title: Procedure-related miscarriages and Down syndrome-affected births: implications for prenatal testing based on women's preferences.
abstract: OBJECTIVE
  To determine how pregnant women of varying ages, races, ethnicities, and socioeconomic backgrounds value procedure-related miscarriage and Down-syndrome-affected birth.
  
  
  METHODS
  We studied cross-sectionally 534 sociodemographically diverse pregnant women who sought care at obstetric clinics and practices throughout the San Francisco Bay area. Preferences for procedure-related miscarriage and the birth of an infant affected by Down syndrome were assessed using the time trade-off and standard gamble metrics. Because current guidelines assume that procedure-related miscarriage and Down syndrome-affected birth are valued equally, we calculated the difference in preference scores for those two outcomes. We also collected detailed information on demographics, attitudes, and beliefs.
  
  
  RESULTS
  On average, procedure-related miscarriage was preferable to Down syndrome-affected birth, as evidenced by positive differences in preference scores for them (time trade-off difference: mean = 0.09, median = 0.06; standard gamble difference: mean = 0.11, median = 0.02; P <.001 for both, one-sample sign test). There was substantial subject-to-subject variation in preferences that correlated strongly with attitudes about miscarriage, Down syndrome, and diagnostic testing.
  
  
  CONCLUSIONS
  Pregnant women tend to find the prospect of a Down syndrome-affected birth more burdensome than a procedure-related miscarriage, calling into question the equal risk threshold for prenatal diagnosis. Individual preferences for those outcomes varied profoundly. Current guidelines do not appropriately consider individual preferences in lower-risk women, and the process for developing prenatal testing guidelines should be reconsidered to better reflect individual values.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, California 94143-0856, USA. kuppermannm@obgyn.ucsf.edu
authors.forename: M
authors.initials: M
authors.lastname: Kuppermann
authors.forename: R F
authors.initials: RF
authors.lastname: Nease
authors.forename: L A
authors.initials: LA
authors.lastname: Learman
authors.forename: E
authors.initials: E
authors.lastname: Gates
authors.forename: B
authors.initials: B
authors.lastname: Blumberg
authors.forename: A E
authors.initials: AE
authors.lastname: Washington
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology / Q000523:psychology*; D001290:Attitude; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D017060:Patient Satisfaction; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis / Q000009:adverse effects* / Q000523:psychology