Prenatal Screening For Down Research Articles

A systematic review of the global implementation and impact of non-invasive prenatal testing (NIPT) during prenatal screening for Down’s syndrome

A systematic review of the global implementation and impact of non-invasive prenatal testing (NIPT) during prenatal screening for Down’s syndrome

5.O. Workshop: Migrants and differential care in the perinatal period

Abstract Nationwide, more than 22% of births in France are to women who were born elsewhere. It is now well documented that overall, these women, like migrants throughout Europe, have higher perinatal and maternal risk levels than non-migrants. The mechanisms of these social inequalities in health have not yet been sufficiently and adequately explored. Access to and quality of care are likely to be intermediate factors in their explanation. This hypothesis is especially probable in view of recent work showing higher rates of inadequate prenatal and suboptimal perinatal care in some groups of migrant women compared to women born in France. This workshop aims to present and discuss a mixed-methods research program founded by the French National Research Agency (ANR). The program was designed to address and assess the role played by health professional's implicit bias (IB) in the provision of differential care that could explain disparities in maternal and perinatal health between certain groups of migrants and women born in France. The existence of these IB has been demonstrated in healthcare professionals in several specialties, mainly in North America, but never in the perinatal field nor in European settings. While this program has focused on care as diverse as cesarean section, epidural analgesia during labor, prevention and management of eclampsia, and Down syndrome screening, we propose to report on our approach through the issue of Down syndrome screening. IB has been shown to be less likely to induce differential care in highly protocolized emergency care settings. Conversely, non-emergency situations such as prenatal care, where there is nevertheless time pressure on health care professionnals, are more likely to be contexts for the existence of non-medically based differential care. Access to prenatal screening for Down's syndrome, where patient information plays a fundamental role, seemed to us to be a particularly interesting model for the study of differential care and the role played by IB. While the role of conscious and unconscious discrimination phenomena in the mechanisms of social health inequalities appears as increasingly probable, this workshop, based on data from a multidisciplinary research program, will shed additional light on these issues from the very concrete question of down syndrome screening. Researchers involved in this multidisciplinary project will present the results successively from epidemiological, qualitative sociological, and quantitative psycho-sociological approaches addressing differential care practices in Down syndrome screening. This mixed-methods approach will provide complementary insights into the research question. Our methods and results will then be discussed in an audience session led by moderators external to the project but experts in social health inequalities. Key messages Differential care between pregnant migrant women and native women has been evidenced in Down syndrome screening in France. Disparities in the use of Down syndrome screening according to women place of birth are almost partly related to differences in the opportunity of an informed choice.

The Urinary Peptidome as a Noninvasive Biomarker Development Strategy for Prenatal Screening of Down's Syndrome.

Prenatal screening for Down's syndrome based on maternal age, ultrasound measures, and maternal serum biomarkers is recommended worldwide, but the false-positive rate and poor diagnostic performance of these screening tests remain problematic. Genetic analysis of cell-free DNA in maternal blood has been developed as a new prenatal screening for Down's syndrome, but it has a number of limitations, including turnaround time and cost. Prenatal screening diagnostic innovation calls for new tests that are noninvasive, accurate, and affordable. We report original observations on potential peptide biomarkers in maternal urine for screening of fetal Down's syndrome. The peptidome of urine samples from 23 pregnant women carrying Down's syndrome fetuses and 30 pregnant women carrying fetuses with normal karyotype was fractionated by weak cation exchange magnetic beads and analyzed by MALDI-TOF mass spectrometry. Levels of six peptides (m/z 1022.1, 1032.1, 1099.5, 1155.9, 1306.6, and 2365.6) were significantly altered between the case and control groups after controlling for maternal and gestational age. A classification model was constructed based on these candidate peptides that could differentiate fetuses with Down's syndrome from controls with a sensitivity of 95.7%, a specificity of 70.0%, and an area under receiver operating characteristic curves of 0.909 (95% confidence interval, 0.835-0.984). Peptide peaks at m/z 1099.5 and 1155.9 were identified as the partial sequences of alpha-1-antitrypsin and heat shock protein beta-1, respectively. These new findings support the new idea that maternal urinary peptidome offers prospects for noninvasive biomarker discovery and development for the prenatal screening of fetal Down's syndrome.

