untitled

Abstract In this third year study, there are two parts: in the first part, we want to explore the effect of genetic counseling on helping pregnant women with abnormal fetus(es) (including chromosomal anomalies) to understand the informed consent and on alleviating anxiety of them. The subjects were 50 pregnant women who opted artificial abortion in delivery room in a medical center. Genetic counseling was provided to 28 women (experimental group) before answering the questionnaire whereas to 22 women control group after answering the questionnaire. More subjects in experimental group thought the inform consent providing complete information. The anxiety of experimental group is lower than the control group, but it is not statistically different in the statistics. In the second part, we interviewed 400 postpartum women to inquiry their experience of taking the maternal serum screening, ultrasound, amniocentesis. We also used Knowledge of Prenatal Screening and Diagnostic Tests and Women s Attitudes Towards the Pregnancy and the Fetus to understand the willingness of participating the prenatal screening and willingness-to-pay for the examination. In conclusion, genetic counseling can help the pregnant women to have more information for the abnormal prenatal diagnosis. Most of the postpartum women were satisfied to the informed consent given at outpatient clinic and would like to undergo prenatal serum screening as well as sonographic examination in their next pregnancy. Key words: prenatal diagnosis, antenatal maternal serum screening, ultrasound, artificial abortion, ethics I

II

III

1998 1995 Maternal Serum Screening Ultrasound amniocentesis 5-10% 1 2 2004 maternal-fetal attachment 1998 1993 1/5 1998 91-93 1 1

2 3 1 2 3 4 5 Ko et al., 1996 34 Kuller & laifer, 1996 Skidmore et al., 2003 1.18/1000 Lin, S.J. et al, 1995 1996 1993 1993 2000 12% Parker et al., 2003 Christian et al., 2000 Marteau et al., 2002 1 2 3 Lin et al., 1995 1991 2002 Rubin 1984 2

2004 1 93 12 1 94 6 30 22 28 2 400 1 State Trait Anxiety Inventory, STAI Spielberger 1970 Consulting Psychologists Press 50 6000 3

1 2 5 8 10 11 15 16 19 20 18 0 1-2 1 3-4 2 5-7 3 2 Reading AE, Cox DN, Sledmere CM, Campbell S 1984 Health Psychology: the Official Journal of the Division of Health Psychology, American Psychological Association 1 2 3 4 5 6 8 9 8 9 10 11 1 SPSS/PC 50 22 28 1 31.42 60% 34% 32% 4%~6% 33.46 64% 36% 50000-74999 75000-99999 25% 24999 6% 125000 6% 70% 1 N=50 n=22 (%) (n=28) (%) X 2 31.42 5.62 14 6 27.3 7 25.0 4

5 5 22.7 1 3.6 30 11 50.0 19 67.8 7.96 7 2 9.1 5 17.9 16 5 22.7 11 39.3 2 1 4.5 1 3.6 8 7 31.8 1 3.6 17 7 31.8 10 35.7 1.42 46 20 90.9 26 92.9 3 2 9.1 1 3.6 1 0 0 1 3.6 6.09 4 1 4.5 3 10.7 1 1 4.5 0 0 15 10 45.5 5 17.9 5 2 9.1 3 10.7 24 8 36.4 16 57.1 0.15 47 21 95.5 26 92.9 3 1 4.5 2 7.1 1.64 48 22 100.0 26 92.9 2 0 0 2 7.1 1.62 2 0 4.5 2 7.1 46 21 95.5 25 89.3 33.46 7.18 10 5 22.7 5 17.9 4 3 13.6 1 3.6 32 10 45.5 22 67.9 1 - N=50 n=22 (%) (n=28) (%) X 2 4.74 10 3 13.6 7 25.0 5 3 13.6 2 7.1 5

18 5 22.7 13 46.4 1 0 0 1 3.6 12 7 31.8 5 17.9 14.97 2 0 0 2 7.1 1 1 4.5 0 0 16 12 54.5 4 14.3 5 1 4.5 4 14.3 23 5 22.7 18 64.3 9.04 35 11 50 24 85.7 10 8 36.4 2 7.1 1 0 0 1 3.6 1 0 0 1 3.6 9.30 24,999 3 1 4.5 2 7.1 25,000-49,999 9 3 13.6 6 21.4 50,000-74,999 14 3 13.6 11 39.3 75,000-99,999 12 7 31.8 5 13.9 100,000-124,999 5 1 4.5 4 14.3 125,000 3 3 13.6 0 0 2 15 68.2%17 77.3% 3 13.6% 16 57.1%25 (89.3%) 6 21.4% 10 45.5% 6 27.3% 6 27.3% 11 39.3% 11 39.3% 4 14.3% 1 3.6% 10 45.5% 7 31.8% 5 22.7% 10 35.7% 14 50.0% 2 7.1% 1 3.6% 63.6% 85.7% X 2 =3.92 p 0.05 90.9% 27.3% 18.2% 100.0% 50.0% 25.0% 6

