Reed, K.Gender and Genetics: Sociology of the Prenatal. London: Routledge. 2012. 198pp. £34.99 ISBN 978‐1‐138‐82289‐4 (pbk)

Public funding for non-invasive prenatal testing for fetal aneuploidy - It's time.

To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

Wahlberg and Gammeltoft's interest in the routinisation of reproductive technologies across the globe provided the basis for a prolific collaboration among scholars working in the area, resulting in the publication of Selective Reproduction in the 21st Century, a collection of ethnographic studies addressing the use of selective reproduction in different cultural, socio-economic and regulatory contexts. Defining selective reproduction as ‘practices that aim to prevent or promote the birth of particular kinds of children’ (p. 1), Wahlberg and Gammeltoft argue that the biomedical developments of the last 40 years, and the increasing availability of selective reproductive technologies (SRTs), ‘have separated reproduction from sex as well as genetics from gestation’ (p. 1). Rather than acting as a ‘helping hand’ as in the case of assisted reproduction, SRTs become a ‘guiding hand’, conceptualised as ‘a vote of no confidence against nature’ (p. 6). The collection is divided in three parts according to the purpose of selective reproduction: sex selection (chapters 2 and 3), prevention of disease and disability (chapters 4, 5, 6), and selection of traits (chapters 7 and 8). In chapter 2, Hang's ethnographic study of sex-selective abortions in Vietnam provides insight into the emotional experiences of 35 women before, during and after the abortion of female foetuses, a practice linked to cultural notions of son preference in this context. In chapter 3, Bhatia is concerned with what she terms ‘lifestyle sex selection’, that is, sex selection before pregnancy via preimplantation genetic diagnosis (PGD) and via MicroSort, a technique sorting sperm based on the chromosomes determining sex to be used with intrauterine insemination or IVF. Providing the historical framework within which these technologies developed in the United States and the United Kingdom, Bhatia analyses the interplay between scientific developments, politics, and ethics. In chapter 4, Heinsen engages with prenatal screening in Denmark, analysing the position of Danish pregnant women as ‘moral adherers’ of SRTs. Chapter 5 draws on Shih's research with Taiwanese women and couples, exploring the inextricable link between prenatal screening and testing and the cultural notion of ‘moral bearing’, and its translation as the prospective mothers’ responsibility to not bring a disabled child to society. Pavone and Lafuente Funes, in chapter 6, examine women's experiences of pre-implantation genetic diagnosis and pre-implantation genetic screening, across Spain, as a means to either overcome infertility or to avoid the transmission of hereditary disease. In chapter 7, Martin draws on her fieldwork in ‘fertility industry’ sites in the United States, where the use of third-party eggs is commercial, to illustrate how egg providers are recruited and managed as a marketing device for intending parents who desire children of specific racial-ethnic backgrounds or with particular physical and personality traits. In the last chapter of the collection, Stockey-Bridge explores the emotional investment of heterosexual and non-heterosexual Australian couples during the selection of egg donors and surrogates in the framework of commercial arrangements in India, and provides valuable insight into their decision-making processes. The collection makes a significant contribution to the growing literature of human reproduction in general and the interplay between reproduction, technology, and society in particular. The introduction provides a very useful overview of different SRTs and the important milestones that led to their development. Through the rich ethnographic accounts presented, the collection enhances our understanding of the accessibility of SRTs within diverse contexts, provides an in-depth look into the interpretations, decision-making, and the experiences of the people who engage with them, and generates thought-provoking questions on ethical considerations. In the Introduction, Wahlberg and Gammeltoft state that selective reproduction can be empirically examined through the technique(s) used (e.g. egg harvesting, sperm sorting, PGD, ultrasound screening, carrier testing), the sites where selective reproduction takes place (e.g. IVF clinics, prenatal care units, egg agencies), the people who engage with SRTs (prospective parents, practitioners and policy makers), as well as through the relevant legislation and guidelines. While the collection is indeed successful in bringing together the four empirical routes to the study of selective reproduction, the diversity of perspectives tackled could be argued to constitute the collection's major weakness. The reader becomes obliged to mentally ‘jump’ from women's (and generally users’) experiences to biomedical developments, and from laws and regulations to marketing strategies employed by commercial fertility hubs. In this respect, I found the book's structure somewhat challenging to follow. Nonetheless, the rich and complex insights of selective reproduction presented in the collection opens up new horizons for the understanding of contemporary selective reproduction practices around the world. A stimulating collection, Selective Reproduction in the 21st Century breaks new ground and leads to the development of further questions to be answered about current practices. Social scientists working in the areas of human reproduction, science and technology studies, health and illness, gender, and family and kinship studies, will find the book eye-opening.

Commercial screening services for inheritable diseases raise concerns about pressure on parents to terminate "imperfect babies".

