Determinant of Prenatal Diagnostic Testing among Women with Increased Risk of Fetal Aneuploidy and Genetic Disorders

Tamandra Morgan; Catherine D. Tan; Micaela Della-Torre; Tia Jackson-Bey; Laura DiGiovanni; Christopher A. Enakpene

doi:10.1055/a-1692-0309

American Journal of Perinatology, Table of Contents

CC BY-NC-ND 4.0 · Am J Perinatol 2024; 41(04): 470-477
DOI: 10.1055/a-1692-0309

Original Article

Determinant of Prenatal Diagnostic Testing among Women with Increased Risk of Fetal Aneuploidy and Genetic Disorders

Tamandra Morgan

¹Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California

,

Catherine D. Tan

²Department of Obstetrics and Gynecology, Advocate Illinois Masonic Medical Center, Chicago, Illinois

,

Micaela Della-Torre

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beacon Memorial Hospital, South Bend Indiana

,

Tia Jackson-Bey

⁴Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, New York

,

Laura DiGiovanni

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beacon Memorial Hospital, South Bend Indiana

,

Christopher A. Enakpene

⁵Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, Texas Tech University Health Sciences Center, Permian Basin, Texas

› Author Affiliations

Abstract

Objective This study aimed to assess factors that influence patients' decisions in accepting prenatal diagnostic testing following genetic counseling for increased risk of fetal aneuploidy.

Methods This is a retrospective cohort study of women at increased risk of fetal aneuploidy and genetic disorders who had genetic counseling from January 2012 to December 2016 at a single academic center. Demographics, indications for genetic counseling, and rates of diagnostic testing were collected and compared between those who accepted diagnostic testing and those who chose cell free DNA. The variables were analyzed using Chi-square, Fisher's exact test, and multiple logistic regression.

Result Of the 2,373 pregnant women who underwent genetic counseling for increased risk of fetal aneuploidy and genetic disorders during the study period, 321 women had diagnostic testing (13.5%). Women at 35 years and older accepted diagnostic testing more than women younger than 35 years (20.7 vs. 11.5%, p < 0.001). Asian women accepted diagnostic testing at 27.7% more than white, non-Hispanic Black, and Hispanic women at 18.0, 12.1, and 11.7%, respectively, p = 0.002. Number of indications for genetic counseling influenced the likelihood of accepting diagnostic testing. Women with one indication had 11.5% acceptance of diagnostic testing, and with two and three indications, it was 17.0 and 29.2%, respectively. The commonest indication for diagnostic testing was cystic hygroma (risk ratio [RR] = 7.5, 95% confidence interval [CI]: 3.12–8.76 p < 0.001). The relative risk of diagnostic testing for fetuses with shortened long bones, femur and humerus, thickened nuchal fold, echogenic bowel, single umbilical artery, and increased nuchal translucency were 4.0, 3.3, 3.1, 2.7, and 2.7, respectively. Abnormal serum analyte alone was associated with less acceptance of diagnostic testing (RR = 0.8, 95% CI: 0.7–0.96, p = 0.017).

Conclusion Age, race, ethnicity, and cumulative number of indications for genetic counseling influenced acceptance of diagnostic testing in at-risk women of fetal aneuploidy and genetic disorders.

Key Points

Genetic counseling.
Fetal aneuploidy.
Genetic disorders.
Prenatal diagnostic testing. Prenatal diagnostic testing in women with increased risk of fetal aneuploidy and genetic disorders.

Keywords

genetic counseling - fetal aneuploidy - genetic disorders - diagnostic testing

Full Text

References

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