2 (N=50) n=22 (%) (n=28) (%) X 2 15 68.2 16 57.1 0.64 17 77.3 25 89.3 1.32 3 13.6 6 21.4 0.51 2.43 10 45.5 11 39.3 6 27.3 11 39.3 6 27.3 4 14.3 0 0 1 3.6 4.15 10 45.5 10 35.7 7 31.8 14 50.0 5 22.7 2 7.1 0 0 1 3.6 3.92 6 27.3 2 7.1 14 63.6 24 85.7 20 90.9 28 100.0 2.65 6 27.3 1 3.6 5.75 4 18.2 14 50.0 5.41 6 27.3 7 25.0 0.03 2 9.1 3 10.7 0.04 1 4.5 4 14.3 1.30 2.47 2 9.1 0 0 20 90.9 26 92.9 7

1.76 6 27.3 3 10.7 16 72.7 22 78.6 p<0.05 3 17 77.3% 10 45.9% 50 11.0% 2 9.1% 21 75.0% 20 71.4% 15 53.6% 8 28.6% 15 68.2% 7 31.8% 15 53.6% 13 46.4% 72.7% 89.3% 18.2% 57.1% X 2 =7.79 p<0.05 3 (N=50) n=22 (%) (n=28) (%) X 2 17 77.3 16 57.1 2.23 20 90.9 24 85.7 0.32 22 100.0 25 89.3 2.51 5 22.7 13 46.4 3.00 5 22.7 5 17.9 0.18 4 18.2 9 32.1 1.25 10 45.5 14 50.0 1.10 8

4 18.2 1 3.6 2.92 2 9.1 8 28.6 2.92 10 45.5 15 53.6 0.33 17 77.3 21 75.0 0.04 11 50.0 20 71.4 2.40 1 4.5 1 3.6 0.03 13 59.1 15 53.6 0.15 13 59.1 16 57.1 0.02 17 77.3 21 75.0 0.04 18 81.8 23 82.1 <0.01 6 27.3 15 53.6 3.50 3 13.6 4 14.3 <0.01 3 (N=50)- n=22 (%) (n=28) (%) X 2 4 18.2 9 32.1 1.25 5 22.7 2 7.1 2.49 15 68.2 15 53.6 1.10 7 31.8 13 46.4 1.10 5 22.7 12 42.9 2.23 9

4 18.2 3 10.7 0.57 3 13.6 1 3.6 1.70 8 36.4 10 35.7 0.01 5 22.7 4 14.3 0.60 4 18.2 16 57.1 7.79 16 72.7 25 89.3 2.29 1 4.5 0 0 1.36 1 4.5 4 14.3 1.19 4 18.2 12 42.9 3.09 18 81.8 24 85.7 0.01 p<0.05 State Trait Anxiety Inventory STAI 4 56.00 55.39 t 5 13.5 8.75 t 10

4 (N=50) n=22 n=28 t 3.09 0.68 3.36 0.91-1.14 3.09 0.75 3.36 0.78-1.22 2.59 1.01 2.29 0.98 1.08 5.91 20.81 1.11 0.31 1.22 3.82 0.50 3.75 0.52 0.47 2.55 0.80 2.14 0.85 1.71 6.55 20.66 1.96 0.74 1.18 3.86 0.35 3.79 0.50 0.62 2.55 1.06 2.43 1.14 0.37 3.73 0.55 3.82 0.48-0.65 3.59 0.59 3.43 0.74 0.84 2.09 0.87 2.00 0.90 0.36 1.73 0.88 1.39 0.57 1.63 1.91 0.97 1.39 0.57 2.35 3.91 0.29 3.82 0.48 0.76 8.32 20.25 3.96 0.19 1.14 2.82 0.96 2.43 1.14 1.29 1.50 0.60 1.11 0.31 2.99 4.00 0.00 3.93 0.26 1.28 4.00 0.00 3.93 0.26 1.28 56.00 11.35 55.39 8.41 0.22 5 (N=50) n=22 n=28 t 1.18 0.96 1.11 0.88 0.29 1.27 0.70 1.11 0.83 0.75 0.45 0.60 0.36 0.49 0.64 1.23 0.92 0.79 0.79 1.83 0.73 0.94 0.50 0.64 1.02 0.68 0.72 0.36 0.49 1.90 11

