PRENATAL TESTING FOR LIMB REDUCTION DEFECTS - HOW PATIENTS VIEWS AFFECT THEIR CHOICE OF CVS

OBJECTIVE: To determine the effect of reports and media coverage on ch orionic villus sampling (CVS) and limb reduction defects (LRD) on pati ents' utilization of CVS for prenatal testing for advanced maternal ag e and to quantitate the relation of preferences for CVS and amniocente sis (AMN) outcomes to test utilization. STUDY DESIGN: We compared CVS and AMN utilization rates in two groups of women seen at one academic medical center before and after publicity concerning CVS and LRD. We m easured preferences, in rating-scale units, for potential outcomes of prenatal testing in the after-publicity group. Relationships between p references and CVS utilization were examined using multivariate method s. RESULTS: The proportion of women utilizing CVS for prenatal testing declined significantly for the after-publicity group (23%) as compare d with the prepublicity group (47.4%, P = .0001). Belief that the birt h of It child with LRD after CVS was worse than a similar birth after AMN significantly reduced the odds of choosing CVS. A decrement in pre ference for a child with LRD after CVS of 5 rating-scale units reduced the likelihood of CVS by 15% (confidence interval [CI], 1-28%); a dec rement of 10 units reduced the likelihood of CVS by 28% (CI, 1-48%). T his effect persisted after adjustment for demographic and obstetric co variates, prior prenatal testing, locus of decision making (patient ve rsus physician or shared) and other maternal preferences for outcomes of prenatal testing. CONCLUSION: Lower patient preference for a child with LRD after CVS was an independent predictor of choosing AMN over C VS and was probably responsible for the significant de crease in CVS u tilization at our hospital.