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Change in prenatal Down syndrome screening recommendations

Posted Sep 12 2008 12:00pm
The American College of Obstetricians and Gynecologists (ACOG) recently issued new guidelines regarding prenatal screening. The new recommendation is that all women--regardless of age--be offered prenatal testing for Down syndrome. Until now, more invasive diagnostic testing (amniocentesis and chorionic villi sampling, or CVS) was routinely offered to women starting at age 35. Age is no longer to be used as a cutoff for these tests; and ACOG anticipates that the availability of ultrasound testing will help decrease the use of invasive tests for prentatal diagnosis of Down syndrome. You can read more about the recommendation here.

I've written here before about the disability-rights critique of eliminating disability by preventing birth. With regard to Down syndrome, there are a few additional issues to consider. One is that some number of women will receive this test without really understanding ahead of time what they might be getting themselves into. A positive screening result would indicate a higher-than-average risk that the fetus has Down syndrome. This forces a choice of whether to pursue diagnostic testing. A positive diagnostic test then forces a decision about whether to continue the pregnancy, in light of this information.

I worry that testing will be ordered routinely--especially as less invasive options become available--and some doctors will not take the time to explain to women the choices they will face if the screen comes back positive.

And given that many, if not most, medical practitioners view abortion for Down syndrome as an appropriate choice, how will they guard against inappropriately influencing patients' decisions? A doctor I know once referred to abortion in this situation as "a no-brainer. " I wonder what, if anything, she would say about screening for Down's to a woman who's 15 weeks into her pregnancy.
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