Research
Obstetrics
Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter?

Presented at the Joint Meeting of the Pediatric Academic Societies and Asian Society for Pediatric Research, Denver, CO, April 30-May 3, 2011, and at the 6th Congress and Exhibition of the Joint Societies of Pediatric Radiology (International Pediatric Radiology Congress), London, England, UK, May 27-31, 2011.
https://doi.org/10.1016/j.ajog.2012.01.026Get rights and content

Objective

We sought to characterize practices and attitudes of maternal-fetal medicine (MFM) and fetal care pediatric (FCP) specialists regarding fetal abnormalities.

Study Design

This was a self-administered survey of 434 MFMs and FCPs (response rate: MFM 60.9%; FCP 54.2%).

Results

For Down syndrome (DS), congenital diaphragmatic hernia (CDH), spina bifida: MFMs were more likely than FCPs to support termination (DS 52% vs 35%, P < .001; CDH 49% vs 36%, P < .001; spina bifida 54% vs 35%, P < .001), and consider offering termination options as highly important (DS 90% vs 70%, P < .001; CDH 88% vs 69%, P < .001; spina bifida 88% vs 70%, P < .001). For DS only, MFMs were less likely than FCPs to think that pediatric specialist consultation should be offered prior to a decision regarding termination (54% vs 75%, P < .001). MFMs reported report higher termination rates among patients only for DS (DS 51% vs 21%, P < .001).

Conclusion

MFM and FCP specialists' counseling attitudes differ for fetal abnormalities.

Section snippets

Materials and Methods

The research team designed the survey with fieldwork conducted through self-administered mail survey and telephone reminders by Harris Interactive during the period Nov. 13, 2009, through Feb. 5, 2010. The study protocol, and instrument and recruitment materials were approved by the Children's Hospital Boston Clinical Investigation Committee.

Physician and practice characteristics

In all, 242 MFM and 192 FCP specialists completed the survey, yielding response rates of 60.9% and 54.2%, respectively. Table 1 shows physician characteristics. Compared to MFMs, FCPs were younger, more likely male, and more likely to work within nonprofit and/or academic centers.

MFM and FCP respondents did not differ significantly regarding political affiliation (MFM: 36% Democrat, 19% Republican, 31% independent vs 44%, 15%, 27%, respectively, for FCPs), religious affiliation (MFM: 22% Roman

Comment

This study characterized the practices of FCP specialists and MFM specialists and evaluated whether their counseling and recommendations differed for fetal abnormalities. We found significant differences between MFMs and FCPs in their clinical practices and many of their prenatal counseling attitudes. For each congenital condition studied, FCPs and MFMs differed significantly regarding their support for pregnancy termination, and the importance they ascribed to provision of information about

Acknowledgments

Survey review panel. Anne D. Lyerly, MD, Department of Social Medicine and Center for Bioethics, University of North Carolina; James M. Perrin, MD, Division of General Pediatrics and Massachusetts General Hospital Center for Child and Adolescent Health Policy; Eric G. Campbell, PhD, Mongan Institute for Health Policy, Massachusetts General Hospital.

Other contributors. Sandra Applebaum, MS, led the fieldwork team from Harris Interactive and provided key assistance throughout this project.

References (53)

  • A. Carnevale et al.

    Counseling following diagnosis of a fetal abnormality: comparison of different clinical specialists in Mexico

    Am J Med Genet

    (1997)
  • L. Zahed et al.

    Attitudes towards prenatal diagnosis and termination of pregnancy among health professionals in Lebanon

    Prenat Diagn

    (2002)
  • D.C. de Silva et al.

    Attitudes toward prenatal diagnosis and termination of pregnancy for genetic disorders among healthcare workers in a selected setting in Sri Lanka

    Prenat Diagn

    (2008)
  • Foundation homepage

  • NAFTNet homepage

  • A. Comarow

    America’s best children’s hospitals

    US News & World Report

    (2009)
  • R.F. Antonak et al.

    Measurement of attitudes towards persons with disabilities

    Disabil Rehabil

    (2000)
  • M. Bell et al.

    Reactions to prenatal testing: reflection of religiosity and attitudes toward abortion and people with disabilities

    Am J Ment Retard

    (2000)
  • F.A. Curlin et al.