Ethnicity and Language Proficiency Differences in the Provision of and Intention to Use Prenatal Screening for Down\u2019s Syndrome and Congenital Anomalies. A Prospective, Non-selected, Register-Based Study in the Netherlands

Objective We aimed to conduct an analysis of the associations between the information provision procedure of prenatal screening for Down’s syndrome and congenital anomalies and the intention to participate in prenatal screening (PS) of ethnicity groups and Dutch language proficiency groups. Design Using a prospective web-based registration form, we asked counselors (midwives, general practitioners, nurses and gynecologists) to report whether and how they offered information about PS to pregnant women. Duration The study was conducted from 2008 to 2010. Participants We collected data on the characteristics of the women who received an information offer about PS from counselors. Measurements Measures included socio-demographic and language proficiency level (LPL) characteristics, key elements of the provision procedure of PS, and intentional participation in PS. Findings The dataset represents 37% of the total population in the study area. Women with a non-native Dutch background and/or insufficient Dutch LPL received fewer information offers about PS, faced a reduced chance of receiving counseling, and showed lower intentional participation rates for PS. Key Conclusions Women with a non-native Dutch background and/or with an insufficient LPL are underserved in the Dutch PS program. These findings present evidence indicating that the fundamental principle of the Dutch Population Screening Act, namely, equal access to PS for all pregnant women, is not being realized. Implications for Practice Therefore, the study findings are important for national and international healthcare, policy makers and governmental professionals to allow ethnic and LPL-related differences in the provision and intentional uptake of PS.

Prenatal Screening for Down's Syndrome: Parent and Healthcare Practitioner Experiences

AbstractThis article reviews research on both parent and healthcare practitioner experiences of prenatal screening for Down's syndrome. Whilst studies on Down's syndrome screening are broad in scope and diverge in theoretical and epistemological foundations, their core focus can be classified into two main and intertwining categories: (i) the decision‐making practices of expectant parents and why they do/do not participate in screening and (ii) the interactions between parents and practitioners, particularly the discrepancies of knowledge and the pursuit of “informed choice” and “non‐directive care.” To conclude, I highlight current knowledge gaps and the areas of substantial interest for future critical sociological engagements.

‘I don’t want to see my children suffer after birth’: the ‘risk of knowing’ talk and decision-making in prenatal screening for Down’s syndrome in Hong Kong

In this article, we examine the ‘risk of knowing’ talk (Sarangi, S., et al., 2003. ‘Relatively speaking’: relativisation of genetic risk in counselling for predictive testing. Health, risk & society, 5 (2), 155–170, p. 155) in prenatal screening for Down’s syndrome in Hong Kong. The ‘risk of knowing’ talk refers to the consequences of learning about a health condition, such as the psychosocial and interpersonal implications of testing, and the subsequent management of the condition. The stigma of eugenics and that the termination of pregnancy is the only available ‘medical intervention’ imply that the risk talk and decision-making in prenatal screening carry serious ethical, moral and social implications (Pilnick, A. and Zayts, O.A, 2012. ‘Let’s have it tested first’: choice and circumstances in decision-making following positive antenatal screening in Hong Kong. Sociology of health and illness, 34 (2), 266–282). This issue has not attracted much attention in the previous literature. This study is part of a larger project on prenatal screening conducted in one Prenatal Diagnostics and Counselling Department of a Hong Kong hospital in 2006–2013. It draws on 20 video-recorded consultations with pregnant women who had received a ‘positive’ (high risk) screening result and were invited to consider further diagnostic testing. Using theme-oriented discourse analysis (Roberts, C. and Sarangi, S., 2005. Theme-oriented discourse analysis of medical encounters. Medical education, 39 (6), 632–640), we show that in these consultations, the ‘risk of knowing’ talk was not initiated by the health care professionals. It might, however, be evoked by the women. We examine the impact of the ‘risk of knowing’ on decision-making, and discuss specific discourse (linguistic and rhetorical) devices that the participants employed to negotiate three competing agendas: the health care professionals’ preference of diagnostic testing, clients’ concerns of having a baby with Down’s syndrome and the overarching professional goal of these encounters of facilitating the clients’ informed choice regarding further testing.

