Attitudes Toward and Uptake of Prenatal Genetic Screening and Testing in Twin Pregnancies
The rate of twinning is rising and since the introduction of non-invasive prenatal testing, interest in and uptake of genetic screening and testing in twin pregnancies has not been investigated. This study aimed to explore the attitudes toward and uptake of current prenatal genetic screening and diagnostic testing options for fetal aneuploidy in twin pregnancies. Women being seen for genetic counseling with twin gestations were recruited for participation in a descriptive study with questionnaire (n = 42) and semi-structured phone interview (n = 15). Women were significantly more in favor of screening than diagnostic testing (p = 0.049). Sixty-nine (n = 25) percent elected screening, while one participant had a diagnostic procedure. Women were interested in screening for preparation or reassurance despite having concerns about accuracy and uncertainty. Most women (86%) felt they would make the same decision in a singleton pregnancy. Despite this, 48% cited twin pregnancy as influential to some degree. Information learned from providers, past experiences, and family and friends were also cited as influencing and anchoring factors, suggesting that tailoring prenatal genetic counseling sessions for twins might parallel that of singletons. No significant differences between natural and assisted conception patients were found. Although it did not alter patient decisions, genetic counseling was used as a platform to raise concerns and gather information.
KeywordsPrenatal genetic counseling Prenatal genetic testing Twin pregnancies Attitudes Uptake
This research was conducted as an M.S. thesis project per the degree requirements at the University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences in the Genetic Counseling Program. We would like to thank the prenatal genetic counselors from UTHealth and Baylor College of Medicine who assisted with recruitment and data collection. Additionally, we would like to thank all of the patients for their time and participation in this research.
Compliance with Ethical Standards
Conflict of Interests
Kathryn M. Reese, Jennifer Czerwinski, Sandra Darilek, Anthony Johnson, Malorie Jones, and Claire N. Singletary declare that they have no conflict of interest.
Human Studies and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
No animal studies were carried out by the authors for this article.
- Cahill, A. G., Macones, G. A., Stamilio, D. M., Dicke, J. M., Crane, J. P., & Odibo, A. O. (2009). Pregnancy loss rate after mid-trimester amniocentesis in twin pregnancies. American Journal of Obstetrics and Gynecology, 200(3), 257 e251–257 e256. https://doi.org/10.1016/j.ajog.2008.09.872.CrossRefGoogle Scholar
- Centers for Disease Control and Prevention. (2015). Fertility Clinic Success Rates Report. Retrieved from https://www.cdc.gov/art/artdata/index.html.
- Lenis-Cordoba, N., Sanchez, M. A., Bello-Munoz, J. C., Sagala-Martinez, J., Campos, N., Carreras-Moratonas, E., & Cabero-Roura, L. (2013). Amniocentesis and the risk of second trimester fetal loss in twin pregnancies: Results from a prospective observational study. The Journal of Maternal-Fetal & Neonatal Medicine, 26(15), 1537–1541. https://doi.org/10.3109/14767058.2013.791271.CrossRefGoogle Scholar
- Malone, F. D., Canick, J. A., Ball, R. H., Nyberg, D. A., Comstock, C. H., Bukowski, R., Second-Trimester Evaluation of Risk Research, C, et al. (2005). First-trimester or second-trimester screening, or both, for Down’s syndrome. The New England Journal of Medicine, 353(19), 2001–2011. https://doi.org/10.1056/NEJMoa043693.CrossRefPubMedGoogle Scholar
- Taylor-Phillips, S., Freeman, K., Geppert, J., Agbebiyi, A., Uthman, O. A., Madan, J., Clarke, A., Quenby, S., & Clarke, A. (2016). Accuracy of non-invasive prenatal testing using cell-free DNA for detection of Down, Edwards and Patau syndromes: A systematic review and meta-analysis. BMJ Open, 6(1), e010002. https://doi.org/10.1136/bmjopen-2015-010002.CrossRefPubMedPubMedCentralGoogle Scholar