Health News Review

There’s a big change coming for pregnant women: Down syndrome testing no longer hinges on whether they’re older or younger than 35.

Our Review Summary

The story notes new screening guidelines and methods of detecting Down syndrome and other chromosomal abnormalities earlier in pregnancy. The story explains why pregnant women of any age may wish to be screened. The story does not provide enough information on the downside or risks of these earlier methods of screening, and genetic counseling, including counseling about the risks of screening, is not mentioned.  The story does not mention the cost of the early screening or multiple screenings, or if these are covered by health insurance.

The story engages in test mongering.  Testing for Down's syndrome may now be recommended for all pregnant women, regardless of age, but it does not always provide "peace of mind", as a positive result may mean a decision for more invasive testing and/or the decision to terminate a pregnancy.  Sources cited in the story may be [or are likely] biased towards screening [all/most] pregnant women for Down's syndrome and other chromosomal defects.  The story quotes ACOG committee members (ACOG established the new guidelines) and a physician affiliated with the March of Dimes. Not screening for chromosomal abnormalities during pregnancy is still an option for women, so a physician or patient could be cited to explain the rationale for this decision, providing some balance to the story.

The story does provide the rationale for the change in screening guidelines, that is, why age 35 is no longer a benchmark for determining who should receive screening for Down syndrome, but there is no quantitative evidence for the recommendations for earlier and wider  screening. In the context of the "testing is good" flavor, there needs to be some better sense of ability to find the target condition as well as risk of mis-labeling a normal pregnancy.

If screening is available, sonographer/physician skill and training have a large effect on reliability. This point is not addressed in the story. The story does not mention the rate of false negatives or false positives of newer methods of screening. The story also does not mention how many women have an amniocentesis after a positive result with the earlier screening. 

The story notes that a woman with a positive Down’s result who chooses not to terminate her pregnancy may need to plan for specialized care at birth based on further ultrasound evaluation of anatomy. Finally, the story does not mention that children and adults with Down's syndrome can lead full lives, despite having health and learning problems.


Criteria

Not Satisfactory

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of the early screening or multiple screenings. The story also does not mention if health insurance covers the cost of the newer methods of screening for Down syndrome.

Not Satisfactory

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story  only mentions that women will know earlier if her fetus shows signs of Down syndrome.  The story does not provide good data on the specificity of the earlier screening tests or how many women choose to end their pregnancies if they are given a positive result. The story does not provide enough information about benefits of screening, which need to be available to weigh in the context of cost, accuracy, and potential harms.

Not Satisfactory

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story minimizes the harms of testing. The story does list the risk of miscarriage with amniocentisis, but does not mention the risks with newer tests. The story does not provide much detail on the specificity of the newer tests, but says they are "80 percent accurate".  We are not told how this compares to older methods of screening. The story also does not mention the rate of false negatives or false positives of newer methods of screening, such as nuchal translucency.  The story says that earlier screening would provide women with "peace of mind", which may not be true in the case of a positive test. The decision to terminate a pregnancy–one option with a positive result–may be difficult for many women. This is not mentioned in the story.  The story only notes that women with a positive Down's screening will need to plan for specialized care at delivery. Specialized pediatric care and other support services may be needed long after delivery and the post-partum period.

Not Satisfactory

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story should be given credit for providing the rationale for the change in screening guidelines, that is, why age 35 is not longer a benchmark for determining who is screened for chromosomal abnormalities in pregnancy.  However, the story does not provide any quantitative evidence for the change in recommended earlier screening. In the context of the "testing is good" flavor, there needs to be some better sense of ability to find the target condition as well as risk of mis-labeling a normal pregnancy. The story does not mention the rate of false positives or false negatives with the newer, first-trimester screenings. The story also does not mention how many women have an amniocentesis after a positive result.

Not Satisfactory

Does the story commit disease-mongering?

Not Satisfactory

The story engages in test mongering.  Testing for Down's syndrome may now be recommended for all pregnant women, regardless of age, but it does not always provide "peace of mind" and a woman should know that a positive result would mean a decision for more invasive testing and possibly the decision to terminate a pregnancy. The article caught the cultural current that dictates that all biomedical information is good and of course everyone will want testing. It over-amplified the significance of the results.

Additionally, detection of Down syndrome does not mean a woman must terminate her pregnancy. The story does not mention that children and adults with Down's syndrome can lead full lives, despite having health and learning problems.

Not Satisfactory

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Sources cited in the story may be [or are likely] biased towards screening [all/most] pregnanct women for Down's syndrome and other chromosomal defects.  The story quotes ACOG committee members (ACOG established the new guidelines) and a physician affiliated with the March of Dimes. Not screening for Down's during pregnancy is still an option for women, so a physician or patient could be cited to explain the rationale for this decision, providing some balance to the story.

 

Not Satisfactory

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions earlier methods of screening, as well as amniocentesis for detecting Down's syndrome and other chromosomal abnormalities in pregnancy. However, the piece only partially fulfllls the criteria by listing or alluding to these tests, but does not attempt to provide any sense of direct comparison among options.

Satisfactory

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story notes that not all of the newer methods of early screening, such as nuchal translucency, are available in all hospitals, as they require specialized training. If screening is available, sonographer/physician skill and training have a large effect on reliability. This point is not addressed in the story.

Satisfactory

Does the story establish the true novelty of the approach?

Satisfactory

The story notes that screening guidelines for women younger than age 35 have changed.  The story also covers changes in recommendations as new, while pointing out that in some locations nuchal translucency has been in use for more than a decade.

Not Applicable

Does the story appear to rely solely or largely on a news release?

Not Applicable

The story conducts independent reporting and does not rely solely on a press release for information.

Total Score: 2 of 9 Satisfactory


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