Noninvasive prenatal testing and good motherhood

The study in the European Journal of Human Genetics conducted semi-structured interviews with 29 pregnant women who were offered NIPT as a first-tier screening test in the Dutch nationwide study TRIDENT-2.

“Women's views on responsible motherhood influence decision-making regarding participation in prenatal screening,” wrote the authors. “Previous studies showed that the probabilistic nature of the first-trimester combined test and the potential requirement for subsequent invasive diagnostics serve as legitimate reasons for women to exclude prenatal screening from their moral responsibilities.”

However, these moral barriers are perhaps less relevant today because of NIPT, according to the authors.

The women were recruited from 3 midwifery practices in the region of North Holland (Amsterdam and surroundings) and via snowball sampling. All participants were intermediate to highly educated Dutch women of no religious faith.

Among the 29 women who were offered NIPT between September 2017 and February 2018, 20 of them opted for NIPT screening (including 1 woman requesting first-trimester combined test [FCT] in addition to NIPT) and 9 women declined screening.

To avoid influencing the decision-making process, interviews were performed after participants had made their decision about prenatal screening for fetal aneuploidy.

The study found that despite the improved accuracy of NIPT, there is limited information to be gleaned from the technology. Participants reported that the lack of complete certainty about the health of the fetus was the No. 1 reason for considering the use of NIPT as morally obligatory.

The women also cited lack of preventive options, other than pregnancy termination, for the disorders targeted by NIPT.

Moreover, they noted the potential to obtain information about treatable abnormalities via the fetal anomaly scan (FAS), as well as parental autonomy to choose screening and give birth to a disabled child.

These findings support women's perspectives that NIPT is not an obligation of good motherhood; rather, acceptance of NIPT is considered to be a free decision, based on the information each woman needs to be a good mother for her child and her family.

Although none of the women reported costs as a reason for not choosing screening, they expressed concern that price might undermine a free decision for parents who lack financial resources.

Study results contradict the expectations of some other authors who believe the availability of NIPT will have an impact on the normative meaning of prenatal testing, thus causing women to perceive NIPT as a moral duty of good motherhood.

The current study indicates that women are not opposed to obtaining knowledge about the health of the fetus; in fact, they feel a moral responsibility to glean information that might improve the health of their child, including FAS.

One of the drawbacks of NIPT is that it cannot predict the severity or nature of a detected condition, according to the authors.

“Women's views may change when NIPT has expanded to include treatable or preventable conditions,” they wrote.

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Reference

Garcia E, Henneman L, Gitsels-van der Wal JT, et al. Non-invasive prenatal testing (NIPT) and pregnant women's views on good motherhood: a qualitative study. Eur J Hum Genet. Published online August 17, 2021. doi:10.1038/s41431-021-00945-3