Grobman W A, Dooley S L, Welshman E E, Pergament E, Calhoun E A
Sections of Maternal-Fetal Medicine and Reproductive Genetics, Northwestern University Medical School Institute for Social Research and Health Policy Studies, Northwestern University, Chicago, Illinois, USA.
Prenat Diagn. 2002 Dec;22(13):1195-200. doi: 10.1002/pd.494.
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.
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.
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).
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.
比较孕妇对唐氏综合征患儿出生和流产的看法，并评估这些偏好对传统的35岁产妇年龄风险界限的影响。
对在大学医院接受产前护理的186名孕妇进行了访谈式调查。评估了按患者特征分层的对唐氏综合征患儿出生和妊娠流产的偏好（以效用值表示）。
随着临床严重程度从轻度（0.78）增加到重度（0.65），唐氏综合征患儿出生的效用值下降（p < 0.001）。妊娠流产的平均效用值为0.76 +/- 0.31。希望进行产前诊断的女性对流产的效用值（0.79 +/- 0.28）显著高于对严重程度未知的唐氏综合征患儿出生的效用值（0.73 +/- 0.27）。在多变量逻辑回归中，希望进行产前诊断是唯一与偏好流产而非患病患儿出生相关的因素（优势比2.26，95%置信区间1.03，4.96）。
希望进行产前诊断的女性并不认为唐氏综合征患儿出生和妊娠流产是同等的健康状况。这一发现对35岁产妇年龄标准的合理性提出了质疑，并表明在决定提供确定性产前诊断时应更好地纳入患者的实际偏好。
