The effect of the introduction of prenatal diagnosis on the reproductive history of women at increased risk from neural tube defects

Abstract

The reproductive history of 45 couples at increased risk for neural tube defect (NTD) who came for genetic counseling in 1970 and 1971 were compared with a similar number counselled in 1975 and 1976, when prenatal diagnostic tests were freely offered. They were subsequently interviewed in their homes and had their reproductive history recorded to the end of 1973 and 1978, respectively. Nearly all had a previous child with an NTD and none were pregnant at the time of counseling. The effect of prenatal diagnosis was to speed somewhat the decision about further pregnancies, but the number of couples deciding on no further children and on having further pregnancies were almost identical in the 2 groups. The average number of pregnancies was 2.8/family, with only 1.2 surviving children. The pregnancy outcomes are discussed as are the reasons for not attempting further pregnancies in both groups, which included very high risk of recurrence, a surviving spina bifida child, inability to accept the tests or its implications. Of the 2nd group, 90% had tests. Their reactions to the tests were favorable but all complained of the waiting time between amniocentesis and obtaining the results. They all would have tests again in any future pregnancy. The reason for women not having prenatal diagnostic tests included inability to accept termination. Evidently couples in South Wales [UK] decide either to have no more children or to have further pregnancies regardless of tests, but tests speed a decision and enable the women to enjoy the pregnancy after obtaining the results, and an NTD greatly reduces the number of children per family. A termination for an NTD is much more acceptable to most than an NTD at term. The reasons for this are discussed.