Comparative Effectiveness, 2008
American College of Obstetricians and Gynecologists
AHRQ-funded research on women's preferences for prenatal testing helped to influence one of six clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The guidelines, published as a new Practice Bulletin, include a recommendation that invasive diagnostic testing should be available to all women, regardless of age.
Released in December 2007, the bulletin provides a series of guidelines to clinicians about the use of invasive diagnostic testing for aneuploidy, which is caused by an abnormal variation in chromosome number. In cases where the abnormality is an extra chromosome 21, the fetus will develop Down syndrome. Fetuses with aneuploidy also account for between 6 and 11 percent of all stillbirths and neonatal deaths.
AHRQ-funded research by Miriam Kuppermann, PhD, MPH, and Eugene Washington, MD, MPH, MSc, both Professors at the University of California-San Francisco, explored the effectiveness of tools that can help women and their health care providers make more informed decisions about invasive procedures and other health care services.
Building on previous research on communications between clinicians and minority populations facing decisions about invasive procedures, this work has sought to devise interventions that address patients' values, expectations, and interpersonal relationships.
The collaborative research by Kuppermann and Washington was "very helpful in deciding that invasive testing should be an option for all women," said James Goldberg, MD, medical director, San Francisco Perinatal Associates. He is one of the authors of ACOG's new clinical management guidelines.
ACOG recommends the following:
- Early amniocentesis (at less than 15 weeks of gestation) should not be performed because of the higher risk of pregnancy loss and complications compared with traditional amniocentesis (15 weeks of gestation or later).
- Amniocentesis at 15 weeks of gestation or later is a safe procedure. The procedure-related loss rate after mid-trimester amniocentesis is less than 1 in 300 to 500.
- In experienced individuals and centers, chorionic villus sampling procedure-related loss rates may be the same as those for amniocentesis.
- Invasive diagnostic testing for aneuploidy should be available to all women, regardless of maternal age.
- Patients with an increased risk of fetal aneuploidy include women with a previous fetus or child with an autosomal trisomy or sex chromosome abnormality; one major or at least two minor fetal structural defects identified by ultrasound; either parent with a chromosomal translocation or chromosomal inversion; or parental aneuploidy.
- Nondirective counseling before prenatal diagnostic testing does not require a patient to commit to pregnancy termination if the result is abnormal.
To determine adherence to the guideline, ACOG proposed measuring the percentage of pregnant women undergoing invasive testing who were counseled about the risks of the procedure.
Representing over 52,000 members, ACOG is a national medical organization that represents professionals who provide health care services to women. The group also develops and maintains clinical practice guidelines, patient education, and awareness of changing issues in women's health.
The guidelines can be downloaded from the December 2007 issue of Obstetrics & Gynecology, available by subscription at http://www.greenjournal.org/cgi/reprint/110/6/1459.
Impact Case Study Identifier: COE 08-08
AHRQ-Sponsored Activity: Research
Women's Health, Pediatrics,
Disparities, Health Literacy
Kuppermann M, Nease RF, Learman LA, Gates E, Blumberg B, Washington AE. Procedure-related miscarriages and Down syndrome-affected births: Implications for prenatal testing based on women's preferences. Obstetrics & Gynecology 2000; 96: 511-6. (HS10214, HS10856)
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