1.32 0.89 0.75 0.80 2.37 0.77 0.92 0.43 0.57 1.62 1.14 0.99 1.00 0.94 0.50 0.45 0.67 0.18 0.55 1.60 0.55 0.67 0.18 0.39 2.42 0.45 0.80 0.14 0.36 1.85 0.64 0.79 0.39 0.57 1.27 0.77 0.75 0.54 0.64 1.21 0.41 0.85 0.25 0.59 0.78 0.41 0.67 0.18 0,48 1.43 0.64 0.79 0.43 0.57 1.08 0.41 0.67 0.07 0.26 2.46 13.5 10.71 8.75 6.26 1.96 2 SAS/PC 3-5 400 6-1 6-3 35 300 75.0% 35 100 25.0% 31.74 / 77 19.5% 318 80.5% 35% 28.6 190 47.5% 210 52.5% 50,001-100,000 53.1% 100,001-150,000 24.3% 10 270 70% 10 116 30% 6-1 n % 75 19.0 243 61.5 / 74 18.7 3 0.8 0 0.0 0 0.0 16 4.1 12

137 35.0 112 28.6 37 9.5 86 22.0 3 0.8 24 6.9 2 0.6 154 44.1 61 17.5 0 0.0 108 31.0 20,000 1 0.3 20,001-50,000 57 14.3 50,001-100,000 212 53.1 100,001-150,000 97 24.3 150,001-200,000 19 4.8 200,000 13 3.3 6-2 n Mean SD 400 31.74 3.99 400 1.87 1.09 400 1.47 0.68 400 0.15 0.43 400 0.25 0.67 400 0.03 0.17 400 1.48 0.66 6-3 n % 35 300 75.0 35 100 25.0 13

/ 77 19.5 318 80.5 190 47.5 210 52.5 10 270 70.0 10 116 30.0 75.2% 98.7% 39.8% 7~ 7-4 393 99% 4 1% <35 67.9% 89.1% 35 100% 96% P=0.038<0.005/ 94.7% 100% P<0.05 99.5% 98.6% 10 98.5% 10 100% P=0.047 P=0.039 P<0.05 42 10.9% 35 29 10% 35 13 13.4% / 5 6.8% 37 12% 13.5% 8.4% 10 10.4% 10 11.5% 14

7 n % 4 1.0 393 99.0 1 273 69.5 1 358 91.1 1 197 50.1 1 335 85.2 1 206 52.4 1 42 10.9 1 7-1 <35 35 P-value n % n % 4 1.3 0 0.0 0.576 b 293 67.9 100 100.0 1 199 67.9 74 74.0 0.254 a 1 261 89.1 96 96.0 0.038 a 1 145 49.5 52 52.0 0.664 a 1 243 82.9 91 91.0 0.051 a 1 150 51.2 55 55.0 0.511 a 1 29 10.0 13 13.4 0.351 a 1 a Chi-Square test b Fisher's Exact Test 15

7-2 / P-value n % n % 4 5.3 0 0.0 0.001 b 72 94.7 316 100.0 1 48 66.7 222 70.3 0.551 a 1 59 81.9 293 92.7 0.004 a 1 28 38.9 167 52.8 0.033 a 1 52 72.2 278 88.0 <0.001 a 1 37 51.4 165 52.2 0.899 a 1 5 6.8 37 12.0 0.208 a 1 a Chi-Square test b Fisher's Exact Test 7-3 P-value n % n % 1 0.5 3 1.4 0.625 b 188 99.5 205 98.6 1 129 68.6 144 70.2 0.727 a 1 172 91.5 185 90.2 0.669 a 1 92 48.9 105 51.2 0.651 a 1 159 84.6 175 85.4 0.826 a 100 53.2 105 51.2 0.696 a 16

1 1 25 13.5 17 8.4 0.107 a 1 Chi-Square test Fisher's Exact Test 7-4 10 10 P-value n % n % 4 1.5 0 0.0 0.321 b 264 98.5 115 100.0 1 175 66.3 88 76.5 0.047 a 1 237 89.8 106 92.2 0.464 a 1 121 45.8 66 57.4 0.039 a 1 219 83.0 103 89.6 0.098 a 1 131 49.6 66 57.4 0.164 a 1 27 10.4 13 11.5 0.748 a 1 a Chi-Square test b Fisher's Exact Test 77.4%57.5% 341 85.7% 75.3% 61.5% 53.8% 57 14.3% 44.8% 33.3% 8 8 n % 308 77.4 17

229 57.5 43 10.8 67 16.8 42 10.6 57 14.3 341 85.7 7 12.1 13 22.4 0 0.0 26 44.8 19 33.3 183 53.8 128 37.7 163 47.9 80 23.5 209 61.5 256 75.3 18 5.3 9 9-4 383 98.5% 84.9% 21.7% 86 22.4% 6 1.5% 35 291 98.3% 35 92 98.9% 35 83.4% 23.4% 54 18.6% 1.7% 35 87.2% 16% 32 34% 1.1% / 74 98.7% 304 98.4% / 18

