Concerns of Pregnant Women in “Prenatal Screening/Diagnosis” Practice and Termination of Pregnancy

Abstract

Objective To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP).

Study Design This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients’ feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP.

Results Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP.

Conclusion Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing womenʼs decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

Key words

antenatal care - pregnancy - prenatal diganostics

Publication History

Received: 28 October 2019

Accepted: 25 November 2019

Article published online:
10 March 2020

• References

• 1 Tuffnell D. Medicolegal issues in obstetrics. Obstet Gynaecol Reprod Med 2019; 29: 12-14
• 2 Chandraharan E, Arulkumaran S. Medico-legal problems in obstetrics. Curr Obstet Gynaecol 2006; 16: 206-210
• 3 Studdert DM, Mello MM, Sage WM. et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. Jama 2005; 293: 2609-2617
• 4 Reschovsky JD, Saiontz-Martinez CB. Malpractice claim fears and the costs of treating medicare patients: a new approach to estimating the costs of defensive medicine. Health Serv Res 2018; 53: 1498-1516
• 5 Zhang J, Brackbill D, Yang S. et al. Identifying the effects of social media on health behavior: Data from a large-scale online experiment. Data Brief 2015; 5: 453-457
• 6 Korda H, Itani Z. Harnessing social media for health promotion and behavior change. Health promotion practice 2013; 14: 15-23
• 7 Cuckle H, Maymon R. Development of prenatal screening – A historical overview. Semin Perinatol 2016; 40: 12-22
• 8 De Jong A, Dondorp WJ, Frints SG. et al. Advances in prenatal screening: the ethical dimension. Nat Rev Genet 2011; 12: 657-663
• 9 Gokcen O, Mehmet D, Emine A. et al. An overview of prenatal screening/diagnosis programs for Down syndrome in Turkey. Int J Hum Genet 2016; 16: 29-34
• 10 Hacettepe University, Institute of Population Studies 2013 Turkey Demographic and Health Survey. Nov. 2014. Ankara, Turkey:
• 11 Natoli JL, Ackerman DL, McDermott S. et al. Prenatal diagnosis of Down syndrome: a systematic review of termination rates (1995–2011). Prenat Diagn 2012; 32: 142-153
• 12 Green E. Proposals to ban abortion in Turkey provoke protests. BMJ 2012; 344: e4030
• 13 Letsch C. Turkish law will make legal abortion impossible, say campaigners. The Guardian. 2013; http://www.theguardian.com/world/2013/feb/01/turkish-law-abortion-impossible
• 14 Beksaç MS, Aydın E, Tuğral M. et al. An obstetrics index for the assessment of risk levels of “high risk pregnancy” groups. Gynecol Obstet Reprod Med 2016; 21: 10-13
• 15 Fadiloglu E, Unal C, Beksac MS. Management and the pregnancy outcomes of patients positive for anti-parietal cell antibody. Hum Antibodies 2018; 27: 1-6
• 16 Beksaç K, Örgül G, Çağan M. et al. Retrospective evaluation of pregnant women with celiac disease. J Turk Ger Gynecol Assoc 2017; 18: 56-59
• 17 Turgal M, Gumruk F, Karaagaoglu E. et al. Methylenetetrahydrofolate reductase polymorphisms and pregnancy outcome. Geburtshilfe und Frauenheilkunde 2018; 78: 871-878
• 18 Bianchi DW. Pregnancy: prepare for unexpected prenatal test results. Nature 2015; 522: 29-30
• 19 de Jong A, de Wert GM. Prenatal screening: an ethical agenda for the near future. Bioethics 2015; 29: 46-55
• 20 De Jong A, Maya I, Van Lith JM. Prenatal screening: current practice, new developments, ethical challenges. Bioethics 2015; 29: 1-8
• 21 Bjerregaard L, Stenbakken AB, Andersen CS. et al. The rate of invasive testing for trisomy 21 is reduced after implementation of NIPT. Dan Med J 2017; 64: A5359
• 22 Balkan M, Kalkanli S, Akbas H. et al. Parental decisions regarding a prenatally detected fetal chromosomal abnormality and the impact of genetic counseling: an analysis of 38 cases with aneuploidy in Southeast Turkey. J Genet Couns 2010; 19: 241-246
• 23 Turhan OT, Kütük MS, Büyükoğlan R. et al. Factors determining parental attitudes towards termination of pregnancy in prenatally detected Down syndrome. Gynecol Obstet Reprod Med 2014; 20: 150-153
• 24 Ternby E, Axelsson O, Annerén G. et al. Why do pregnant women accept or decline prenatal diagnosis for Down syndrome?. J Community Genet 2016; 7: 237-242
• 25 Suzumori N, Kumagai K, Goto S. et al. Parental decisions following prenatal diagnosis of chromosomal abnormalities: implications for genetic counseling practice in Japan. J Genet Couns 2015; 24: 117-121
• 26 Raz AE, Amano Y, Timmermans S. Coming to terms with the imperfectly normal child: attitudes of Israeli parents of screen-positive infants regarding subsequent prenatal diagnosis. J Community Genet 2019; 10: 41-50
• 27 Gesser-Edelsburg A, Shahbari NAE. Decision-making on terminating pregnancy for Muslim Arab women pregnant with fetuses with congenital anomalies: maternal affect and doctor-patient communication. Reprod Health 2017; 14: 49
• 28 Zaręba K, Ciebiera M, Bińkowska M. et al. Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland. Eur J Contracept Reprod Health Care 2017; 22: 305-309
• 29 Atkin K, Ahmed S, Hewison J. et al. Decision-making and ante-natal screening for sickle cell and thalassaemia disorders: to what extent do faith and religious identity mediate choice?. Current Sociology 2008; 56: 77-98
• 30 Korenromp MJ, Page-Christiaens GC, van den Bout J. et al. Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol 2007; 196: 149 e1–11
• 31 Schuth W, Karck U, Wilhelm C. et al. Parents’ needs after ultrasound diagnosis of a fetal malformation: an empirical deficit analysis. Ultrasound Obstet Gynecol 1994; 4: 124-129