BackgroundPopulation-based prenatal screening has become a common and widely available obstetrical practice in majority of developed countries. Under the patient autonomy principle, women should understand the screening options, be able to take their personal preferences and situations into account, and be encouraged to make autonomous and intentional decisions. The majority of the current research focuses on the prenatal screening uptake rate, women’s choice on screening tests, and the influential factors. However, little attention has been paid to women’s choice-making processes and experiences in prenatal screening and their influences on choice satisfaction. Understanding women’s choice-making processes and experiences in pregnancy and childbirth is the prerequisite for designing women-centered choice aids and delivering women-centered maternity care. This paper presents a pilot study that aims to investigate women’s experiences when they make choices for screening tests, quantify the choice-making experience, and identify the experiential factors that affect women’s satisfaction on choices they made.MethodWe conducted a mixed-method research at Helsinki and Uusimaa Hospital District (HUS) in Finland. First, the women’s choice-making experiences were explored by semi-structured interviews. We interviewed 28 women who participated in prenatal screening. The interview data was processed by thematic analysis. Then, a cross-sectional self-completion survey was designed and implemented, assessing women’s experiences in choice-making and identifying the experiential factors that influence choice satisfaction. Of 940 distributed questionnaires, 185 responses were received. Multivariable linear regression analysis was used to detect the effects of the variables.ResultsWe developed a set of measurements for women’s choice-making experiences in prenatal screening with seven variables: activeness, informedness, confidence, social pressure, difficulty, positive emotion and negative emotion. Regression revealed that activeness in choice-making (β = 0.176; p = 0.023), confidence in choice-making (β = 0.388; p < 0.001), perceived social pressure (β = − 0.306; p < 0.001) and perceived difficulty (β = − 0.274; p < 0.001) significantly influenced women’s choice satisfaction in prenatal screening.ConclusionsThis study explores the experiential dimension of women’s choice-making in prenatal screening. Our result will be useful for service providers to design women-centered choice environment. Women’s willingness and capabilities of making active choices, their preferences, and social reliance should be well considered in order to facilitate autonomous, confident and satisfying choices.

ACOG approves new trisomy screen for high‐risk pregnancies

During recent decades, prenatal screening strategies have evolved greatly. Prenatal screening, including the diagnosis of fetal aneuploidy, includes invasive and non-invasive methods. Various combinations of first and second trimester maternal serum analytes and fetal ultrasound measurements have been proposed to construct a screening method with high sensitivity and specificity. Non-invasive tests are performed either by maternal serum analyte screening alone (double marker test, triple test, quadruple test, or serum integrated test), serum screening combined with ultrasound (integrated test, sequential test, or contingent test), or most recently, the cell-free fetal DNA test. Recent advances in prenatal screening methods have resulted in tremendous advantages to patients and healthcare providers. Therefore new approaches to counseling are necessary to ensure that all patients and healthcare providers receive the most comprehensive access to prenatal screening and diagnostic testing options. This article summarizes the various prenatal maternal serum screening options for fetal aneuploidy.

ABSTRACTIn Vanuatu, the practice of bridewealth is widespread. However, according to international and national development organizations based in the capital Port‐Vila, this practice impedes women's freedom, including women's reproductive autonomy. In this paper, using data gathered in Port‐Vila between 2009 and 2018, I examine the practice of marriage in Port‐Vila and argue against this development discourse. I analyse the transformations of marriage showing the increasing autonomy of young people in the selection of marriage partners and the links between marriage, bridewealth and reproductive autonomy. I emphasize the changes in the nature of bridewealth marriage in a contemporary urban context and its implications for female fertility control. I conclude that bridewealth is only one among several factors that influence women's reproductive autonomy in Port‐Vila.

Outcomes of a prenatal cytogenetic screening program in an urban state university medical center

First-trimester combined screening (FTS) has been offered to all pregnant women in Iceland since 2003. Individuals with high-risk FTS results are offered an invasive test option with a ≤1% risk of fetal loss. This study gives insight into the prenatal screening and diagnosis experiences and preferences of 101 women who underwent FTS in Iceland in the years 2012-2016, comparing the experience of those who received false-positive FTS results to those who received true-negative results. Retrospective patient-reported anxiety levels at the time of receiving FTS results were significantly higher in those who received false-positive results compared to those who received true-negative results. For a subset of these participants, the anxiety lasted through pregnancy, and for a smaller subset, it lasted even longer. Non-invasive prenatal testing (NIPT) is currently not offered in Iceland, aside from the rare exceptional case. Given the extremely low false-positive rates of NIPT, we believe NIPT is worth considering as Iceland's standard first-tier screening method for trisomy 13, 18, and 21. We believe the findings of this study are beneficial not only for Iceland but also for other countries where FTS is the first-tier prenatal screening method or the only offered test. Additionally, only 21% of participants in our study reported that they had heard of NIPT, which emphasizes the need for comprehensive NIPT pretest information to be available prior to its uptake to ensure informed and autonomous decision-making.

