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

Authors

  • W. A. Grobman,

    Corresponding author
    1. From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois
    • 333 East Superior St., Suite 410, Chicago, IL 60611.
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  • S. L. Dooley,

    1. From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois
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  • E. E. Welshman,

    1. From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois
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  • E. Pergament,

    1. From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois
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  • E. A. Calhoun

    1. From the Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois
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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. Copyright © 2002 John Wiley & Sons, Ltd.

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