Attitudes of women of childbearing age towards prenatal diagnosis in southeastern France

Abstract

The objective of this study was to explore women's attitudes towards prenatal diagnosis of trisomy 21 and to examine some of the factors possibly responsible for these attitudes before implementing in real practice serological screening of pregnant women at risk for trisomy 21. We carried out a telephone survey on a representative sample of women who had recently had a normal livebirth delivery in the Marseille district in 1990. The participation rate was 80 per cent and the average age of the mothers was 28.9 years. Among the 514 women interviewed, 78 per cent stated that they would ask for an amniocentesis for a 1 per cent risk of trisomy 21 at their next pregnancy. When adjusting for confounding factors, the decision to have or not to have an amniocentesis was found to depend not only on the women's attitude towards induced abortion, but also on their understanding of the risk involved and on the social context (knowing a handicapped child, discussion with the father). It also depended on the women's age and on what they knew about amniocentesis from the medical point of view. The risk of miscarriage can influence a woman's choice but this objection was not found to affect the women's decisions significantly in our survey. The data showed the existence of a high potential demand for fetal karyotyping.

PIP: In southeastern France, 514 women aged 19-38 years who had recently delivered a normal infant at one of 19 public and private maternity hospitals in the Marseille district participated in a telephone survey designed to examine their attitudes towards amniocentesis and some factors influencing their attitude. Researchers wanted the results of this survey before implementing a serologic screening of pregnant women at risk for trisomy 21. 77.6% of the women said they would request an amniocentesis if they had a 1% risk of bearing a child with Down's syndrome at their next pregnancy. The multiple regression analysis revealed that age was the only significant factor among the cultural, sociodemographic, and reproductive factors examined which affected the acceptability of the test. Women who knew handicapped children were more likely to refuse the test than those who did not know such children (odds ratio [OR] = 0.45; p = 0.003). Mothers who talked to the father about the possibility of having a handicapped child were more likely to agree to have amniocentesis than those who did not (OR = 1.71; p = 0.03). Understanding the risk of trisomy 21 significantly influenced the acceptability of amniocentesis (OR - 1.82; p = 0.0193). The best predictive variable of acceptability of amniocentesis was desire for an induced abortion of a Down's syndrome fetus (OR = 6.16; p = 0.0001). A 1% risk of miscarriage negatively affected women's acceptability of amniocentesis, but the effective was not significant. 47% of all women believed induced abortion is justified in the case of a severely malformed fetus. 42% supported euthanasia at the birth of a severely malformed newborn. These findings suggested that the potential demand for prenatal diagnosis of chromosomal anomalies after serological screening would likely be very high.