83.8% 17.6% 24 32.4% 1.3% 84.6% 22.5% 61 20% 1.6% 184 98.4% 199 98.5% 86.5% 19.5% 36 19.5% 1.6% 82.4% 23.5% 50 25.1% 1.5% 10 257 97.7% 10 113 100% 10 85.2% 20.5% 57 22.2% 2.3% 10 80.7% 20.2% 26 22.8% 0 p=0.002<0.05 p=0.021<0.05 1:270 298 82.8% 1:270 282 78.3% 5-10% 64 17.8% 1-2% 108 30.5% 35 1:270 228 82.3% 1:270 220 79.4% 5-10% 52 18.8% 1-2% 84 30.9% 35 1:270 70 84.3% 1:270 62 74.7% 5-10% 19

12 14.5% 1-2% 24 29.3% / 1:270 47 73.4% 1:270 31 48.4% 5-10% 11 17.2% 1-2% 22 34.4% 1:270 249 85.3% 1:270 249 85.3% 5-10% 52 17.8% 1-2% 85 29.7% 1:270 143 79.9% 1:270 141 78.8% 5-10% 33 18.4% 1-2% 49 28% 1:270 155 85.6% 1:270 141 77.9% 5-10% 31 17.1% 1-2% 59 33% 10 1:270 197 81.4% 1:270 183 75.6% 5-10% 41 16.9% 1-2% 62 26.2% 10 1:270 90 84.9% 1:270 89 84% 5-10% 18 17% 1-2% 41 39% 1:270 1:270 1-2% 20

p=0.017<0.05 9 n % 6 1.5 383 98.5 1 86 22.4 1 325 84.9 1 358 93.0 1 369 95.8 1 83 21.7 1 371 96.4 1 243 63.1 (>1:270) 1 270 75.0 (>1:270) 298 82.8 1 (<1:270) 1 352 97.8 (<1:270) 1 282 78.3 5-10% ( ) 1 64 17.8 50% ( ) 1 330 91.7 ( ) 1-2% 1 108 30.5 1 9-1 <35 35 n % n % P-value 5 1.7 1 1.1 0.999 b 291 98.3 92 98.9 21

1 54 18.6 32 34.0 0.002 a 1 242 83.4 82 87.2 0.380 a 1 269 92.4 89 94.7 0.460 a 1 280 96.2 89 94.7 0.554 b 1 68 23.4 15 16.0 0.129 a 1 280 96.2 91 96.8 0.999 b 1 180 61.9 63 67.0 0.367 a (>1:270) 1 217 78.3 53 63.9 0.008 a (>1:270) 228 82.3 70 84.3 0.668 a 1 (<1:270) 1 270 97.5 82 98.8 0.688 b (<1:270) 220 79.4 62 74.7 0.360 a 1 5-10% ( ) 1 52 18.8 12 14.5 0.367 a 50% ( ) 1 255 92.1 75 90.4 0.624 a ( ) 1-2% 1 84 30.9 24 29.3 0.781 a 1 a Chi-Square test b Fisher's Exact Test 9-2 / P-value n % n % 1 1.3 5 1.6 0.999 b 74 98.7 304 98.4 1 24 32.4 61 20.0 0.021 a 22

1 62 83.8 258 84.6 0.864 a 1 69 93.2 285 93.1 0.974 a 1 72 97.3 292 95.4 0.747 b 1 13 17.6 69 22.5 0.350 a 1 71 95.9 295 96.4 0.741 b 1 42 56.8 198 64.7 0.203 a (>1:270) 1 45 70.3 222 76.0 0.339 a (>1:270) 47 73.4 249 85.3 0.022 a 1 (<1:270) 1 60 93.8 288 98.6 0.038 b (<1:270) 1 31 48.4 249 85.3 <0.001 a 5-10% ( ) 1 11 17.2 52 17.8 0.906 a 50% ( ) 1 58 90.6 268 91.8 0.763 a ( ) 1-2% 1 22 34.4 85 29.7 0.465 a 1 a Chi-Square test b Fisher's Exact Test 9-3 P-value n % n % 3 1.6 3 1.5 0.999 b 184 98.4 199 98.5 1 36 19.5 50 25.1 0.183 a 1 160 86.5 164 82.4 0.272 a 23

1 174 94.1 184 92.0 0.430 a 1 176 95.1 193 96.5 0.503 a 1 36 19.5 47 23.5 0.335 a 1 178 96.2 193 96.5 0.882 a 1 120 64.9 123 61.5 0.494 a (>1:270) 1 136 76.0 134 74.0 0.670 a (>1:270) 143 79.9 155 85.6 0.149 a 1 (<1:270) 1 176 98.3 176 97.2 0.724 b (<1:270) 141 78.8 141 77.9 0.841 a 1 5-10% ( ) 1 33 18.4 31 17.1 0.745 a 50% ( ) 1 168 93.9 162 89.5 0.135 a ( ) 1-2% 1 49 28.0 59 33.0 0.311 a 1 a Chi-Square test b Fisher's Exact Test 9-4 10 10 P-value n % n % 6 2.3 0 0.0 0.184 b 257 97.7 113 100.0 1 57 22.2 26 22.8 0.894 a 1 219 85.2 92 80.7 0.276 a 1 240 93.0 106 93.0 0.989 a 24