Prenatal screening for Down’s syndrome: recent progress

Down's syndrome is an autosomal disease and its prenatal screening is particularly important.In recent years, clinical application of serological screening markers has been widely used,which improved the detection rate of Down's syndrome,but still remained at about 60%.The new generation of sequencing technology for direct analysis of nucleic acids, which can be used for fetal chromosomal aneuploidy detection,can detect Down's syndrome more accurately.In this paper,we compared the prenatal screening methods for Down's syndrome in recent decades,and reviewed the new screening markers based on proteomics and bioinformatics technology for clinical application.

Decision‐making process of prenatal screening described by pregnant women and their partners

Pregnant women are often faced with having to decide about prenatal screening for Down's syndrome. However, the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners. The aim of this study was to explore the couples' processes of decision making about prenatal screening. A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description. The study was carried out in Maternal health-care centres, Örebro County Council, Sweden. Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed. Three different patterns of decision making were identified. For the couples in 'The open and communicative decision-making process', the process was straightforward and rational, and the couples discussed the decision with each other. 'The closed and personal decision-making process' showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing 'The searching and communicative decision-making process' followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result. The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration.

Validity of Different Methods to Prenatal Screening for Down's Syndrom During First and Second Trimester Pregnancy of Chinese Women

ObjectiveTo identify and determine the optimal method to screening for fetal Down's syndrome (DS). MethodsThree large cohorts with 17 118, 39 903, 16 646 subjects were enrolled for the first trimester double marker (pregnancy-associated plasma protein A and free β-human chorionic gonadotropin) screening (FTDMS), second trimester double marker (α-fetoprotein and free β-human chorionic gonadotropin) screening (STDMS), and second trimester triple marker (α-fetoprotein, free β-human chorionic gonadotropin and unconjugated estriol 3) screening (STTMS), respectively. The sensitivity, specificity, false positive rate (FPR), false negative rate (FNR) and the areas under ROC curves (AUCs) were estimated in order to determine the optimal screening method in women under or above 35 years old. ResultsFor women under 35 years old, STTMS was the best method with a detection rate of 68.8% and FPR of 4.3% followed by the STDMS with a detection rate (sensitivity) of 66.7% and FPR of 4.9%. The FTDMS had a lower detection rate of 61.1% and FPR of 6.3%. For women above 35 years old, the detection rate of all the methods was similar, but STTMS method had a lowest FPR of 15.9%. For women under 35 years old AUCs were 0.77 (95% CI, 0.64 to 0.91), 0.81 (95% CI, 0.71 to 0.91), and 0.82 (95% CI, 0.69 to 0.96) for FTDMS, STDMS, and STTMS methods, respectively; for those above 35 years old, AUCs were 0.70 (95% CI, 0.56 to 0.83), 0.70 (95% CI, 0.59 to 0.82), 0.78 (95% CI, 0.58 to 0.97) for FTDMS, STDMS and STTMS, respectively. ConclusionFindings from our study revealed that STDMS is optimal for the detection of fetal DS in pregnant women aged under 35. For individual women, if economic condition permits, STTMS is the best choice, while for women aged above 35, STTMS is the best choice in this regard.

Analysis of three different strategies in prenatal screening for Down’s syndrome in twin pregnancies

Objectives: To compare the performance of three different strategies in prenatal screening for Down’s syndrome in twins [nuchal translucency, the combined test, the combined test + ductus venosus pulsatility index (DVPI)].Methods: We included 277 twin pregnancies with two cases of trisomy 21 (both dichorionic). We performed a computer simulation of Down’s syndrome NT screening, combined test screening and the combined test with the addition of DVPI screening using the commercialized software SsdwLab6. The strategies were compared using the area under the receiver operating characteristic curve.Results: NT screening false-positive rate (FPR) was 10.9% (95% CI: 8.3–13.5). The combined test FPR was 6.2% (95% CI: 4.1–8.2%) and the combined test plus DVPI was 6% (95% CI: 4–8). FPR was higher in advanced maternal age patients. Detection rate was 100% in all cases. The area under the curve was 0.987 (95% CI: 0.972–0.994) in NT screening; 0.987 (95% CI: 0.978–0.997) in the combined test and 0.983 (95% CI: 0.977–0.996) in the combined test + DVPI.Conclusions: Down’s syndrome screening is feasible in twins with low FPR. The results of this study are similar to the results achieved in singletons. The combined test appears to be the most effective. The addition of DVIP does not significantly improve the prenatal screening for trisomy 21.

