title: Antenatal care implications of population-based trends in Down syndrome birth rates by rurality and antenatal care provider, Queensland, 1990-2004.
abstract: OBJECTIVE
  To assess whether the rates of Down syndrome births in Queensland vary according to rurality (ie, whether the mother lives in a rural or urban area) and type of antenatal care provider, and to consider any implications for antenatal care.
  
  
  METHODS
  Population-based study of Down syndrome births in Queensland between 1990 and 2004, stratified by rurality and type of antenatal care provider (private obstetrician, public hospital or shared care).
  
  
  RESULTS
  Since 2000, there has been a large fall in maternal-age-adjusted rates of Down syndrome births among mothers living in urban areas (-14.3% per year; 95% CI, -22.7%, -5.0%) and among mothers receiving their antenatal care from private obstetricians (-27.5% per year; 95% CI, -37.6%, -15.8%). Similar decreases have not occurred among mothers living in rural areas (0.0%; 95% CI, -11.7%, 13.1%) or among mothers receiving antenatal care from public hospitals (+2.9%, 95% CI, -10.3%, 17.9%).
  
  
  CONCLUSIONS
  Possible reasons for the observed trends include unequal access to antenatal screening; confusion about screening guidelines and protocols; late presentation for antenatal care; and differences in attitudes to screening and termination of pregnancy among expectant parents, such that they may choose not to have screening or not to act on a positive screening test result.
authors: School of Population Health, University of Queensland, Brisbane, QLD, Australia. m.coory@uq.edu.au
authors: Michael D
authors: MD
authors: Coory
authors: Timothy
authors: T
authors: Roselli
authors: Heidi J
authors: HJ
authors: Carroll
mesh_terms: D000328:Adult; D001723:Birth Rate; D004314:Down Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011296:Prenatal Diagnosis; D011793:Queensland / Q000453:epidemiology; D012424:Rural Population; D014505:Urban Population