title: Prenatal diagnosis for women aged 37 years and over: to have or not to have.
abstract: Forty percent of pregnant women aged 37 years and over do not have prenatal diagnosis despite being eligible for a free test. The present study aimed to determine how often, and which, untested women were making a choice about this, how many declined an offer and why. A questionnaire was given to untested women, aged 37 years and over, at no less than 24 weeks gestation. A total of 375 (81.5%) women declined, 72 (16%) were not offered a test and 13 presented too late antenatally. There was a three-fold increased likelihood (OR 3.10 95% CI 1.44, 6.65) of no offer for urban non-English speaking background women, compared with the reference group (metropolitan, English speaking). Unpartnered women were also significantly less likely to receive an offer (OR 3.18, 95% CI 1.19, 8.46). Risk to the baby was the main reason for declining. When offered non-invasive prenatal screening, most decliners of prenatal diagnosis accepted, even those who declined because they were opposed to abortion. We estimate that overall 33% of older pregnant women were being offered and declining amniocentesis and/or chorion villus sampling (CVS). Only 6% were not offered a test, but this small proportion is over-represented by minority groups who must be given equal opportunity to make this choice.
authors.affiliation: Epidemiology and Genetics Unit, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia. halliday@cryptic.rch.unimelb.edu.au
authors.forename: J L
authors.initials: JL
authors.lastname: Halliday
authors.forename: R
authors.initials: R
authors.lastname: Warren
authors.forename: G
authors.initials: G
authors.lastname: McDonald
authors.forename: P L
authors.initials: PL
authors.lastname: Rice
authors.forename: R J
authors.initials: RJ
authors.lastname: Bell
authors.forename: L F
authors.initials: LF
authors.lastname: Watson
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data; D015193:Chorionic Villi Sampling / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007802:Language; D016015:Logistic Models; D017533:Marital Status; D008423:Maternal Age; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis; D012424:Rural Population; D011795:Surveys and Questionnaires; D016312:Treatment Refusal; D014505:Urban Population