Women's Health

Tool helps women decide if prenatal genetic testing is the right decision for them

The American College of Obstetrics and Gynecology recommends that all pregnant women be given an opportunity to have the fetus tested for genetic disorders, such as Down syndrome. The decision to undergo this testing can be a difficult one, because some tests pose risks to the fetus and some results pose ethical dilemmas for parents. Researchers in San Francisco evaluated the effect of a computerized tool, the Prenatal Testing Decision-Assisting Tool (PT Tool), which is designed to help pregnant women decide whether to undergo prenatal testing. The researchers evaluated the women's knowledge, decisional conflict, and prenatal diagnostic testing choices. The tool provides personalized estimates of the chances a woman is carrying a fetus with chromosomal abnormalities, describes prenatal screening and diagnostic tests, and develops a tailored testing strategy.

Nearly 80 percent of women who used the PT Tool were able to answer questions on prenatal testing correctly compared with 65 percent of women in the control group who only read a computerized educational booklet on prenatal testing provided to all pregnant women by the State of California. Compared with the control group, women who used the PT Tool were also more able to correctly estimate their risk of experiencing a procedure-related miscarriage (48 vs. 65 percent, respectively) and chance they were carrying a fetus with Down syndrome (15 vs. 64 percent, respectively). Women who used the PT Tool were more satisfied with the educational intervention than women in the control group and were also more confident about their decision to undergo or forego testing.

After using the PT Tool, many women changed their opinions about prenatal testing. For example, women who at baseline said they would undergo no-cost prenatal diagnostic testing if it were offered, were less likely to have the tests after determining their risks with the PT Tool. Some women who at baseline said they were not inclined to have testing, ended up having an amniocentesis or chorionic villus sampling procedure. The authors suggest that tools such as these can improve women's decisionmaking about prenatal testing before they decline or request these procedures. This study was funded in part by the Agency for Healthcare Research and Quality (HS10856).

See "Computerized prenatal genetic testing decision-assisting tool: A randomized controlled trial," by Miriam Kuppermann, Ph.D., M.P.H., Mary E. Norton, M.D., Elena Gates, M.D., and others in the January 2009 Obstetrics & Gynecology 113(1), pp. 53-63.

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