L B
authors.initials: LB
authors.lastname: Lave
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D018803:Models, Economic; D009436:Neural Tube Defects / Q000175:diagnosis*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics / Q000523:psychology; D016216:Ultrasonography, Prenatal / Q000191:economics / Q000523:psychology; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins