• Vol. 44 No. 2
  • 15 February 2015

Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?

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ABSTRACT

Introduction: Aneuploidy screening is widely practised in the field of obstetrics in current times. This study thus aims to gain an insight on pregnant women’s knowledge and risk perception of Down syndrome and first trimester screening (FTS), as well as their views on various potential pregnancy outcomes and how these may affect their decision-making processes.

Materials and Methods: A cross-sectional questionnaire-based qualitative study of consecutive 50 women choosing to undergo FTS at KK Women’s and Children’s Hospital (KKH), Singapore was conducted. The women completed a questionnaire after their FTS pretest counselling session. Basic knowledge of Down syndrome and FTS as well as participants’ risk perception with regards to various cut-off values used in FTS were examined. Patients’ views of various potential pregnancy outcomes were also studied.

Results: : Most patients had good retention and comprehension of what FTS entailed after a FTS counselling session at the KKH Antenatal Monitoring Clinic. However, knowledge of the risks of invasive diagnostic testing was poor. Patients also did not possess an adequate understanding of FTS risk values. With regards to risk perception, patients had very different views on acceptable pregnancy outcomes and what constituted a high-risk FTS value to them personally. A significant number of women were concerned even at medically low-risk values of 1:500 and 1:1000 in FTS. The majority of patients viewed highest detection rate followed by a lowest false positive rate as the more important factors impacting their choice of a Down syndrome screening test.

Conclusion: This study demonstrates the diversity of pregnant women’s risk perception, risk aversion and participation in decision processes when there are 2 different values in competition. The study also highlights our patients’ gaps in knowledge and lack of understanding of risk values used in FTS.


The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers, namely beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein A (PAPP-A), at 11 to 13+6 weeks gestation to determine one’s risk of having a pregnancy with aneuploidies and a broader range of pregnancy disorders. Since its introduction, many developed nations around the world have been offering this screening test to pregnant women as part of routine antenatal care, with many patients choosing to undergo it. However, there is relatively little published knowledge on whether these patients understand their own motivations for choosing to undergo the test, and the potential impact of the results of the screening test on their pregnancy, be it emotionally in terms of anxiety regarding the results, or physically if invasive diagnostic testing is done following a high-risk FTS. In addition, we also recognise that as individuals, one’s perception of risk may differ from another, and as such, their decision-making processes and preferences may differ accordingly as well.

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