Incorporating DNA Sequencing into Current Prenatal Screening Practice for Down's Syndrome

BackgroundPrenatal screening for Down's syndrome is performed using biochemical and ultrasound markers measured in early pregnancy such as the Integrated test using first and second trimester markers. Recently, DNA sequencing methods have been introduced on free DNA in maternal plasma, yielding a high screening performance. These methods are expensive and there is a test failure rate. We determined the screening performance of merging the Integrated test with the newer DNA techniques in a protocol that substantially reduces the cost compared with universal DNA testing and still achieves high screening performance with no test failures.MethodsPublished data were used to model screening performance of a protocol in which all women receive the first stage of the Integrated test at about 11 weeks of pregnancy. On the basis of this higher risk women have reflex DNA testing and lower risk women as well as those with a failed DNA test complete the Integrated test at about 15 weeks.ResultsThe overall detection rate was 95% with a 0.1% false-positive rate if 20% of women were selected to receive DNA testing. If all women had DNA testing the detection rate would be 3 to 4 percentage points higher with a false-positive rate 30 times greater if women with failed tests were treated as positive and offered a diagnostic amniocentesis, or 3 times greater if they had a second trimester screening test (Quadruple test) and treated as positive only if this were positive. The cost per women screened would be about one-fifth, compared with universal DNA testing, if the DNA test were 20 times the cost of the Integrated test.ConclusionThe proposed screening protocol achieves a high screening performance without programme test failures and at a substantially lower cost than offering all women DNA testing.

Feasibility of Using Plasma Rather Than Serum in First and Second Trimester Multiple Marker Down's Syndrome Screening

To compare maternal plasma with serum for measuring markers currently used in first and second trimester screening for Down's syndrome. A laboratory-based investigation of two sample types in assays used in prenatal screening for Down's syndrome. A paired data-set included both plasma and serum from 101 pregnant women. A nested case/control data-set included only plasma samples from 34 first and 23 second trimester Down's syndrome pregnancies, each matched with six euploid controls. Analyte levels were measured and converted to multiples of the median (MoM). In the paired data-set, each of the five analytes (alphafetoprotein, unconjugated estriol, human chorionic gonadotropin, inhibin-A and pregnancy-associated plasma protein A) in serum and plasma was highly correlated (r > 0.970) and after conversion to MoM, the resulting distributions were equivalent (P > 0.7). In the matched data-set, plasma-based median MoM levels in cases were consistent with the published serum counterparts for all markers. This study provides strong evidence that current serum-based prenatal screening can be performed equally well using plasma samples. This may prove useful, especially if secondary screening using a DNA-based test requires maternal plasma.

I183 THE STRATEGIES OF PRENATAL SCREENING FOR DOWN SYNDROME

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S206-S206 Invited presentations and presentations by organisations and societies I183 THE STRATEGIES OF PRENATAL SCREENING FOR DOWN SYNDROME M.Y. Kim, M.Y. KimSearch for more papers by this author M.Y. Kim, M.Y. KimSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60213-6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S206-S206 RelatedInformation

Preliminary proteomic-based identification of a novel protein for Down's syndrome in maternal serum

