Factors determining uptake of invasive testing following first-trimester combined testing

• Published in: Prenatal diagnosis Vol. 33; no. 4; pp. 328 - 333
• Main Authors: Lichtenbelt, Klaske D., Schuring-Blom, G. Heleen, van der Burg, N., Page-Christiaens, Godelieve C. M. L., Knoers, Nine V., Schielen, Peter C. J. I., Koster, Maria P. H.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-04-2013; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Confidence intervals; Down syndrome; Down Syndrome - diagnosis; Female; Health risk assessment; Humans; Middle Aged; Patient Acceptance of Health Care - psychology; Pregnancy; Pregnancy Trimester, First - psychology; Prenatal Diagnosis - psychology; Young Adult
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.4067

ABSTRACT
Objective
This study aims to analyze differences in characteristics between women who opted for invasive testing after first‐trimester combined testing and those who did not.
Method
Follow‐up was performed in 20 215 combined tests conducted between 2007 and 2011 in the central region of the Netherlands. Multivariate logistic regression analysis compared variables (Down syndrome risk estimate, maternal age, previous Down syndrome pregnancy, IVF/ICSI, parity and nuchal translucency measurement) between different groups.
Results
65.4% of women with a Down syndrome risk estimate ≥1 in 200 opted for invasive 49 testing. In a multivariate model, women opting for invasive testing were significantly younger (odds ratio 0.92; 95% confidence interval 0.88–0.95) and less likely to have had IVF/ICSI (odds ratio 0.57; 95% confidence interval 0.37–0.87) than women opting out on invasive testing. In this high risk group, women <36 years opted for invasive testing more frequently, regardless of their Down syndrome risk estimate magnitude. Women ≥36 years let the magnitude of the risk estimate count significantly in their decision to opt for invasive testing.
Conclusion
Because of the dissimilarity in the offer of prenatal screening and invasive diagnosis in the Dutch prenatal screening policy, women <36 years and women >36 years make different choices when confronted with similar Down syndrome risk estimates. © 2013 John Wiley & Sons, Ltd.
What's already known about this topic?
Not all women with an increased risk at first‐trimester Down syndrome screening opt for invasive testing.
What does this study add?
Women are less likely to opt for invasive testing with an increasing maternal age and in pregnancies after assisted reproduction.
Only in women ≥36 years was the magnitude of the risk estimate positively correlated with the percentage of women opting for invasive testing.