title: Perceived risk of prenatal diagnostic procedure-related miscarriage and Down syndrome among pregnant women.
abstract: OBJECTIVE
  The objective of the study was to identify correlates of perceived risk of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage among a diverse group of pregnant women.
  
  
  METHODS
  We conducted a cross-sectional survey of 1081 English-, Spanish-, or Chinese-speaking women receiving prenatal care in the San Francisco Bay area. Perceived risk of procedure-related miscarriage or carrying a Down syndrome-affected fetus was assessed using a linear rating scale from 0 (no risk) to 1 (high risk). Bivariate and multivariable analyses were used to explore associations between maternal characteristics including age, race/ethnicity, and socioeconomic status and perceived risks of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage.
  
  
  RESULTS
  Women aged 35 years old or older had a higher perceived risk of Down syndrome than younger women (0.28 vs 0.22 on a scale from 0 to 1, P < .001) but a lower perceived risk of a procedure-related miscarriage (0.31 vs 0.36, P = .004). In multivariable linear regression analysis among women younger than age 35 years, the perceived risk of carrying a Down syndrome-affected fetus was higher in women who had not attended college (+0.06, P = .019) or had poor self-perceived health status (+0.08, P = .045). Latinas (+0.11, P = .008), women with an annual income less than $35,000 (+0.09, P = .003), and those who had difficulty conceiving (+0.09, P = .026) had higher perceived procedure-related miscarriage risk. Among women aged 35 years or older, perceived risk of carrying a Down syndrome-affected fetus was associated with the inclination to undergo prenatal diagnosis.
  
  
  CONCLUSIONS
  Women's perceived risks of carrying a Down syndrome-affected fetus or having a procedure-related miscarriage are associated with numerous characteristics that have not been shown to be associated with the actual risks of these events. These perceived risks are associated with prenatal diagnostic test inclination. Understanding patients' risk perceptions and effectively communicating risk is critical to helping patients make informed decisions regarding use of invasive prenatal testing.
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. abcmd@berkeley.edu
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: A Eugene
authors.initials: AE
authors.lastname: Washington
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology*; D000328:Adult; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000009:adverse effects*; D012307:Risk Factors; D011795:Surveys and Questionnaires