Prenatal cytogenetic diagnosis: medical and social implications. Indications, acceptance by doctors and patients, impact and cost: a 10-year review

Prenatal cytogenetic diagnosis has been in widespread use for a decade, and access to it has been determined by medical attitudes towards what constitutes "high risk", and by pragmatic questions about the logistics of delivering a new diagnostic test to as many couples as costs will allow. The most common indication - advanced maternal age - has led to different access criteria in various parts of Australia. Factors such as socioeconomic status, education, and religion affect the acceptance of prenatal cytogenetic diagnosis from the point of view both of patients and of the doctors who care for them. Cost-benefit analyses conducted elsewhere indicate that, in purely monetary terms, it is probable that prenatal cytogenetic diagnosis is cost-effective if offered to all couples in which the woman is over the age of 32 years. An assessment of the impact of prenatal cytogenetic diagnosis on the birth incidence of major chromosomal abnormalities, particularly Down's syndrome, indicates that the maximum reduction which might be achieved in current practice is 30%.