Volume 187 - Issue 9
Antenatal care implications of population-based trends in Down syndrome birth rates
Author: Michael D Coory
Med J Aust 2007; 187 (9): 543-544. || doi: 10.5694/j.1326-5377.2007.tb01406.x
Published online: 5 November 2007
Published online: 5 November 2007
In reply: The aim of our article was to assess trends in Down syndrome births by rurality and type of antenatal care provider.1 Whether to have prenatal screening is a decision for expectant parents. It has been argued that the availability of screening for Down syndrome means that expectant parents are confronted with unprecedented ethical dilemmas and responsibilities.2 However, the available evidence shows that expectant parents do not take decisions about Down syndrome screening lightly and, in particular, do not take the implications of a positive result lightly.3
We cited three analyses of the cost-effectiveness of Down syndrome screening, but could have cited several more, all of which use essentially the same methods. Our calculation of the absolute number of Down syndrome births (the number which might have occurred if screening rates had been lower) was a statistical analysis and carries no intrinsic ethical judgement. Others may choose to apply their own moral evaluation to it. Our only intention was to report the data as clearly as possible.
Several expert groups, including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists,4 recommend a population-based approach to Down syndrome screening. An important aspect of such population-based screening is to provide equal access for all expectant parents, regardless of where they live or who provides their antenatal care. Another is to provide clear information so that expectant parents can make their own well informed decisions.
References
- Coory MD, Roselli T, Carroll HJ. Antenatal care implications of population-based trends in Down syndrome birth rates by rurality and antenatal care provider, Queensland, 1990–2004. Med J Aust 2007 186: 230-234.
- Getz L, Kirkengen A. Ultrasound screening in pregnancy. Advancing technology, soft markers for fetal chromosomal aberrations, and unacknowledged ethical dilemmas. Soc Sci Med 2003; 56: 2045-2057. 0_i1091815
- Williams C, Sandall J, Lewando-Hundt G, et al. Women as moral pioneers? Experiences of first trimester antenatal screening. Soc Sci Med 2005; 61: 1983-1992. 0_i1091818
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Prenatal screening tests for trisomy 21 (Down syndrome), trisomy 18 (Edward syndrome) and neural tube defects. Melbourne: RANZCOG, 2007. 0_i1091820