Prenatal screening for Down's syndrome (DS) is in need of improvement. As a powerful platform, proteomics techniques could also be used for identification of new biomarkers for DS screening. In this case-control proteome study, pregnant women were diagnosed prenatally by karyotype analysis from amniotic fluid (AF). Maternal serum samples were collected from six pregnancies with fetuses affected by DS and six pregnancies with normal fetuses. First, we used two-dimensional electrophoresis and mass spectrometry to identify the different levels of expression of proteins in maternal serum between the DS and control groups in the second trimester. Second, we used bioinformatics to analyze the proteins by DAVID. Then, the interesting candidates were further tested by enzyme-linked immunosorbent assay (ELISA). Twenty-nine proteins were successfully identified in maternal serum obtained from pregnancies with fetuses affected by DS. The top five proteins up-regulated were serotransferrin (TF), alpha-1b-glycoprotein (A1BG), desmin (DES), alpha-1-antitrypsin (SERPINA1) and ceruloplasmin (CP), while serum amyloid P-component (APCS) was the most down-regulated protein. These 29 proteins were categorized based on binding, catalytic activity and enzyme regulator activity. The biological roles were involved in biological regulation, metabolic processes, cellular processes and response to a stimulus. Based on ELISA, the median concentrations of CP and complement factor B (CFB) were 332.3 and 412.3 ng/mL, respectively. The concentrations of CP and CFB were significantly higher in the DS group than in the control group (P < 0.05). In conclusion, proteomic approaches offer the possibility of further improving the performance of DS screening and our identification of up- and down-regulated proteins may lead to new candidates for DS screening.

Unified prenatal screening for Down's syndrome and pre-eclampsia

Unified prenatal screening for Down's syndrome and pre-eclampsia

Assessment of sonographer nuchal translucency measurement performance – central tendency and dispersion

Objective. To assess center and sonographer nuchal translucency (NT) measurements that were performed as part of routine prenatal screening for Down syndrome.Methods. Sonographers were assessed for measures of central tendency and dispersion by comparing them with expected population median and dispersion parameters. NT measurements were converted to multiples of the expected NT values according to CRL (NTMoM) and transformed to their log10 equivalent (log10 NTMoM). Central tendency and measurement were assessed by checking whether the median of the NTMoM distribution and SD of the log10 NTMoM distributions were, respectively, within 5% or 10% of the expected median of 1 and SD of 0.1. Assessment was performed using both the Center specific and Fetal Medicine Foundation (FMF) reference NT for Crown rump length (CRL).Results. The median NT MoM was 0.95 MoM using the FMF reference and 1.01 MoM when assessed using our center specific reference median. The difference between the center and FMF derived NT MoMs was statistically significantly (p < 0.0001). NTMoM medians increased over time at a rate of 0.0099 MoM per year while log10 NT MoM measurement dispersement was similar to the 0.1 value expected and decreased by 0.0048 per year.Conclusion. Centers should routinely monitor the quality of NT measurements used to estimate Down syndrome screening risk and should provide individualized feedback to sonographers of their measures of central tendency and dispersion to ensure consistent and improved performance. NT reference medians adopted from other populations should be assessed and validated against a centers own measurement distribution.

Informed decision-making in prenatal screening for Down's syndrome: What knowledge is relevant?

Objective To determine the content of decision-relevant knowledge needed for informed decision-making about (non-) participation in prenatal screening for Down's syndrome (DS), in order to develop a knowledge questionnaire for routine application in large-scale programme evaluations. Methods A generic list of content domains for knowledge about screening was extracted from the literature. Items reflecting specific knowledge domains were constructed. An expert group of professionals and pregnant women expressed whether domains and items represented decision-relevant information. Results All presented domains were scored as (very) important. Options when receiving an ‘increased probability for DS’ test result, the meaning of this result, the aim of the screening, and voluntary nature of the test were scored as most important. The condition being screened for, prevalence, and the screening procedure were scored as relatively less important, with a high amount of expert consensus. Conclusion A knowledge measure for prenatal screening for DS was developed, based on domains and items acquired by expert consensus. Practice implications This measure of decision-relevant knowledge can be used in routine, large-scale evaluations of the procedure for offering information about prenatal screening for DS.

Dépistage prénatal de la trisomie 21 par les marqueurs sériques : expérience tunisienne

