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Higher incidence of birth defects may be linked to lower use
of prenatal testing in black and Hispanic women
Latinas and black women are much less likely to undergo
amniocentesis and chorionic villus sampling (CVS) to detect
chromosomal abnormalities than white and Asian women. Latinas
older than 35 years of age are three times more apt to give birth
to a Down syndrome-affected infant than white women, and black
women are nearly twice as likely to do so. These findings suggest
a causal relationship between use of prenatal testing and the
incidence of birth defects, concludes a study supported in part
by the Agency for Health Care Policy and Research (HS07373).
Miriam Kuppermann, Ph.D., M.P.H., and colleagues at the
University of California, San Francisco (UCSF), examined the
medical charts of 238 pregnant women 35 years of age and older
seen at UCSF in 1993 and 1994 to assess their use of prenatal
diagnostic tests. After adjusting for socioeconomic
characteristics, black women had one-third the odds of undergoing
prenatal diagnosis as white women, and Latinas had one-fourth the
odds. On the other hand, Asian women had nearly twice the chance
of undergoing prenatal testing as white women.
Regardless of race or ethnicity, women who were professionals or
students, or had partners who were professionals or students,
were significantly more likely to undergo prenatal diagnosis than
women who indicated that they or their partners were homemakers,
unemployed, or employed in blue-collar jobs. But even after
accounting for patient or partner occupation, black and Hispanic
women were less likely to receive prenatal diagnosis than white
or Asian women. This suggests that attitudes toward prenatal
testing, pregnancy termination, and/or raising a disabled child
may differ across these racial-ethnic groups, transcending
socioeconomic strata. Alternatively, black and Hispanic women may
not be receiving adequate, clearly understandable, and culturally
sensitive information about the possible ramifications and
outcomes of testing or not testing.
See "Racial-ethnic differences in prenatal diagnostic test use
and outcomes: Preferences, socioeconomics, or patient knowledge?"
by Dr. Kuppermann, Ph.D., M.P.H., Elena Gates, M.D., and A.
Eugene Washington, M.D., M.Sc., in the May 1996 issue of
Obstetrics & Gynecology 87, pp. 675-682.
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