New guidelines urge every pregnant woman to get early testing for risk of Down syndrome

Our Review Summary

This story reports on a new American College of Obstetricians and Gynecologists (ACOG) recommendation that all pregnant women, regardless of their age, be offered screening for Down syndrome. This represents a departure from previous guidelines, which stated that only women 35 and older be offered testing. The new guidelines involve the use of less invasive techniques, a combination of a blood test and a new kind of ultrasound. This story does a good job of describing what is involved with the new screening and why it is being promoted, and featuring a woman who chose testing. However, the story lacks balance by not presenting the evidence to support the new screening, by not mentioning the potential harms, and by not quoting experts with differing views, or a woman who chose not to be tested.

The story does state that the new recommendations represent a departure from existing guidelines and does state that the availability of the new ultrasound may be limited to academic or large city hospitals. The story also mentions amniocentesis, chorionic villus sampling and the quadruple screen as alternatives. The story should have also pointed out that no screening remains a viable option. By accurately presenting the prevalence of Down syndrome, the story avoids disease mongering. Furthermore, the story does quote multiple experts, but the story should have quoted experts with differing opinions on the value of the new screening recommendations in order to provide some much needed perspective.

However, the story does not describe the strength of the available evidence. The story states that the new screening protocol is much more accurate, but there is no evidence presented to support these claims. Furthermore, although the story does state the "accuracy rate" for the new twofold screening protocol with and without the addition of the quadruple screen, there is no comparison to existing screenings such as amniocentesis. Furthermore, the more important information to give consumers would be the positive predictive value of the screening, or the probability of Down syndrome given a positive test result. This is especially important when the prevalence of Down is so low, causing most positive test results to be false positives.

The story also does not mention potential harms of treatment, such as anxiety from positive test results and the possibility that patients will fail to follow up on a positive initial screen. The story also fails to define the potential harm of providing false reassurance – the risk of false negative results, which is failing to identify an affected infant, which would be of concern to women who are seeking accurate answers. Finally, although the story does mention the cost of amniocentesis and chorionic villus sampling, the story does not mention the cost of the new twofold screening protocol. This is important information for consumers given that insurance may not cover the screening yet.