PRENATAL GENETIC TESTING - CONTENT OF DISCUSSIONS BETWEEN OBSTETRIC PROVIDERS AND PREGNANT-WOMEN

Objective: To document the content and accuracy of discussions about p renatal genetic testing between obstetric providers and pregnant women . Methods: The first prenatal visits of 169 pregnant women with 21 obs tetricians and 19 certified nurse-midwives were audiotaped and analyze d for whether a discussion of family history or genetic testing took p lace and if so, its length, content, and accuracy. Results: Family his tory was discussed in 60% of visits, maternal serum marker screening i n 60%, second-trimester ultrasonography for fetal anomalies in 34%, an d for women at least 35 years old, amniocentesis or chorionic villus s ampling (CVS) in 98%. The length of discussions of genetic testing ave raged 2.5 minutes for women younger than 35 years of age and 6.9 minut es for older women. Topics discussed most often were the practical det ails of testing, the purpose of testing, and the fact that testing is voluntary. Discussions seldom were comprehensive. Obstetricians were m ore likely to make a recommendation about testing than were nurse-midw ives and were less likely to indicate that testing is voluntary. Most women were satisfied with the amount of information, and the majority of women of advanced maternal age had made a decision about amniocente sis or CVS by the end of the visit. Conclusion: The information about genetic testing provided in the first prenatal visit is inadequate for ensuring informed autonomous decision-making. Guidelines addressing t he content of these discussions should be developed with input from ob stetricians, nurse-midwives, genetic counselors, and pregnant women. ( C) 1998 by The American College of Obstetricians and Gynecologists.