title: Integrating Microarrays into Routine Prenatal Diagnosis: Determinants of Decision Making.
abstract: OBJECTIVE
  The explosion in genetic technologies, including array comparative genomic hybridization (aCGH), has increased the complexity of genetic counseling. We now offer chorionic villus sampling (CVS) and aCGH to all first-trimester patients, as this allows the prenatal diagnosis of an additional 1% of anomalies not otherwise detectable and can detect genetic copy number variants at a much higher resolution than conventional cytogenetics. Here, we explored some of the determinants of how patients are deciding to use or not use this new technology and evaluate risk-benefit analyses for that decision.
  
  
  METHODS
  This is a retrospective case-control study of singleton and multiples pregnancies at our center. Those having aCGH testing along with CVS were defined as 'testers' and those who declined aCGH but had the CVS were 'nontesters'.
  
  
  RESULTS
  Demographic data of 181 educated women who chose CVS were compared. Among those carrying singletons (n = 144), older women, defined as over 35 years of age (or 'advanced maternal age'; AMA), were more likely to choose the aCGH than younger women. Further, women who had a prior history of genetic testing and who wanted to know the gender of the fetus were more likely to choose the aCGH test. In women carrying multiples (n = 37), AMA ceases to be a predictor of choice. Having had prior genetic counseling remains a strong predictor for choosing aCGH, as does wanting to know the gender of the fetus. Neither prior abortions nor having prior children were significant for women carrying singletons or multiples.
  
  
  CONCLUSIONS
  Offering pregnant couples an individualized choice regarding aCGH seems an appropriate approach. There are discrete patterns associated with the choice of taking the aCGH that varied depending on whether the patient was carrying a singleton or multiples.
authors.affiliation: Comprehensive Genetics, New York University Langone Medical Center, New York, N.Y.,USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: Cordoba
authors.forename: Stephanie
authors.initials: S
authors.lastname: Andriole
authors.forename: Shara M
authors.initials: SM
authors.lastname: Evans
authors.forename: David
authors.initials: D
authors.lastname: Britt
authors.forename: Melissa
authors.initials: M
authors.lastname: Chu Lam
authors.forename: Mark I
authors.initials: MI
authors.lastname: Evans
mesh_terms: D000328:Adult; D000649:Amniocentesis; D015193:Chorionic Villi Sampling; D000066491:Clinical Decision-Making; D055028:Comparative Genomic Hybridization / Q000706:statistics & numerical data; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis / Q000523:psychology / Q000639:trends*; D012189:Retrospective Studies