Attitudes of pregnant women and male partners towards non-invasive prenatal testing and widening the scope of prenatal screening.

Non-invasive prenatal testing (NIPT) and its potential to test for multiple disorders has received much attention. This study explores attitudes of women and men towards NIPT, and their views on widening the scope of prenatal testing in a country with a low uptake of prenatal screening (The Netherlands). Five focus groups with low-risk pregnant women (n=28), three focus groups with men (n=19) and 13 interviews with high- and low-risk pregnant women were conducted. Participants felt that current prenatal screening has great disadvantages such as uncertain results and risk of miscarriage from follow-up diagnostics. Characteristics of NIPT (accurate, safe and early testing) could therefore diminish these disadvantages of prenatal screening and help lower the barrier for participation. This suggests that NIPT might allow couples to decide about prenatal testing based mostly on their will to test or not, rather than largely based on fear of miscarriage risk or the uncertainty of results. The lower barrier for participation was also seen as a downside that could lead to uncritical use or pressure to test. Widening the scope of prenatal testing was seen as beneficial for severe disorders, although it was perceived difficult to determine where to draw the line. Participants argued that there should be a limit to the scope of NIPT, avoiding testing for minor abnormalities. The findings suggest that NIPT could enable more meaningful decision-making for prenatal screening. However, to ensure voluntary participation, especially when testing for multiple disorders, safeguards on the basis of informed decision-making will be of utmost importance.

Does offering prenatal screening influence pregnant women's attitudes regarding prenatal testing?

OBJECTIVES: This study aims to find out whether offering prenatal screening for Down syndrome and neural tube defects influences pregnant women's attitudes toward having a screening test. METHODS: Women were randomised into a group that was offered prenatal screening and a group that was not offered screening (controls). Both groups completed questionnaires before screening was offered, after the offer (not the control group), and in the last trimester of pregnancy. RESULTS: Women with a neutral attitude at baseline who accepted the screening test had a more positive attitude, decliners became more negative and the attitude of the control group did not change. CONCLUSION: Offering prenatal screening triggers a change in some pregnant women's attitude regarding prenatal testing. This instability of women's attitudes may pose a problem for determining whether some women made an informed choice.

Does offering and performing prenatal screening influence women's attachment to their unborn child? A longitudinal randomized controlled trial.

OBJECTIVE: The question addressed was: Does offering prenatal screening and receiving a negative screening outcome influence women's attachment to their unborn child? METHODS: Women were offered a nuchal translucency measurement, maternal serum screening, or no screening at all in a randomized controlled trial. Attachment was measured by a self-developed questionnaire at four points in time: before screening was offered, after the offer, after receiving the negative screening result (or at comparable points in time) and in the last trimester of pregnancy. In the last trimester, the Prenatal Attachment Inventory was also filled in. RESULTS: Women who had been offered screening (n = 1031) showed more attachment (F(1,1415) = 19.42, p < .001) compared to women who had not been offered screening (n = 387). This difference disappeared later in pregnancy. At all points in time, negatively screened women (n = 466) had equal levels of attachment compared to screening decliners (n = 565). No difference was observed between women who received a negative result of the ultrasound screening (n = 285) as compared to the blood screening (n = 162). CONCLUSION: Offering prenatal screening seems to temporarily increase attachment. However, this difference is very small. Attachment is not influenced by whether a blood screening or an ultrasound screening is performed.

Are counsellors' attitudes influencing pregnant women's attitudes and decisions on prenatal screening?

OBJECTIVES: It is generally recognised that choices concerning treatment or screening should be people's own, autonomous decisions. However, in the context of genetic counselling, many studies found that counsellors deviate from nondirectiveness, or that subjective norm influences behaviour. The present study aimed to investigate whether prenatal counsellors (midwives, gynaecologists) influence pregnant women's decisions and their attitudes regarding prenatal screening. It was hypothesised that uptake rates and attitudes would be associated with the counsellor's attitude toward prenatal screening. METHODS: Pregnant women attending their midwifery or gynaecology practice were asked to fill out postal questionnaires before and after they were offered prenatal screening for Down syndrome. Their prenatal counsellors also filled in a questionnaire. These questionnaires assessed attitudes toward prenatal screening and background variables. The study sample consisted of 945 pregnant women, being guided by 97 prenatal counsellors. RESULTS: Multilevel regression analyses revealed that neither uptake rates, nor attitude toward prenatal screening were significantly predicted by counsellors' attitudes toward prenatal screening. CONCLUSION: It is suggested that the advice these pregnant women were reported to have received, should rather be interpreted as an indication of shared decision-making and social support than of social pressure and undesired influence.

Does prenatal screening influence anxiety levels of pregnant women? A longitudinal randomised controlled trial.

OBJECTIVES: Questions addressed are: (1) Does offering prenatal screening increase anxiety? (2) Does receiving a negative screening result make women less anxious and does a positive screening result make women more anxious? (3) What are the long-term consequences on anxiety of offering screening and receiving a screening result? METHODS: Women were offered prenatal screening or no screening in a randomised controlled trial. State anxiety (STAI) and child-related anxiety (PRAQ-R) were measured. Questionnaires were filled in before prenatal screening was offered (T1), after the offer (T2), after the test result (T3), and in the third trimester of pregnancy (T4). RESULTS: Child-related anxiety levels were higher in women who chose to be screened compared to women who declined screening. Offering prenatal screening did not lead to increased anxiety levels. General anxiety increased in positively screened women, but decreased later in pregnancy. Women who were negatively screened or declined screening scored lower than the control group. CONCLUSION: For most women, offering prenatal screening and receiving the test result do not adversely affect anxiety. Giving pregnant women a choice to have prenatal screening done seems to have a small favourable effect on general feelings of anxiety.

Accepting or declining the offer of prenatal screening for congenital defects: test uptake and women's reasons.

OBJECTIVES: Prenatal screening for Down syndrome has become standard practice in many western countries. In the Netherlands, however, prenatal screening tests for congenital defects are not offered routinely. The present study aims to assess test uptake in a large, unselected population of pregnant women, and to give more insight into the decision for or against prenatal screening through nuchal translucency measurement or maternal serum screening. PATIENTS AND METHODS: The study is part of a randomized controlled trial with two groups, each being offered a different prenatal screening test, and a control group. Pregnant women received postal questionnaires at three stages of their pregnancy. RESULTS: Of the women being offered the nuchal translucency measurement or the second trimester maternal serum test, 53 and 38% respectively accepted the test offer. The main reasons for accepting were 'gaining knowledge about the health of the foetus/curiosity' (50%), 'favourable characteristics of the screening test' (18%), and 'increased risk of having a child with DS' (15%). The main reasons for declining were 'unfavourable characteristics of the screening test' (42%), 'not applicable/not necessary' (35%), 'anxiety/uncertainty' (36%), 'adverse characteristics of the invasive tests' (32%), and 'being against abortion' (15%). DISCUSSION: The uptake of prenatal screening was relatively low, and different distributions of reasons were reported, compared to other studies. These differences may be due to the specific Dutch situation in which prenatal screening is not part of standard prenatal care. The question arises as to whether informed decision-making would be reduced if prenatal screening became routinised.