Prenatal genetic testing: content of discussions between obstetric providers and pregnant women.
OBJECTIVE
To document the content and accuracy of discussions about prenatal genetic testing between obstetric providers and pregnant women.


METHODS
The first prenatal visits of 169 pregnant women with 21 obstetricians and 19 certified nurse-midwives were audiotaped and analyzed for whether a discussion of family history or genetic testing took place and if so, its length, content, and accuracy.


RESULTS
Family history was discussed in 60% of visits, maternal serum marker screening in 60%, second-trimester ultrasonography for fetal anomalies in 34%, and for women at least 35 years old, amniocentesis or chorionic villus sampling (CVS) in 98%. The length of discussions of genetic testing averaged 2.5 minutes for women younger than 35 years of age and 6.9 minutes for older women. Topics discussed most often were the practical details of testing, the purpose of testing, and the fact that testing is voluntary. Discussions seldom were comprehensive. Obstetricians were more likely to make a recommendation about testing than were nurse-midwives and were less likely to indicate that testing is voluntary. Most women were satisfied with the amount of information, and the majority of women of advanced maternal age had made a decision about amniocentesis or CVS by the end of the visit.


CONCLUSIONS
The information about genetic testing provided in the first prenatal visit is inadequate for ensuring informed autonomous decision-making. Guidelines addressing the content of these discussions should be developed with input from obstetricians, nurse-midwives, genetic counselors, and pregnant women.
Bernhardt
B A
BA
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. bbernhar@welchlink.welch.jhu.edu
Geller
G
G
Doksum
T
T
Larson
S M
SM
Roter
D
D
Holtzman
N A
NA
D000328:Adult; D003142:Communication; D005260:Female; D006580:Genetic Carrier Screening; D005819:Genetic Markers; D005820:Genetic Testing; D006801:Humans; D008487:Medical History Taking; D009721:Nurse Midwives; D009774:Obstetrics; D010353:Patient Education as Topic; D011247:Pregnancy; D011296:Prenatal Diagnosis
D005819:Genetic Markers