Determinants associated with making prenatal screening decisions in a national study.

This study sought to evaluate the associations between background exposures and psychological determinants, among postpartum Jewish and Arab women, relative to actual prenatal test endorsement. The independent and aggregative effects of contextual features and the subjective opinions and attitudes relative to a prenatal testing were evaluated, using logistic regressions. After accounting for contextual features, Jews with positive vs. negative opinions on screening were significantly more likely to undergo a prenatal screening. Specifically, having more favourable ideas on pregnancy termination, among Jews, was associated with a greater likelihood of triple test, nuchal translucency and ultrasound uptake as compared with those that refused. Similarly, Arabs who were more inclined to abort the pregnancy had a greater chance of using nuchal translucency and ultrasound vs. those that declined testing. As the preferences for prenatal test outcomes are multifaceted and vary according to population group, a better understanding of the factors involved in making testing choices could help ease the decision-making process. Impact Statement What is already known on this subject? The choice to undergo prenatal screening tests is influenced by various determinants, which include: social, demographic and emotional factors that vary by cultural preferences. Indeed, women integrate (subjective) beliefs and values that extend beyond rational (objective) reasoning when estimating whether or not to undergo testing. It may then be that, prenatal test choices might be, influenced less by actual risk status and more so by emotional factors. And while, the latter are more likely to be amendable, and thus influence changes in perception, the effect of psychological exposures on the decision making process in the genetic testing context, especially among Israeli Jews and Arabs, has been understudied. What the results of this study add? The current study extends the focus by addressing the role of evaluative beliefs and emotional factors involved with formulating prenatal screening judgments relative to actual testing among individuals with diverse profiles (Israeli Jews and Arabs). What was clarified was that background factors and psychological perceptions, such as having supportive attitudes on screening and a willingness to undergo abortion were, for the most part, related to prenatal test uptake. Concomitantly, these involve dense decision-making practices that can be difficult to approximate, as cultural settings and individual preferences often have an impact on intention-to-test. What the implications are of these findings for clinical practice and/or further research? Culturally appropriate counselling that would account for personal preferences alongside actual risk appraisals could enable pregnant women to make informed and autonomous prenatal testing choices. The integration of socio-demographics, psychological correlates and other contextual factors into a theoretical framework, studied uniquely by sub-populations, could enrich future research. Such research can, in turn, provide a clearer picture of the social need for genetic counselling, help customise local interventions, and on a broader scale inform national policy.

Increasing rates of prenatal testing among Jewish and Arab women in Israel over one decade.

UNLABELLED: BACKGROUND/AIMS/OBJECTIVE: This study compared data on the use of prenatal tests offered to pregnant women in Israel as reported in a national survey conducted by the Israel Center for Disease Control in 2001 to data from 2010. METHODS: Mothers of newborns were interviewed 8-72 h after delivery in 29 maternity wards in Israel on May 31, 2010. RESULTS: A total of 768 women were interviewed, 569 (72.3%) were Jewish and 197 (25.7%) were Arabs. Nuchal translucency screening and early ultrasound level 2 were significantly more frequently done in both Jewish and Arab women in 2010 than in 2001. The use of the biochemical triple marker test and amniocentesis did not change. The increased rate of nuchal translucency screening and early ultrasound level 2 was significantly higher among the Jewish women compared to the Arabs (21.5 and 28.0% vs. 2.9 and 13.7% in 2001; 62.0 and 65.6% vs. 30.1 and 30.9% in 2010, respectively). The rates of amniocentesis in the Jewish women aged ≥35 years were 47.6 and 47.5% in 2001 and 2010, respectively; they are significantly higher than among the Arabs (18.5 and 28.5%, respectively). The factors associated with making more use of different prenatal tests were: secularity, a higher income, and supplementary medical insurance for the Jewish women, and supplementary medical insurance and printed information on prenatal testing for the Arabs. CONCLUSIONS: The prenatal testing rates have risen over the last decade in both population groups, but there are still significant gaps. We suggest that public funding of additional prenatal tests may increase their use in both population groups.