Document Detail

Uptake of prenatal screening for chromosomal anomalies: impact of test results in a previous pregnancy.
MedLine Citation:
PMID:  12478639     Owner:  NLM     Status:  MEDLINE    
AIM: To assess whether the uptake of prenatal screening for trisomy 21 in a subsequent pregnancy is influenced by being classified in the 'increased risk' or 'not at increased risk' group in the first pregnancy. SETTING: District General Hospital Maternity Unit. METHODS: Amongst a group of women attending for maternity care at this hospital, the maternity records were examined to find women having at least two pregnancies. Any prenatal screening record for each pregnancy was retrieved from the prenatal screening database. Prenatal screening for trisomy 21 was by a combination of maternal serum alpha-fetoprotein (AFP) and free beta-human chorionic gonadotrophin (beta-hCG) in the second trimester and by maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency (NT) thickness in the first trimester. Women were stratified according to their trisomy 21 risk into an 'increased risk' group (1: <250 in the second trimester and 1: <300 in the first trimester) or 'not at increased risk' group based on their first pregnancy. In a second pregnancy, the records were examined to see if the mother accepted prenatal screening in the second pregnancy. The rate of acceptance of screening in a subsequent pregnancy, depending on whether 'at increased risk' or 'not at increased risk' in the first pregnancy, was examined using chi square tests. RESULTS: In the second trimester study, 4601 women were identified with two pregnancies during the study period. Of these, 4559 women had prenatal screening in a subsequent pregnancy. Initially, 273 women were identified in the high-risk group, and of these 252 (92.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 4307 of 4328 (99.5%) women in the low-risk group. In the first trimester study, 1077 women were identified with two pregnancies during the study period. Of these, 1072 had prenatal screening in a subsequent pregnancy. Initially, 60 women were identified in the high-risk group, and of these 56 (93.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 1016 of 1017 (99.9%) in the low-risk group. Statistically, there was no difference between the rate of declining prenatal screening in a second pregnancy amongst those in the high-risk group in a first pregnancy or those in the low-risk group (p = 0.429 for second trimester screening and p = 0.794 for first trimester screening). Similarly, no difference could be demonstrated between rates when screening in the first or second trimester (p = 0.961) for those in the high-risk group. CONCLUSION: Despite the understandable anxiety associated with being identified in the high-risk group (as a false positive finding) in a previous pregnancy, this did not seem to deter women from accepting prenatal screening in a subsequent pregnancy.
Kevin Spencer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Prenatal diagnosis     Volume:  22     ISSN:  0197-3851     ISO Abbreviation:  Prenat. Diagn.     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-12-12     Completed Date:  2003-06-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8106540     Medline TA:  Prenat Diagn     Country:  England    
Other Details:
Languages:  eng     Pagination:  1229-32     Citation Subset:  IM    
Copyright Information:
Copyright 2002 John Wiley & Sons, Ltd.
Prenatal Screening Unit, Clinical Biochemistry Dept, Harold Wood Hospital, Gubbins Lane, Romford, RM3 0BE, UK.
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MeSH Terms
Biological Markers / blood*
Chorionic Gonadotropin, beta Subunit, Human / blood
Down Syndrome / diagnosis*
Mass Screening / statistics & numerical data,  utilization*
Neck / embryology,  ultrasonography
Patient Acceptance of Health Care / psychology*,  statistics & numerical data
Pregnancy / blood
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pregnancy-Associated Plasma Protein-A / analysis
Prenatal Diagnosis / statistics & numerical data,  utilization*
Treatment Refusal
alpha-Fetoproteins / analysis
Reg. No./Substance:
0/Biological Markers; 0/Chorionic Gonadotropin, beta Subunit, Human; 0/alpha-Fetoproteins; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A
Comment In:
Prenat Diagn. 2003 Jul;23(7):599; author reply 599-600   [PMID:  12868092 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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