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Better informed women chose fewer prenatal tests.


Pregnant women who used an interactive computer program to help them decide whether to undergo prenatal testing were 55% less likely to choose invasive testing than women who received standard prenatal care, even when they were offered free testing, researchers reported.

Women who used the computer program also were more likely to correctly estimate the risks of amniocentesis-related miscarriage and fetal trisomy 21, said Miriam Kuppermann, Ph.D., of the University of California, San Francisco, and her associates.

"If validated in additional populations, this approach may result in more informed and preference-based prenatal testing decision making and fewer women undergoing testing," the investigators said.

The multicenter study included 710 English- or Spanish-speaking women who were at 20 weeks' gestation or less.

A bilingual actress narrated the computer program, emulating a "warm and knowledgeable friend" and emphasizing "the personal nature of prenatal testing decisions," said the researchers.

The control group received prenatal care based on current guidelines, and did not receive financial support for prenatal tests beyond their own insurance plans, the investigators added (JAMA 2014 Sept. 23 [doi: 10.1001/ jama.2014.11479]).

Medical record reviews showed that the intervention group was significantly less likely to pursue amniocentesis or chorionic villi sampling than was the control group (5.9% vs. 12.3%; odds ratio, 0.45; 95% confidence interval, 0.25-0.80).

In addition, computer program users were more than three times as likely to forego testing altogether and more than twice as likely to elect screening alone than to choose screening followed by invasive testing.

Although the computer program did not address cell-free DNA testing, the findings should extend to these tests because they cover the same conditions, the researchers said.

The intervention group also was more likely to correctly estimate the risk of amniocentesis-related miscarriage (73.8% vs. 59.0%; OR, 1.95; 95% CI, 1.39-2.75) and the age-adjusted chance of fetal trisomy 21 (58.7% vs. 46.1%; OR, 1.66; 95% CI, 1.22-2.28) than the control group, Dr. Kuppermann and her associates reported.


Key clinical point: Pregnant women who received interactive computerized guidance on prenatal testing were better informed, but less likely to choose invasive testing than women who received typical prenatal care.

Major finding: Women who received computerized guidance on prenatal testing were 55% less likely to choose invasive testing than women who received usual care, even when tests were offered without cost.

Data source: A randomized multicenter trial of 710 pregnant women in the San Francisco Bay area.

Disclosures: The National Institutes of Health and the March of Dimes Foundation funded the study. Dr. Kuppermann reported past research support from Ariosa Diagnostics, Verinata Health, and Natera. Two coauthors reported advisory or financial relationships with Verinata Health, Natera, Ariosa Diagnostics, and Cellscape. The authors disclosed no other financial conflicts.

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Title Annotation:OBSTETRICS
Author:Karon, Amy
Publication:OB GYN News
Date:Oct 1, 2014
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