Preferences of pregnant women and obstetric healthcare professionals on using noninvasive prenatal testing to predict adverse pregnancy outcomes: a discrete choice experiment

Abstract

Objectives: Noninvasive prenatal testing (NIPT) to screen for fetal aneuploidies by analysing cell-free DNA in maternal plasma is available to pregnant women worldwide. In the future, the scope of NIPT could potentially be expanded to the prediction of adverse pregnancy outcomes. The objective of this study was to assess and compare the preferences of pregnant women and obstetric healthcare professionals on this new test purpose of NIPT.

Design: A discrete choice experiment was designed to assess participants' preferences on the use of NIPT to predict adverse pregnancy outcomes regarding three attributes on test characteristics: test accuracy rate, unnecessary intervention rate and false reassurance rate. A questionnaire assessed general attitudes towards using noninvasive prenatal testing to predict adverse pregnancy outcomes.

Setting: Dutch prenatal healthcare system.

Participants: Pregnant women with singleton pregnancies and obstetric healthcare professionals.

Results: In total, 1580 pregnant women and 308 obstetric healthcare professionals participated in the discrete choice experiment. Higher test accuracy, fewer unnecessary interventions and less false reassurance all had a statistically significant (p<0.05) impact on the preference for a test. For pregnant women, the most important test characteristic when choosing a preferred test was the test accuracy rate, while for obstetric healthcare professionals, the most important test characteristic was the unnecessary intervention rate. The false reassurance rate was the least important test characteristic for both groups. Overall, 74% (n=1181) of pregnant women (strongly) agreed that NIPT to predict adverse pregnancy outcomes should be offered to pregnant women compared with 49% (n=151) of obstetric healthcare professionals.

Conclusions: Most pregnant women have a positive attitude towards using NIPT to predict adverse pregnancy outcomes compared with slightly less than half of the obstetric healthcare professionals. Pregnant women prioritise a prognostic test with higher test accuracy, while obstetric healthcare professionals prioritise a test that results in fewer unnecessary interventions.

Keywords: GYNAECOLOGY; OBSTETRICS; Pregnancy.

Figure 1. Visualisation of the relative importance of attributes for pregnant women and healthcare professionals. This figure visualises the importance of attributes relative to the most important attribute. The most important attribute is set to 1.00 and was test accuracy rate for pregnant women and unnecessary intervention rate for obstetric healthcare professionals.