Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy

Brian Shaffer, Aaron Caughey, Mary E. Norton

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Objective: To investigate the rate of pregnancy termination for various fetal aneuploidies, and to evaluate predictors of this choice. Methods: A retrospective cohort study identified all patients with any of seven common fetal aneuploidies (trisomies 21, 18, and 13; 45,X, 47,XXX, 47,XXY, and 47,XYY) at a referral prenatal diagnosis unit from 1983 to 2003. We abstracted type of aneuploidy, time and type of diagnostic procedure, maternal age, and ethnicity as predictors of the decision to terminate. Statistical comparisons were made using the chi-square test. Potential confounding variables were controlled for using multivariate logistic regression. Results: Overall, there were 833 patients who had fetuses with aneuploidy. In our study population, the overall rate of termination was 81%: 86% in cases of autosomal trisomy and 60% in cases of sex chromosome aneuploidy (SCA) (p <0.001). Rates were lowest in cases with the least severe prognosis, 47,XYY (57%) and 47,XXX (40%) compared with 45,X (65%) and 47,XXY (70%) (p = 0.05). Patients with SCA detected by chorionic villus sampling (CVS) had a higher termination rate than those who had undergone amniocentesis (77% vs 55%, p = 0.015). Increased maternal age was associated with higher termination rates in autosomal trisomy (88% vs 76% p <0.001) and a trend toward decreased rates in those with SCA (55% vs 71%, p = 0.06). Hispanic women were less likely to terminate pregnancy (69%, p = 0.01) than those from other racial/ethnic groups. Conclusion: Type and severity of aneuploidy, type of diagnostic procedure, maternal age, and ethnicity contribute to patients' decision-making in the setting of fetal aneuploidy.

Original languageEnglish (US)
Pages (from-to)667-671
Number of pages5
JournalPrenatal Diagnosis
Volume26
Issue number8
DOIs
StatePublished - Aug 2006
Externally publishedYes

Fingerprint

Aneuploidy
Pregnancy
Sex Chromosomes
Maternal Age
Trisomy
Chorionic Villi Sampling
Confounding Factors (Epidemiology)
Amniocentesis
Pregnancy Rate
Chi-Square Distribution
Down Syndrome
Prenatal Diagnosis
Hispanic Americans
Ethnic Groups
Decision Making
Fetus
Cohort Studies
Referral and Consultation
Retrospective Studies
Logistic Models

Keywords

  • Ethnicity
  • Pregnancy termination
  • Prenatal diagnosis
  • Sex chromosome aneuploidy
  • Trisomy

ASJC Scopus subject areas

  • Genetics(clinical)
  • Obstetrics and Gynecology

Cite this

Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy. / Shaffer, Brian; Caughey, Aaron; Norton, Mary E.

In: Prenatal Diagnosis, Vol. 26, No. 8, 08.2006, p. 667-671.

Research output: Contribution to journalArticle

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abstract = "Objective: To investigate the rate of pregnancy termination for various fetal aneuploidies, and to evaluate predictors of this choice. Methods: A retrospective cohort study identified all patients with any of seven common fetal aneuploidies (trisomies 21, 18, and 13; 45,X, 47,XXX, 47,XXY, and 47,XYY) at a referral prenatal diagnosis unit from 1983 to 2003. We abstracted type of aneuploidy, time and type of diagnostic procedure, maternal age, and ethnicity as predictors of the decision to terminate. Statistical comparisons were made using the chi-square test. Potential confounding variables were controlled for using multivariate logistic regression. Results: Overall, there were 833 patients who had fetuses with aneuploidy. In our study population, the overall rate of termination was 81{\%}: 86{\%} in cases of autosomal trisomy and 60{\%} in cases of sex chromosome aneuploidy (SCA) (p <0.001). Rates were lowest in cases with the least severe prognosis, 47,XYY (57{\%}) and 47,XXX (40{\%}) compared with 45,X (65{\%}) and 47,XXY (70{\%}) (p = 0.05). Patients with SCA detected by chorionic villus sampling (CVS) had a higher termination rate than those who had undergone amniocentesis (77{\%} vs 55{\%}, p = 0.015). Increased maternal age was associated with higher termination rates in autosomal trisomy (88{\%} vs 76{\%} p <0.001) and a trend toward decreased rates in those with SCA (55{\%} vs 71{\%}, p = 0.06). Hispanic women were less likely to terminate pregnancy (69{\%}, p = 0.01) than those from other racial/ethnic groups. Conclusion: Type and severity of aneuploidy, type of diagnostic procedure, maternal age, and ethnicity contribute to patients' decision-making in the setting of fetal aneuploidy.",
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