Obstetric professionals\u2019 perceptions of non-invasive prenatal testing for Down syndrome: clinical usefulness compared with existing tests and ethical implications

Olivia Miu Yung Ngan,Daljit Sahota,Huso Yi,Shenaz Ahmed,Samuel Yeung Shan Wong

doi:10.1186/s12884-017-1474-6

Olivia Miu Yung Ngan, Daljit Sahota + Show 3 more

Open Access

https://doi.org/10.1186/s12884-017-1474-6

Copy DOI

Abstract

BackgroundWhile non-invasive prenatal testing (NIPT) for fetal aneuploidy is commercially available in many countries, little is known about how obstetric professionals in non-Western populations perceive the clinical usefulness of NIPT in comparison with existing first-trimester combined screening (FTS) for Down syndrome (DS) or invasive prenatal diagnosis (IPD), or perceptions of their ethical concerns arising from the use of NIPT.MethodsA cross-sectional survey among 327 obstetric professionals (237 midwives, 90 obstetricians) in Hong Kong.ResultsCompared to FTS, NIPT was believed to: provide more psychological benefits and enable earlier consideration of termination of pregnancy. Compared to IPD, NIPT was believed to: provide less psychological stress for high-risk women and more psychological assurance for low-risk women, and offer an advantage to detect chromosomal abnormalities earlier. Significant differences in perceived clinical usefulness were found by profession and healthcare sector: (1) obstetricians reported more certain views towards the usefulness of NIPT than midwives and (2) professionals in the public sector perceived less usefulness of NIPT than the private sector. Beliefs about earlier detection of DS using NIPT were associated with ethical concerns about increasing abortion. Participants believing that NIPT provided psychological assurance among low-risk women were less likely to be concerned about ethical issues relating to informed decision-making and pre-test consultation for NIPT.ConclusionsOur findings suggest the need for political debate initially on how to ensure pregnant women accessing public services are informed about commercially available more advanced technology, but also on the potential implementation of NIPT within public services to improve access and equity to DS screening services.

Highlights

While non-invasive prenatal testing (NIPT) for fetal aneuploidy is commercially available in many countries, little is known about how obstetric professionals in non-Western populations perceive the clinical usefulness of NIPT in comparison with existing first-trimester combined screening (FTS) for Down syndrome (DS) or invasive prenatal diagnosis (IPD), or perceptions of their ethical concerns arising from the use of NIPT
Overall, the obstetric professionals in our study believed that compared with tests in the current screening pathway in the public sector, the main usefulness of NIPT related to psychological benefits
These findings reinforce that while newer, improved technology may be useful in alleviating some psychological implications of screening tests, obstetric professionals should provide pre-test information/ counselling to ensure that women opting for screening tests for psychological assurance are aware of the psychological implications of a high-risk screening result, including decisions about termination of pregnancy (TOP)

Summary

Introduction

While non-invasive prenatal testing (NIPT) for fetal aneuploidy is commercially available in many countries, little is known about how obstetric professionals in non-Western populations perceive the clinical usefulness of NIPT in comparison with existing first-trimester combined screening (FTS) for Down syndrome (DS) or invasive prenatal diagnosis (IPD), or perceptions of their ethical concerns arising from the use of NIPT. Non-invasive prenatal testing (NIPT) for Down syndrome (DS) using cell-free DNA in maternal plasma (cff-DNA) is commercially established [1,2,3], and available in many countries [4]. It is well recognised that in addition to the clinical validity of NIPT, its implementation into public maternity services and the development of national/local guidelines should be based on key stakeholders’ views, ethical, legal and social implication (ELSI) [12]. An American study among obstetricians reported diverse views about whether NIPT should be implemented as a primary or secondary screening test, and whether it should be offered to all or high-risk women [15]

Objectives

Methods

Results

Discussion

Conclusion