Maternal marker screening for Down's syndrome is based on an individual risk calculation obtained by weighting the risk due to maternal age by a factor linked to maternal serum markers. The maternal serum markers used in our study are alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG), previously known of their efficiency at the second trimester. The AFP and hCG were measured for 241 pregnant women, recruited in the maternity units of the center of Tunisia. The age of pregnancy was known for only 163 women. Using the 1/250 cut off for this double test, only one woman has presented a high risk for Down's syndrome (1/32). The foetal karyotyping was performed and chromosomal abnormality was confirmed. This computerized program allowed us to detect 7.46% of neural tube defects. In addition we found 3.7 % of cases with decrease of hCG demonstrating diminution of foetal viability. It would be desirable to generalize prenatal screening for Down's syndrome to all pregnant women regardless of their age through the use of serum markers in the maternal blood. The dissemination of this double test will limit the use of invasive examinations. Le principe du dépistage de la trisomie 21 fœtale par utilisation des marqueurs sériques au deuxième trimestre repose sur le calcul d’un risque individuel de trisomie 21 obtenu en pondérant le risque lié à l’âge maternel par un facteur lié aux concentrations de marqueurs présents dans le sérum maternel. Les marqueurs qui ont prouvé leur efficacité et qui ont été utilisé dans notre étude sont l’alphafœtoprotéine et l’hormone gonadotrophine chorionique. Deux cent quarante et une femmes enceintes recrutées dans les services de maternité de Sousse et de Monastir ont bénéficié du dosage de ces deux marqueurs sériques. Nous avons pu savoir l’issue de la grossesse chez uniquement 163 femmes. Grâce à ce double test et en fixant le risque seuil décidant ou non d’une amniocentèse à 1/250, nous avons observé un cas positif : une femme présentant un risque accru de trisomie 21 avec une valeur de 1/32 à laquelle a été proposé un caryotype ; celui-ci a confirmé l’existence de cette anomalie chromosomique (vrai positif). Ce même logiciel utilisé pour le dépistage de la trisomie 21 ; nous a permis de détecter chez 7,46 % des femmes un risque de défaut de fermeture de tube neural. 3,7 % des femmes ont présenté un taux faible de l’hormone gonadotrophine chorionique, ce qui est en rapport avec une diminution de la viabilité fœtale. À l’échelle nationale, il serait souhaitable de généraliser le dépistage prénatal de la trisomie 21 à toutes les femmes enceintes quel que soit leur âge grâce à l’utilisation des marqueurs sériques dans le sang maternel. La diffusion de ce double test limitera l’utilisation des examens invasifs.

How much do family physicians involve pregnant women in decisions about prenatal screening for Down syndrome?

To assess the extent to which family physicians (FPs) involve women in decisions about prenatal screening for Down syndrome. Based on transcripts of consultations between 41 FPs and 128 women, two raters independently assessed clinician's efforts to involve women in decisions about prenatal screening for Down syndrome using the French-language version of OPTION. Descriptive statistics of OPTION scores were calculated. Construct validity was assessed by performing a principal factor analysis and by measuring association with consultation duration and FPs sociodemograhics. Internal consistency was assessed with Cronbach's alpha and inter-rater reliability with the intraclass correlation coefficient. The overall mean OPTION score was low: 19 +/- 7 (range = 0 [no involvement] to 100 [high involvement]). One factor accounted for 80% of the variance. Both internal consistency and inter-rater reliability were very good (Cronbach's alpha = 0.73; ICC = 0.76). OPTION scores were lower for residents than for licensed FPs (17 +/- 5 vs 21 +/- 4; p = 0.02) and were positively associated with duration of consultation (r = 0.56; p < 0.001). Based on the French-language version of OPTION, which showed satisfactory psychometric properties, FPs studied put minimal efforts to involve women in decisions about prenatal screening for Down syndrome.

How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments

Medical specialists play a pivotal role in health innovation evaluation and policy making. Their influence derives not only from their expertise, but also from their social status and the power of their professional organisations. Little is known, however, about how medical specialists determine what makes a health innovation desirable and why. Our qualitative study investigated the views of 28 medical specialists and experts from Quebec and Ontario (Canada) on three controversial innovations: electroconvulsive therapy, prostate-specific antigen screening and prenatal screening for Down's syndrome. Our findings indicate that the scientific, clinical and social arguments of medical specialists combine to create a relatively consistent narrative for each innovation. Our comparative analysis suggests that these narratives bring about a 'soft' resolution to controversies, which relies on a more or less tacit understanding of the social desirability of innovations and which sets the stage for their routinisation. Such an unpacking of medical specialists' arguments both for and against new technologies is needed because such arguments may easily be considered authoritative and because there are few forums for debating the social desirability of innovations not generally deemed to be highly controversial.