1 246 95.3 111 97.4 0.568 b 1 53 20.5 23 20.2 0.936 a 1 247 95.7 112 98.2 0.359 b 1 161 62.4 74 64.9 0.644 a (>1:270) 1 186 76.9 78 73.6 0.511 a (>1:270) 197 81.4 90 84.9 0.429 a 1 (<1:270) 1 236 97.5 104 98.1 0.999 b (<1:270) 183 75.6 89 84.0 0.083 a 1 5-10% ( ) 1 41 16.9 18 17.0 0.993 a 50% ( ) 1 222 91.7 99 93.4 0.594 a ( ) 1-2% 1 62 26.2 41 39.0 0.017 a 1 a Chi-Square test b Fisher's Exact Test 300 75.2% 172 58.9% 9 3.1% 111 38% 24 8.7% 253 91.3% 10 10 n % 99 24.8 300 75.2 193 80.8 16 6.7 25

30 12.6 172 58.9 9 3.1 111 38.0 0 0.0 0 0.0 24 8.7 253 91.3 253 87.9% 219 75.5% 211 72.3% 250 85.3% 1 0.3% 6 2% 55.4% 42.9% 1.7% 46 15.7% 183 62.2% 62 21.1% 3 1% 11 11 n % 2 253 87.9 2 219 75.5 2 211 72.3 2 283 95.6 2 39 13.2 2 35 11.8 2 40 13.5 26

250 85.3 38 13.0 4 1.4 1 0.3 2 6 2.0 163 55.4 126 42.9 5 1.7 241 81.7 53 18.0 1 0.3 46 15.7 183 62.2 62 21.1 3 1.0 2 [ ] 77.3% 16.7% 2.9% 3.1% 10 2.6% 135 34.7% 8 2.1% 236 60.7% 19 5.1% 1,000 88 23.5% 1,001-2,000 114 30.5% 2,001-3,000 89 23.8% 3,001-4,000 10 2.7% 4,001-5,000 16 4.3% 5,001 38 10.2% 12 27

12 n % 296 77.3 64 16.7 11 2.9 12 3.1 10 2.6 135 34.7 8 2.1 236 60.7 188 50.0 175 46.5 2 0.5 1 0.3 1 0.3 9 2.4 147 41.2 161 45.1 7 2.0 3 0.8 8 2.2 31 8.7 12 ( ) n % 19 5.1 1000 88 23.5 1001-2000 114 30.5 2001-3000 89 23.8 28

3001-4000 10 2.7 4001-5000 16 4.3 5001 38 10.2 66.5% 94.5% 80.4% 81.2% 395 99.8% 85.1% 93.4% 1 0.3% 13 35 208 70% 35 56 56% p=0.01<0.05 13-1 / 76.3% 63.6% p=0.036 / 34.2% 51.7% p=0.006<0.05 13-2 13-3 10 44% 10 55.2% p=0.045<0.05 13-4 393 98.7% 54.2% 44.8% 1% 94.2% 5.8% 14 13 n % 1 264 66.5 1 190 47.7 1 376 94.5 1 320 80.4 1 323 81.2 1 0.3 395 99.8 1 336 85.1 29

1 369 93.4 1 201 50.9 1 369 93.4 1 13-1 <35 35 P-value n % n % 1 208 70.0 56 56.0 0.010 a 1 135 45.3 55 55.0 0.093 a 1 280 94.0 96 96.0 0.440 a 1 244 81.9 76 76.0 0.200 a 1 242 81.2 81 81.0 0.963 a 1 0.3 0 0.0 0.999 b 295 99.7 100 100.0 1 246 83.4 90 90.0 0.109 a 1 277 93.9 92 92.0 0.508 1 146 49.5 55 55.0 0.341 1 278 94.2 91 91.0 0.259 1 Chi-Square test Fisher's Exact Test 13-2 / P-value n % n % 1 58 76.3 201 63.6 0.036 a 1 26 34.2 164 51.7 0.006 a 1 70 92.1 301 95.0 0.401 a 30

1 55 72.4 260 82.0 0.058 a 1 59 77.6 260 82.0 0.380 a 1 1.3 0 0.0 0.194 b 75 98.7 315 100.0 1 67 89.3 266 84.4 0.281 a 1 72 96.0 292 92.7 0.303 a 1 41 54.7 157 49.8 0.453 a 1 71 94.7 293 93.0 0.607 a 1 Chi-Square test Fisher's Exact Test 13-3 P-value n % n % 1 134 70.5 130 62.8 0.103 a 1 93 48.9 97 46.6 0.645 a 1 181 95.3 195 93.8 0.509 a 1 154 81.1 166 79.8 0.755 a 1 158 83.2 165 79.3 0.329 a 1 0.5 0 0.0 0.475 b 187 99.5 208 100.0 1 161 86.1 175 84.1 0.672 a 1 171 91.4 198 95.2 0.157 a 1 89 47.6 112 53.8 0.228 a 1 173 92.5 196 94.2 0.546 a 1 Chi-Square test Fisher's Exact Test 31

