Pregnant patients' risk perception of prenatal test results with uncertain fetal clinical significance: Ultrasound versus advanced genetic testing

Abstract

Objective: A common concern of utilizing prenatal advanced genetic testing is that a result of uncertain clinical significance will increase patient anxiety. However, prenatal ultrasound may also yield findings of uncertain significance, such as 'soft markers' for fetal aneuploidy, or findings with variable prognosis, such as mild ventriculomegaly. In this study we compared risk perception following uncertain test results from each modality. Methods: A single survey with repeated measures design was administered to 133 pregnant women. It included 'intolerance of uncertainty' questions, two hypothetical scenarios involving prenatal ultrasound or advanced genetic testing, and response questions. The primary outcome was risk perception score. Results: Risk perception did not vary significantly between ultrasound and genetic scenarios (p=0.17). The genetic scenario scored a higher accuracy (p=0.04) but lower sense of empowerment (p=0.01). Furthermore, patients were more likely to seek additional testing after an ultrasound than after genetic testing (p=0.05). There were no differences in other secondary outcomes including perception of life-altering consequences and hypothetical worry, anxiety, confusion, or medical care decisions. Conclusions: Our data suggest that uncertain findings on prenatal genetic testing do not elicit a higher perception of risk or anxiety when compared to ultrasound findings of comparable uncertainty.