Counseling often determines outcome after prenatal Dx

May 17, 2012

The decision to continue a pregnancy on the basis of diagnosed fetal conditions may depend on whether the physician counseling the parents is a maternal-fetal medicine or a fetal care pediatric specialist. More >>

Specialists differ widely on the decision to terminate a pregnancy based on the results of an in utero diagnosis of birth defects.

MFMs and FCPs agreed almost unanimously that providing clinical information about the birth defect was of high importance.

The decision to continue or terminate a pregnancy on the basis of diagnosed fetal conditions may depend on whether the physician counseling the parents is a maternal-fetal medicine (MFM) or a fetal care pediatric (FCP) specialist.

Researchers from several Boston-area hospitals sought to determine how counseling from MFMs and FCPs in the United States might differ and influence decisions made by parents concerning fetal conditions diagnosed in utero. They mailed a self-administered survey to a total of 870 physicians; 242 MFMs and 192 FCPs completed the questionnaire.

The findings, published in the American Journal of Obstetrics and Gynecology (2012;206[5]:409.e1-409.e11), indicate that significant differences exist between the 2 groups of specialists in their clinical practices and in many of their prenatal counseling attitudes.

For example, MFMs were more likely than FCPs to support termination for Down syndrome ([DS]; 52% versus 35%; P<.001), congenital diaphragmatic hernia ([CDH]; 49% versus 36%; P<.001), and spina bifida (54% versus 35%; P<.001).

When asked how strongly they would support or oppose a married couple’s decision to terminate a 19-week pregnancy with diagnosed DS, CDH, or spina bifida, MFMs were more likely than FCPs to support a decision to terminate the pregnancy for all 3 conditions.

More than 90% of MFMs and FCPs said that offering information about the clinical characteristics of the conditions is of high importance. For each condition, MFMs were significantly more likely than FCPs to respond that offering options for pregnancy termination at different stages of pregnancy is highly important (P<.001 for all).

Compared to MFMs, FCPs were significantly more likely to agree that pregnant women should consult with a pediatric specialist prior to deciding to continue or terminate a pregnancy with DS.

The groups didn’t differ significantly in political or religious affiliation or in their recommendations for intrauterine interventions, but FCPs were more likely than MFMs to be younger, male, and to work within nonprofit or academic centers.

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