13-4 10 10 P-value n % n % 1 183 68.3 73 63.5 0.360 a 1 118 44.0 64 55.2 0.045 a 1 251 93.7 111 95.7 0.431 a 1 210 78.4 98 84.5 0.167 a 1 212 79.1 99 85.3 0.152 a 1 0.4 0 0.0 0.999 b 266 99.6 115 100.0 1 226 85.0 98 85.2 0.949 a 1 250 94.0 108 93.9 0.978 a 1 131 49.2 63 54.8 0.321 a 1 247 92.9 109 94.8 0.486 a 1 Chi-Square test Fisher's Exact Test 14 n % 393 98.7 5 1.3 214 54.2 4 1.0 177 44.8 23 5.8 372 94.2 32

91.2% 83.5% 78.2% 1 58 14.7% 284 71.9% 53 13.4% 15 15 n % 2 353 91.2 2 323 83.5 2 304 78.2 2 376 96.2 2 76 19.4 2 70 17.9 2 67 17.1 342 86.6 47 11.9 6 1.5 0 0.0 2 1 0.3 287 72.8 107 27.2 0 0.0 0 0.0 340 86.3 54 13.7 0 0.0 0 0.0 33

58 14.7 284 71.9 53 13.4 0 0.0 2 [ ] 87.5% 12.3% 0.3% 61.6% 1,000 21.6% 1,001-2,000 1.3% 10,001 16 16 n % 349 87.5 49 12.3 1 0.3 0 0.0 0 0.0 1000 237 61.6 1001-2000 83 21.6 2001-3000 32 8.3 3001-4000 7 1.8 4001-5000 12 3.1 5001-6000 2 0.5 6001-7000 1 0.3 7001-8000 2 0.5 8001-9000 1 0.3 9001-10000 3 0.8 10001 5 1.3 387 99.5% 1% 34

383 99.2% 34 335 87.5% 189 59.8% 0.8% 98.1% 74.7% 31.2% 24 83.4% 86.6% 33.8% 35 34 83.9% 35 98% p<0.001 / 5.3% / 46.9% 62.1% p=0.047<0.05 10 88.7% 10 96.4% p=0.017<0.05 10 56% 10 72.3% p=0.007<0.05 17~17-4 17 n % 4 1.0 387 99.0 1 380 97.7 1 366 94.1 1 256 65.8 1 387 99.5 3 0.8 383 99.2 1 348 90.9 34 1 335 87.5 1 369 96.3 35

1 189 59.8 0 0.0 154 100.0 1 151 98.1 1 151 98.1 1 115 74.7 1 48 31.2 24 1 131 83.4 1 136 86.6 1 53 33.8 1 153 97.5 1 154 98.1 1 17-1 <35 35 n % n % P-value 4 1.4 0 0.0 0.576 b 288 98.6 99 100.0 1 283 97.9 97 97.0 0.700 b 1 270 93.4 96 96.0 0.347 a 1 188 65.1 68 68.0 0.592 a 1 287 99.3 100 100.0 0.999 b 2 0.7 1 1.0 0.999 b 285 99.3 98 99.0 1 256 89.8 92 93.9 0.230 a 34 1 239 83.9 96 98.0 <0.001 a 36

1 277 97.2 92 93.9 0.207 b 1 136 58.4 53 63.9 0.381 a 0 0.0 0 0.0-69 100.0 85 100.0 1 68 98.6 83 97.6 0.999 b 69 100.0 82 96.5 0.253 b 1 1 52 75.4 63 74.1 0.860 a 1 25 36.2 23 27.1 0.222 a 24 1 60 84.5 71 82.6 0.744 a 1 62 87.3 74 86.0 0.815 a 1 26 36.6 27 31.4 0.491 a 1 70 98.6 83 96.5 0.627 b 1 70 98.6 84 97.7 0.999 b 1 a Chi-Square test b Fisher's Exact Test 17-2 / n % n % P-value 4 5.3 0 0.0 0.001 b 71 94.7 311 100.0 1 70 97.2 305 97.8 0.678 b 1 67 93.1 294 94.2 0.782 b 1 43 59.7 209 67.0 0.242 a 1 70 97.2 312 100.0 0.035 b 1 1.4 2 0.6 0.467 b 71 98.6 308 99.4 1 63 88.7 282 91.6 0.453 a 37

