Caughey Aaron B, Washington A Eugene, Kuppermann Miriam
Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Am J Obstet Gynecol. 2008 Mar;198(3):333.e1-8. doi: 10.1016/j.ajog.2007.09.045. Epub 2008 Feb 21.
The objective of the study was to identify correlates of perceived risk of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage among a diverse group of pregnant women.
We conducted a cross-sectional survey of 1081 English-, Spanish-, or Chinese-speaking women receiving prenatal care in the San Francisco Bay area. Perceived risk of procedure-related miscarriage or carrying a Down syndrome-affected fetus was assessed using a linear rating scale from 0 (no risk) to 1 (high risk). Bivariate and multivariable analyses were used to explore associations between maternal characteristics including age, race/ethnicity, and socioeconomic status and perceived risks of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage.
Women aged 35 years old or older had a higher perceived risk of Down syndrome than younger women (0.28 vs 0.22 on a scale from 0 to 1, P < .001) but a lower perceived risk of a procedure-related miscarriage (0.31 vs 0.36, P = .004). In multivariable linear regression analysis among women younger than age 35 years, the perceived risk of carrying a Down syndrome-affected fetus was higher in women who had not attended college (+0.06, P = .019) or had poor self-perceived health status (+0.08, P = .045). Latinas (+0.11, P = .008), women with an annual income less than $35,000 (+0.09, P = .003), and those who had difficulty conceiving (+0.09, P = .026) had higher perceived procedure-related miscarriage risk. Among women aged 35 years or older, perceived risk of carrying a Down syndrome-affected fetus was associated with the inclination to undergo prenatal diagnosis.
Women's perceived risks of carrying a Down syndrome-affected fetus or having a procedure-related miscarriage are associated with numerous characteristics that have not been shown to be associated with the actual risks of these events. These perceived risks are associated with prenatal diagnostic test inclination. Understanding patients' risk perceptions and effectively communicating risk is critical to helping patients make informed decisions regarding use of invasive prenatal testing.
本研究的目的是在不同的孕妇群体中确定怀有唐氏综合征胎儿或经历与手术相关流产的感知风险的相关因素。
我们对旧金山湾区1081名说英语、西班牙语或中文的接受产前护理的女性进行了横断面调查。使用从0（无风险）到1（高风险）的线性评分量表评估与手术相关流产或怀有唐氏综合征胎儿的感知风险。采用双变量和多变量分析来探讨包括年龄、种族/民族和社会经济地位在内的母亲特征与怀有唐氏综合征胎儿或经历与手术相关流产的感知风险之间的关联。
35岁及以上的女性比年轻女性怀有唐氏综合征的感知风险更高（在0至1的量表上分别为0.28和0.22，P <.001），但与手术相关流产的感知风险更低（0.31对0.36，P =.004）。在35岁以下女性的多变量线性回归分析中，未上过大学的女性（+0.06，P =.019）或自我感知健康状况较差的女性（+0.08，P =.045）怀有唐氏综合征胎儿的感知风险更高。拉丁裔女性（+0.11，P =.008）、年收入低于35,000美元的女性（+0.09，P =.003）以及那些受孕困难的女性（+0.09，P =.026）与手术相关流产的感知风险更高。在35岁及以上的女性中，怀有唐氏综合征胎儿的感知风险与接受产前诊断的倾向有关。
女性怀有唐氏综合征胎儿或进行与手术相关流产的感知风险与许多尚未被证明与这些事件的实际风险相关的特征有关。这些感知风险与产前诊断测试倾向有关。了解患者的风险认知并有效沟通风险对于帮助患者就是否使用侵入性产前测试做出明智决策至关重要。
