Grinshpun-Cohen Julia, Miron-Shatz Talya, Berkenstet Michal, Pras Elon
The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel ; Center for Medicine in the Public Interest, New York, NY USA.
Isr J Health Policy Res. 2015 Aug 17;4:23. doi: 10.1186/s13584-015-0019-6. eCollection 2015.
A primary goal of amniocentesis is the detection of trisomy 21 (Down syndrome- DS) in the fetus. This procedure involves a small risk of miscarriage. As the risk of DS increases with maternal age, screening tests (maternal serum triple test and others) and age are used to generate a risk assessment, and amniocentesis is offered to women with high risk. In Israel, amniocentesis is government funded for women of advanced maternal age (AMA, i.e., ≥35 years), even if their risk assessment is low. The purpose of this study was to explore the reasons AMA women undergo amniocentesis, their knowledge about risk estimates, and to evaluate whether their decision is informed.
Shortly after undergoing amniocentesis, 42 consecutive women without a medical indication for amniocentesis other than age, completed a questionnaire that assessed their knowledge and opinions regarding screening tests, pregnancy termination, amniocentesis risks and the factors that affected their decision.
Women rarely deliberated before undergoing amniocentesis. One third of those who had the screening test did not wait for the results before undergoing amniocentesis. Only one third of those who received the screening results remembered their risk estimation before going ahead with amniocentesis. Almost half (41 %) cited "age" as their main reason for undergoing amniocentesis, though only 44 % of these women could recall their age related DS risk. Sixty percent estimated their DS risk as low or very low but still had amniocentesis. Most participants (74 %) stated that they would consider termination of the pregnancy if the fetus was diagnosed with an intellectual deficit.
These results cast doubt on whether AMA women's decision to undergo amniocentesis is based on risk estimates, as women seem to disregard risk estimates, and sometimes not even wait for them when making the decision. The policy of funding amniocentesis solely on the basis of age may have led to the conception that being over 35 alone is sufficient reason to undergo amniocentesis. This finding should inform policy makers, as it raises questions about the link between public funding and the choices of individual women, and has implications for healthcare expenditures.
羊水穿刺术的主要目标是检测胎儿是否患有21三体综合征（唐氏综合征，DS）。该操作存在小流产风险。由于唐氏综合征的风险随孕妇年龄增加而上升，因此采用筛查试验（母血清三联试验等）和孕妇年龄来进行风险评估，并为高风险女性提供羊水穿刺检查。在以色列，高龄孕妇（AMA，即年龄≥35岁）的羊水穿刺检查由政府资助，即便她们的风险评估结果较低。本研究旨在探究高龄孕妇接受羊水穿刺检查的原因、她们对风险评估的了解情况，并评估她们的决定是否基于充分的信息。
42名除年龄外无羊水穿刺医学指征的孕妇在接受羊水穿刺检查后不久，完成了一份问卷，该问卷评估了她们对筛查试验、终止妊娠、羊水穿刺风险以及影响其决定的因素的了解和看法。
孕妇在接受羊水穿刺检查前很少进行深思熟虑。三分之一接受筛查试验的孕妇在未等待结果的情况下就进行了羊水穿刺检查。在接受筛查结果的孕妇中，只有三分之一的人在进行羊水穿刺检查前还记得自己的风险评估结果。近一半（41%）的孕妇将“年龄”作为接受羊水穿刺检查的主要原因，不过这些孕妇中只有44%能回忆起与年龄相关的唐氏综合征风险。60%的孕妇估计自己患唐氏综合征的风险为低或极低，但仍接受了羊水穿刺检查。大多数参与者（74%）表示，如果胎儿被诊断出智力缺陷，她们会考虑终止妊娠。
这些结果让人怀疑高龄孕妇接受羊水穿刺检查的决定是否基于风险评估，因为孕妇似乎忽视了风险评估，甚至在做决定时有时都不等候评估结果。仅基于年龄为羊水穿刺检查提供资金的政策可能导致一种观念，即仅年龄超过35岁就足以成为接受羊水穿刺检查的理由。这一发现应引起政策制定者的注意，因为它引发了关于公共资金与个体女性选择之间联系的问题，并对医疗保健支出产生影响。