34 1 61 85.9 271 88.0 0.633 a 1 66 93.0 299 97.1 0.152 b 1 23 46.9 164 62.1 0.047 a 0 0.0 0 0.0-29 100.0 125 100.0 1 29 100.0 122 97.6 0.999 b 29 100.0 122 97.6 0.999 b 1 1 19 65.5 96 76.8 0.208 a 1 6 20.7 42 33.6 0.176 a 24 1 26 83.9 105 83.3 0.943 a 1 26 83.9 110 87.3 0.568 b 1 7 22.6 46 36.5 0.142 a 1 30 96.8 123 97.6 0.999 b 1 31 100.0 123 97.6 0.999 b 1 a Chi-Square test b Fisher's Exact Test 17-3 n % n % P-value 0 0.0 4 1.9 0.126 b 184 100.0 203 98.1 1 182 98.4 198 97.1 0.508 b 1 174 94.1 192 94.1 0.979 a 1 118 63.8 138 67.6 0.422 a 1 184 99.5 203 99.5 0.999 b 2 1.1 1 0.5 0.602 b 179 98.9 204 99.5 38

1 161 89.9 187 91.7 0.559 a 34 1 152 84.9 183 89.7 0.158 a 1 176 98.3 193 94.6 0.053 a 1 92 60.1 97 59.5 0.910 a 0 0.0 0 0.0-54 100.0 100 100.0 1 52 96.3 99 99.0 0.281 b 51 94.4 100 100.0 0.042 b 1 1 38 70.4 77 77.0 0.367 a 1 11 20.4 37 37.0 0.034 a 24 1 48 87.3 83 81.4 0.343 a 1 46 83.6 90 88.2 0.419 a 1 20 36.4 33 32.4 0.612 a 1 55 100.0 98 96.1 0.298 b 1 55 100.0 99 97.1 0.552 b 1 a Chi-Square test b Fisher's Exact Test 17-4 10 10 n % n % P-value 4 1.5 0 0.0 0.320 b 259 98.5 114 100.0 1 255 98.1 111 96.5 0.465 b 1 245 94.2 107 93.0 0.659 a 1 165 63.5 81 70.4 0.190 a 1 258 99.2 115 100.0 0.999 b 2 0.8 1 0.9 0.999 b 39

257 99.2 112 99.1 1 228 88.7 108 96.4 0.017 a 34 1 221 86.0 102 91.1 0.175 a 1 246 95.7 109 97.3 0.565 b 1 117 56.0 68 72.3 0.007 a 0 0.0 0 0.0-89 100.0 58 100.0 1 88 98.9 56 96.6 0.562 b 88 98.9 57 98.3 0.999 b 1 1 66 74.2 42 72.4 0.815 a 1 25 28.1 20 34.5 0.411 a 24 1 76 82.6 49 84.5 0.764 a 1 80 87.0 49 84.5 0.671 a 1 28 30.4 20 34.5 0.605 a 1 89 96.7 57 98.3 0.999 b 1 90 97.8 57 98.3 0.999 b 1 a Chi-Square test b Fisher's Exact Test 159 39.8% 68.8% 16.9% 4.6% 6.5% 18.3% 18 18 n % 159 39.8 241 60.3 195 60.4 40

21 6.5 104 32.2 2 0.6 1 0.3 106 68.8 ( ) 26 16.9 7 4.6 10 6.5 28 18.3 140 90.9% 128 83.7% 129 83.8% 96.8% 1.3% 2.6% 19 19 n % 2 140 90.9 2 128 83.7 2 129 83.8 2 151 96.8 2 23 14.7 2 35 22.4 2 33 21.2 124 79.5 27 17.3 3 1.9 2 1.3 2 4 2.6 41

115 73.3 42 26.8 0 0.0 0 0.0 126 80.3 31 19.8 0 0.0 0 0.0 50 31.9 97 61.8 10 6.4 0 0.0 2 [ ] 59.3% 29.8% 9.6% 1.4% 8,000 1% 18,000 20 20 n % 211 59.3 106 29.8 34 9.6 5 1.4 1 7.1 42

1 7.1 3 21.4 5 35.7 7 50.0 7 50.0 1 7.1 0 0.0 14 4.2 2000 65 19.4 2001-4000 74 22.1 4001-6000 73 21.8 6001-8000 61 18.2 8001-10000 32 9.6 10001-12000 3 0.9 12001-14000 1 0.3 14001-16000 3 0.9 16001-18000 0 0.0 18001-20000 4 1.2 20001 5 1.5 104 82.85 24 17.13 36 27.45 44 38.27 80 21~21-4 21 n Mean SD Range 379 82.85 11.23 51~104 388 17.13 3.12 6~ 24 387 27.45 4.80 14~ 36 393 38.27 4.95 21~ 44 43

