Psychological factors influencing choice of prenatal diagnosis in Chinese multiparous women with advanced maternal age

Objectives: To investigate the psychological predictors in Chinese multiparous pregnant women of advanced maternal age (AMA) for choosing aneuploidy screening or diagnostic testing. Methods: A total of 84 pregnant women of AMA were consecutively enrolled from Renming Hospital, Wuhan University. All participants completed three questionnaires: Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and Pregnancy Stress Rating Scale (PSRS). Demographic information and the choice of noninvasive prenatal testing (NIPT) versus invasive prenatal diagnosis (PND) were also collected. Results: Thirty-seven chose to have invasive PND, and 47 chose NIPT. Choosing invasive PND, as opposed to NIPT, was associated with lower educational background (chi(2) = -2.269, p = .023), higher SAS scores (47.62 +/- 7.96 versus 44.21 +/- 6.10, p = .029), and higher SDS scores (50.41 +/- 9.80 versus 45.96 +/- 11.05, p = .058). Logistic regression analysis further showed that the decisive predictors for invasive PND are SAS (OR =1.106, p = .008) scores, scores of factor 3 in PSRS and the stress from changes of shape and motility (OR =0.471, p = .038). Subgroup analysis showed that women with previous negative pregnancy experience had higher scores in factor 2-stress (guarantee of maternal-fetal safety: 1.96 +/- 0.63 versus 2.49 +/- 0.65, p = .004) and total PSRS scores (1.60 +/- 0.4 versus 1.83 +/- 0.31, p = .044) than those without. Additionally, unemployment post pregnancy was associated with marginally significant higher PSRS scores (p = .083). Conclusions: The decision for invasive PND might be swayed by anxiety and attenuated by pregnancy stress originating from worry about changes in fetal shape and motility (measured by SAS and factor 3 score of PSRS, respectively).