title: Prenatal screening, diagnosis, and termination of pregnancy in First Nations and rural women.
abstract: OBJECTIVE
  The objectives of the study were to assess differences in utilization of maternal serum screening (MSS) and prenatal diagnostic testing between population subgroups and to determine the impact on chromosomal anomaly birth rates.
  
  
  METHODS
  This population-based cohort study included all female residents from Saskatchewan, Canada, who delivered a baby, experienced a fetal loss, or had a pregnancy termination between 2000 and 2005. In total, 93 171 women were included in the study dataset, with a subset (n = 35 527) evaluated to identify predictors of screening and diagnostic testing. Incidence and live birth prevalence of Down syndrome were compared across populations.
  
  
  RESULTS
  MSS uptake was lower in First Nations (FN) women (9.6% vs 28.4%), and living in a rural health region moderated the difference (p < 0.001). Consequently, fewer chromosomal anomalies were prenatally diagnosed in FN women than in the rest of the population (8.3% vs 27%). Terminations of pregnancy for fetal anomaly occurred at a lower frequency amongst FN women (0.64 vs 1.34, per 1000 pregnancies), resulting in a smaller effect on Down syndrome birth rates.
  
  
  CONCLUSIONS
  Utilization of MSS and diagnostic testing was lower in FN and rural populations. Further research will be necessary to understand the relevance of value preferences and access barriers. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada. brandy.winquist@usask.ca.
authors.forename: Brandace
authors.initials: B
authors.lastname: Winquist
authors.affiliation: Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Nazeem
authors.initials: N
authors.lastname: Muhajarine
authors.affiliation: Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Ogle
authors.affiliation: Midwifery Services, Saskatoon Heath Region, Saskatoon, Canada.
authors.forename: Debbie
authors.initials: D
authors.lastname: Mpofu
authors.affiliation: Department of Pathology, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Lehotay
authors.affiliation: Saskatchewan Health Quality Council, Saskatoon, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Teare
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis*; D004314:Down Syndrome / Q000208:ethnology; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D062145:Maternal Serum Screening Tests / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population / Q000706:statistics & numerical data*; D012525:Saskatchewan / Q000453:epidemiology