Preference assessment of prenatal diagnosis for Down syndrome: is 35 years a rational cutoff?
OBJECTIVE
To compare the perceptions of miscarriage and birth of a child with Down syndrome among pregnant women and to evaluate the implications of these preferences for the traditional 35-year old maternal age risk boundary.


METHODS
An interviewer-administered survey was given to 186 pregnant women receiving antepartum care at a university hospital. Preferences, as reflected by utilities, for birth of a child with Down syndrome and pregnancy miscarriage, stratified by patient characteristics, were assessed.


RESULTS
The utility for the birth of a child with Down syndrome decreased (p < 0.001) as clinical severity increased from mild (0.78) to severe (0.65). Miscarriage of a pregnancy had a mean utility of 0.76 +/- 0.31. Women who desired prenatal diagnosis had a utility value for miscarriage (0.79 +/- 0.28) that was significantly higher than for the birth of a child with Down syndrome of unknown severity (0.73 +/- 0.27). In multivariable logistic regression, desire for prenatal diagnosis was the only factor associated with a preference of miscarriage over birth of an affected child (odds ratio 2.26, 95% confidence interval 1.03, 4.96).


CONCLUSIONS
Women who desire prenatal diagnosis do not perceive the birth of a child with Down syndrome and a pregnancy miscarriage to be equivalent health states. This finding calls into question the rationale of the 35-year-old maternal age criterion and suggests that actual patient preferences should be better incorporated into the decision to offer definitive prenatal diagnosis.
Grobman
W A
WA
Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois, USA. w-grobman@northwestern.edu
Dooley
S L
SL
Welshman
E E
EE
Pergament
E
E
Calhoun
E A
EA
D000022:Abortion, Spontaneous / Q000209:etiology / Q000523:psychology; D000328:Adult; D002755:Choice Behavior; D004314:Down Syndrome / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D008423:Maternal Age; D017060:Patient Satisfaction; D011247:Pregnancy; D018566:Pregnancy, High-Risk / Q000523:psychology*; D011296:Prenatal Diagnosis / Q000009:adverse effects / Q000523:psychology*; D011788:Quality of Life