Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained?

OBJECTIVES: To assess rates of informed choice among women offered non-invasive prenatal testing (NIPT) for aneuploidy as part of routine clinical care.

METHODS: A cross-sectional survey was conducted across 6 antenatal clinics in England. Women with a high risk (≥1/150) Down syndrome screening result were offered NIPT, invasive testing, or no further testing. Pretest counselling was delivered as part of routine care by the local maternity team. Women were given a questionnaire containing a measure of informed choice immediately after pretest counselling.

RESULTS: In total, 220 of 247 women completed the questionnaire. Seventy-six percent were judged to have made an informed choice, a significant decline from our previous study (89.0% vs 75.6%; χ2 (2) = 20.2, P < .001). Of those making an uninformed choice, 46% had insufficient knowledge, 19% had not deliberated, and 13% had made a value-inconsistent decision. Multivariate analysis showed women who were highly educated (OR, 4.33; 95% CI, 1.08-17.36) or had had screening in a previous pregnancy (OR, 0.24; 95% CI, 0.90-0.65) were significantly more likely to make an informed choice.

CONCLUSIONS: The findings highlight the challenges of ensuring informed choice in routine prenatal care where NIPT is not discussed at multiple points, less time is available for counselling, and written consent is not required.