    Religion, conscience, and controversial clinical practices

    N Engl J Med

    (2007)
  • H. Drake et al.

    Attitudes towards termination for fetal abnormality: comparisons in three European countries

    Clin Genet

    (1996)
  • B. Lo

    Resolving ethical dilemmas

    (2009)
  • K.E. Ormond et al.

    Attitudes of health care trainees about genetics and disability: issues of access, health care communication, and decision making

    J Genet Couns

    (2003)
  • M. Rebagliato et al.

    Neonatal end-of-life decision making: physicians' attitudes and relationship with self-reported practices in 10 European countries

    JAMA

    (2000)
  • D.C. Wertz et al.

    Medical geneticists confront ethical dilemmas: cross-cultural comparisons among 18 nations

    Am J Hum Genet

    (1990)
  • M. Casper

    The making of the unborn patient: a social anatomy of fetal surgery

    (1998)
  • G. Lenard

    Ethical problems in prenatal diagnosis: pediatric considerations

    Brain Dev

    (1995)
  • Cited by (33)

    • Fetal Care Nursing—The Birth of a Specialty

      2023, Nursing for Women's Health
    • Opportunities to enhance parental well-being during prenatal counseling for congenital heart disease

      2022, Seminars in Perinatology
      Citation Excerpt :

      In the context of prenatal counseling, the communication and interpretation of information may be influenced by a range of explicit and implicit biases. Physicians, for example, have variable (and perhaps strong) attitudes towards pregnancy termination,46,47 and may also have differing opinions on the standard of care for some conditions,48-50 which may be based on institutional practices and outcomes, as well as personal or professional experiences.12 How physicians present information affects the choices their patients make,51 and communication regarding risk can affected by either inaccurate physician statements,52 or lack of understanding how the risk is presented (ie probability vs percentage, verbal vs numerical).53-55

    • Counselling in tuberous sclerosis complex: A survey on content and satisfaction in the Netherlands

      2020, European Journal of Paediatric Neurology
      Citation Excerpt :

      We can only speculate about factors involved, such as balancing the amount of information, knowledge and experience of doctors providing the information, and the age-dependent expression of the disease symptoms. Brown et al. reported significant differences in counselling about congenital foetal conditions between obstetricians and paediatricians in the United States, with respect to attitudes and practices around pregnancy termination and the counselling process [17]. Furthermore, recall bias might have played a role, especially in parents.

    • Mothers of a child with Down syndrome: A qualitative analysis of the perspectives on non-invasive prenatal testing

      2019, Midwifery
      Citation Excerpt :

      There are also concerns that in relation to its benefits, NIPT may become a routine aspect of Australian prenatal care with little counselling provided to mothers, leading to potentially uninformed decisions (Hui and Hyett, 2013; Minear et al., 2015). Prospective mothers are reliant on health professionals, such as midwives, and available supports to provide balanced and meaningful information about the implications of NIPT (Brown et al., 2012; Lawson et al., 2012; Summerfield, 2009), and on the overall experience of raising a child with DS (Pillay et al., 2012; Resch et al., 2010) to ensure informed decision-making processes (Hodgson et al., 2010; van den Heuvel et al., 2010). This impact of NIPT on the lives of mothers of a child with DS has generated international interest, with recent publications from Canada (Inglis et al., 2012), the US (Kellogg et al., 2014), South Africa (Scott et al., 2013) and The Netherlands (van Schendel et al., 2017; Verweij et al., 2013).

    View all citing articles on Scopus

    Additional contributors are listed in the Acknowledgments.

    This study was supported by grants from the Greenwall Foundation, the Kornfeld Program in Bioethics and Patient Care, the Harvard University William F. Milton Fund, the American Roentgen Ray Society Leonard Berlin Scholarship in Medical Professionalism, and a Faculty Career Development Award, Office of Faculty Development, Children's Hospital Boston (all to S.D.B.).

    The authors report no conflict of interest.

    Cite this article as: Brown SD, Ecker JL, Ward JRM, et al. Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter? Am J Obstet Gynecol 2012;206:409.e1-11.

    View full text