Preference assessment of prenatal diagnosis for Down syndrome: is 35 years a rational cutoff?

Abstract

Objective To compare the perceptions of miscarriage and birth of a child with Down syndrome among pregnant women and to evaluate the implications of these preferences for the traditional 35‐year old maternal age risk boundary. Methods An interviewer‐administered survey was given to 186 pregnant women receiving antepartum care at a university hospital. Preferences, as reflected by utilities, for birth of a child with Down syndrome and pregnancy miscarriage, stratified by patient characteristics, were assessed. Results The utility for the birth of a child with Down syndrome decreased (p < 0.001) as clinical severity increased from mild (0.78) to severe (0.65). Miscarriage of a pregnancy had a mean utility of 0.76 ± 0.31. Women who desired prenatal diagnosis had a utility value for miscarriage (0.79 ± 0.28) that was significantly higher than for the birth of a child with Down syndrome of unknown severity (0.73 ± 0.27). In multivariable logistic regression, desire for prenatal diagnosis was the only factor associated with a preference of miscarriage over birth of an affected child (odds ratio 2.26, 95% confidence interval 1.03, 4.96). Conclusion Women who desire prenatal diagnosis do not perceive the birth of a child with Down syndrome and a pregnancy miscarriage to be equivalent health states. This finding calls into question the rationale of the 35‐year‐old maternal age criterion and suggests that actual patient preferences should be better incorporated into the decision to offer definitive prenatal diagnosis. Copyright © 2002 John Wiley & Sons, Ltd.