21-1 <35 35 P-value c n Mean SD n Mean SD 287 82.67 11.11 92 83.40 11.64 0.588 291 17.14 3.18 97 17.07 2.94 0.844 294 27.38 4.74 93 27.68 4.99 0.604 296 38.15 4.95 97 38.63 4.95 0.407 c Student s t test 21-2 / P-value n Mean SD n Mean SD 70 83.27 12.21 304 82.96 10.97 0.834 72 17.06 3.61 311 17.20 2.98 0.749 72 27.94 4.86 310 27.39 4.80 0.382 74 38.49 5.23 314 38.30 4.85 0.773 c Student s t test 21-3 P-value n Mean SD n Mean SD 182 81.86 11.18 197 83.76 11.22 0.100 184 17.18 3.01 204 17.08 3.22 0.751 187 27.05 4.77 200 27.83 4.81 0.109 190 37.79 4.94 203 38.71 4.93 0.067 c Student s t test 44

21-4 10 10 P-value n Mean SD n Mean SD 257 82.60 11.23 108 82.78 11.18 0.892 261 17.03 3.20 113 17.26 2.90 0.527 263 27.38 4.82 110 27.46 4.70 0.878 266 38.13 4.87 113 38.19 5.15 0.910 c Student s t test 70% Evans et al.,1998 45

1998 3(2) 101-107 2004 15(2) 209-217 1995 5(2) 224-225 2000 8(2) 177-189 2004 44 1-8 Cederbolm, M., Axelsson, O., & Sjoden, P. O. (1999). Women s knowledge, concerns and psychological reactions before undergoing an invasive procedure for prenatal karyotyping. Ultrasound in Obstetrics and Gynecology, 14, 267-272. Christian, S. M., Koehn, D., Pillay, R., MacDougall, A., & Wilson, R. D. (2000). Parental decisions following prenatal diagnosis of sex chromosome aneuploidy: a trend over time. Prenatal diagnosis, 20, 37-40. De Graaf, I. M., Tijmstra, T., Bleker, O. P., & Van Lith, J. M. M. (2002). Womens preference in Down syndrome screening. Prenatal diagnosis, 22, 624-629. Huang, L. H. (1994). Prenatal screening for high risk pregnancies. Journal of Genetics & Molecular Biology, 5(3), 61-65. Jallinoja, P., Santalahti, P., Toiviainen, H., & Hemminki, E. (1999). Acceptance of screening and abortion for Down syndrome among finnish midwives and public health nurses. Prenatal Diagnosis, 19, 1015-1022. Kaiser, A. S., Ferris, L.E., Pastuszak, A.L., Thomas, H.L., Johnson, J., Conacher, S., & Shaw, B.F. (2002). The effects of prenatal group genetic counseling on knowledge, anxiety and decisional conflict: Issues for Nuchal Translucency Screening. Journal of Obstetrics and Gynaecology, 22(3), 246-255. Larsen, T., Nguyen, T. H., Munk, M., Svendsen, L., & Teisner, L. (2000). Ultrasound screening in the 2 nd trimester. The pregnant woman s background knowledge, expectations, experiences and acceptances. Ultrasound in Obstetrics and Gynecology, 15, 383-386. 46

Lin, S. J., Huang, M.C., Chen, S.H., Tsai, C.J., & Shu, S.F. (1995). A follow-up study of genetic counseling in Down syndrome. Acta Paediatrica Taiwanica, 36(3), 192-196. Marteau, T.M., Johnston, M., Plenicar, M., Shaw, R.W., & Slack, J. (1988). Development of a self-administered questionnaire to measure women s knowledge of prenatal screening and diagnostic tests. Journal of Psychosomatic Research, 32(4), 403-408. Marteau, T. M., Dormandy, E., & Michie, S. (2001). A measure of informed choice. Health Expectations, 4, 99-108. Marteau, T. M., Nippert, I., Hall, S., Limbert, C., Reid, M., et al. (2002). Outcomes of pregnancies diagnosed with Klinefelter syndrome: the possible influence of health professionals. Prenatal Diagnosis, 22, 562-566. Michie, S., Dormandy, E., & Marteau, T.M. (2003). Informed choice: understanding knowledge in the context of screening uptake. Patient Education and Counseling, 50, 247-253. Parker, M. J., Budd, J. L. S., Draper, E. S., & Young, I.D. (2003). Trisomy 13 and trisomy 18 in a defined population: epidemiological, genetic and prenatal observations. Prenatal Diagnosis, 23, 856-860. Reading, A.E., Cox, D.N., Sledmere, C.M., & Campbell, S. (1984). Psychological changes over the course of pregnancy: A study of attitudes toward the fetus/neonate. Health Psychology, 3(3), 211-221. Skidmore, D. L., Pai, A. P., Toi, A., Steele, L., & Chitayat, D. (2003). Prenatal diagnosis of Apert syndrome: report of two cases. Prenatal Diagnosis, 23, 1009-1013. 47