title: Who is and isn't having babies with Down syndrome in western Sydney: a ten year hospital cohort study.
abstract: BACKGROUND
  Screening for Down syndrome (DS) is a key component of antenatal care, recommended to be universally offered to women irrespective of age or background. Despite this, the diagnosis of DS is often not made until the neonatal period.
  
  
  OBJECTIVE
  To retrospectively describe and compare the differences in populations with an antenatal diagnosis (AD) and neonatal diagnosis (ND) of DS and to explore why an antenatal diagnosis was not made.
  
  
  METHODS
  The cohorts were women cared for at Westmead Hospital whose pregnancy received a diagnosis of DS between 2006 and 2015. The demographic variables of the AD and ND cohorts were examined and reasons why an antenatal diagnosis was not made in the ND cohort were analysed.
  
  
  RESULTS
  There were 127 diagnoses of DS in the 10-year period, of which 41% were in the ND cohort (n = 52) and 59% in the AD (n = 75). Declaring a religious affiliation rather than Nil Religion was significantly more common in the ND cohort (88.5%) and especially the ND sub-cohort who declined DS screening/testing (95.8%) than the AD cohort (72%, P < 0.05). Women who were not offered screening were significantly younger (P < 0.001) than those who were, with 69% and 20% being ≤30 years, respectively.
  
  
  CONCLUSIONS
  The proportion of DS pregnancies diagnosed in the antenatal period in western Sydney could be increased by ensuring younger women are not falsely reassured that DS screening is unnecessary for them. While religious affiliation may be a factor when women decline screening, ensuring appropriate counselling remains important.
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Moses
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: James H W
authors.initials: JH
authors.lastname: Brown
authors.affiliation: Department of Cytogenetics, Sydney Genome Diagnostics, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Dale C
authors.initials: DC
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Hayley
authors.initials: H
authors.lastname: Diplock
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Melov
authors.affiliation: Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.|Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Therese Mary
authors.initials: TM
authors.lastname: McGee
mesh_terms: D000328:Adult; D000367:Age Factors; D004314:Down Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D009517:New South Wales / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period; D010818:Practice Patterns, Physicians'; D011296:Prenatal Diagnosis; D012067:Religion; D012189:Retrospective Studies
keywords: Down syndrome; antenatal screening; prenatal diagnosis; trisomy 21