PARENT PREFERENCES AND PRENATAL TESTING FOR NEURAL TUBE DEFECTS
作者:
Fanny Ennever,
Lester Lave,
期刊:
Epidemiology
(OVID Available online 1995)
卷期:
Volume 6,
issue 1
页码: 8-16
ISSN:1044-3983
年代: 1995
出版商: OVID
关键词: prenatal diagnosis;alpha-fetoproteins;neural tube defects;prenatal ultrasonography;risk analysis;benefit-cost analysis
数据来源: OVID
摘要:
Previous analyses of prenatal screening for neural tube defects have generally found benefits to exceed costs. The usual screening battery follows an elevated maternal serum alpha-fetoprotein level with high-resolution ultrasound and/or amniocentesis. Current thinking focuses on weighing the risk of a false-negative (an abnormality missed) against the risk of an amniocentesis-induced fetal loss. This thinking neglects the risk of a false-positive (an unaffected fetus labeled abnormal) and individual parents' preferences concerning a false-negative vs a fetal loss. With these risks included, we find that high-resolution ultrasound is appropriate for all women with elevated serum alpha-fetoprotein. Women with moderately elevated serum alpha-fetoprotein who have negative ultrasound scans need no further testing, nor do women with highly elevated serum alpha-fetoprotein and positive ultrasound scans. Further testing using amniocentesis to confirm the ultrasound result is appropriate for women with moderately elevated serum alpha-fetoprotein and positive ultrasound scans, and for women with highly elevated serum alpha-fetoprotein and negative ultrasound scans. The actual cutoffs defining normal, moderately elevated, and highly elevated serum alpha-fetoprotein depend on several parameters, particularly the underlying prevalence of neural tube defects and the parents' preferences.
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