Preference assessment of prenatal diagnosis for Down syndrome: Is 35 years a rational cutoff?

W. A. Grobman, S. L. Dooley, E. E. Welshman, E. Pergament, E. A. Calhoun

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

Objective: To compare the perceptions of miscarriage and birth of a child with Down syndrome among pregnant women and to evaluate the implications of these preferences for the traditional 35-year old maternal age risk boundary. Methods: An interviewer-administered survey was given to 186 pregnant women receiving antepartum care at a university hospital. Preferences, as reflected by utilities, for birth of a child with Down syndrome and pregnancy miscarriage, stratified by patient characteristics, were assessed. Results: The utility for the birth of a child with Down syndrome decreased (p < 0.001) as clinical severity increased from mild (0.78) to severe (0.65). Miscarriage of a pregnancy had a mean utility of 0.76 ± 0.31. Women who desired prenatal diagnosis had a utility value for miscarriage (0.79 ± 0.28) that was significantly higher than for the birth of a child with Down syndrome of unknown severity (0.73 ± 0.27). In multivariable logistic regression, desire for prenatal diagnosis was the only factor associated with a preference of miscarriage over birth of an affected child (odds ratio 2.26, 95% confidence interval 1.03, 4.96). Conclusion: Women who desire prenatal diagnosis do not perceive the birth of a child with Down syndrome and a pregnancy miscarriage to be equivalent health states. This finding calls into question the rationale of the 35-year-old maternal age criterion and suggests that actual patient preferences should be better incorporated into the decision to offer definitive prenatal diagnosis.

Original languageEnglish (US)
Pages (from-to)1195-1200
Number of pages6
JournalPrenatal Diagnosis
Volume22
Issue number13
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

Keywords

  • Preference assessment
  • Prenatal diagnosis
  • Utilities

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Genetics(clinical)

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