Participating in prenatal screening for chromosomal conditions is premised on an informed choice to accept or decline. The aims of this paper are to describe people's experiences of informed choice and how these relate to the experience of prenatal screening. Thirty-eight people were recruited and their experiences were explored through narrative enquiry, following an iterative and in-depth reflexive analysis. Informed choice meant 'being informed' in ways that met people's cultural needs, values and preferences (e.g., how much information and how it was communicated) and 'having choice' (e.g., choice about 'being informed', who was involved and choice to enact the decision). 'Being informed' affected 'having choice'. Four themes describe experiences of how informed choice as an ethical principle was upheld: 'All I knew it was something that should be done', 'Going in blind', 'It would have been frowned upon' and 'I knew I could decline'. For example, the experience of 'I knew I could decline' describes how the ethical principle of 'informed choice' was fully realised. There was a choice about how information was shared that meant people gained knowledge about prenatal screening and a choice about who was involved in this process. A relational experience for 'being informed' (e.g., with their pregnancy carer and the decision-makers) was upheld. People knew that they would be fully supported in enacting their decision. These experiences were not common. In the absence of 'being informed', the possibility for 'having choice' is eroded. 'Having choice' requires people to have information so that it meets their needs, values and preferences to make sense of it as it relates to their values for decision-making. Considering 'being informed' as an epistemic justice obligation would mitigate eroding the possibility of 'having choice'. For example, when people experienced prenatal screening as 'I knew I could decline', it was an epistemically just experience as all the elements for 'being informed' for them were met and the relational experience upheld 'having choice'. The challenge remains for this to be the experience for everyone considering prenatal screening, not just in Aotearoa but globally. The interview questions were reviewed through group discussion with eight people who had lived experiences of prenatal screening for chromosomal conditions. The research was also informed by a researcher who had no lived experience of the screening service as a counter-view. The premise of this study is to highlight how women and pregnant people experience the consenting process for prenatal screening. The findings may inform organisations, researchers and practitioners about developing approaches for better enabling informed choice in future practice.

Prenatal screening and diagnosis—An introduction

This study explored the experiences of Korean women of advanced maternal age undergoing prenatal genetic screening and diagnostic testing. A descriptive, qualitative design was used to guide the study. Ten participants were purposely recruited from a large metropolitan Korean hospital for clinical observations and individual, semistructured interviews. The content analysis method was used to analyze field notes and interview transcripts. Three themes emerged: reacting to an unfavorable screening result, dealing with the anticipated consequences of diagnostic testing, and realistically embracing the unborn child. The findings of this study inform the development of tailored interventions aimed at reducing the heavy emotional burdens placed on pregnant women and the stigma of bearing children with genetic conditions. Clear reciprocal communication and shared decision making should be promoted in the day-to-day practice of delivering health care for pregnant Korean women.

Objective To determine through the log-linear model analysis technique the impact of women's reproductive autonomy, spouses' educational background and other factors on the use of contraception in Pakistan.Methods Data from the Pakistan Reproductive Health and Family Planning Survey 2000 were used. In this survey a national sample of married women aged 15–49 years (n = 6579) were interviewed. A number of socio-economic, socio-demographic and women's reproductive autonomy variables were taken for the log-linear model fitting and analysis, in order to examine the impact of women's reproductive autonomy on contraceptive use and the factors affecting this latter.Results On the basis of partial and marginal association tests, two hierarchical log-linear models were selected. The first one concerned women's reproductive autonomy and contraceptive use, the second one analysed factors affecting contraceptive use. Standardized values of the model's parameter estimates showed that women's reproductive autonomy was significantly associated with husband-wife education attainment when they were using contraception. In the second model, contraceptive use was strongly associated with women's education, husband's desire for more children, sex preference for the next child and number of living children.Conclusion An improved husband-wife educational level results in greater reproductive autonomy of the women and an increased use of contraception. The husband's desire for more children, a preference for the sex of the next child, and the woman's poor education attainment level are the main barriers to contraceptive use.

Prenatal genetic screening and diagnostic testing can identify many disorders that will require specialized newborn care and follow-up. Pediatricians should be aware of recent advances in testing that may have implications for their patients and families. Over the last half decade, there have been important changes in the breadth and depth of prenatal screening and diagnostic procedures. Carrier screening for selected genetic disorders is now offered routinely to pregnant women or those contemplating pregnancy. Newly developed strategies for first-trimester screening for fetal chromosome abnormalities have improved the detection rate for these disorders, while maintaining a low screen-positive rate. The American College of Obstetricians and Gynecologists and the American College of Medical Genetics now recommend that invasive prenatal diagnostic testing be made available to all pregnant women, regardless of age or prenatal screening results. And prenatal ultrasound findings of unknown clinical significance require that pediatricians provide appropriate follow-up in the newborn period and beyond. Prenatal genetic screening and diagnostic tests are changing rapidly, and results of these tests may impact the postnatal evaluation and treatment strategies for pediatric care.