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Mellquist M, Hoedt M, Fusco KN, Alef R, Dittmer K, Ash H, Shoukat W, Fonteyn L, Herzstein S, Heineman A, Mayrovitz HN. Medical Implications of Restricting Abortions on Women Diagnosed With Fetal Anomalies Following the Overturn of Roe v. Wade: A Scoping Review. Cureus 2024; 16:e58994. [PMID: 38800251 PMCID: PMC11127699 DOI: 10.7759/cureus.58994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
This scoping review addresses the potential maternal health outcomes of abortion restrictions in the U.S. by studying and analyzing the reported effects of abortion bans or limitations globally. The goal was to examine the medical implications for pregnant women who are unable to abort fetuses that have severe medical anomalies due to imposed restrictions. EMBASE, Medline, and CINAHL databases were searched for studies published in English concerning the medical implications of abortion restrictions in any country prior to the overturn of Roe v. Wade in 2022. For the search criteria using Boolean operators, keywords included the terms "fetal anomaly," "abortion ban," and "implications." Inclusion criteria incorporated studies published between 1980 and 2021, and controlled experimental research studies aimed to evaluate interventions were excluded. This resulted in 469 records initially found. Duplicate records were removed, and two separate tier reviews were conducted. Eleven reviewers independently screened abstracts and titles of 332 records to ascertain eligibility. Eligibility included pregnant women diagnosed with fetal anomalies, women denied access to safe abortions, and the maternal and fetal medical impacts of this. Three reviewers in the second screening independently read 36 full articles to further assess eligibility, resulting in 14 articles in the final review. Findings from this study showed that abortion bans in countries around the world have led to health complications in women seeking illegal abortion services, a decline in maternal mental health, including stress and depression, various medical complications such as obstructed labor, and an increase in high-risk fetuses born with severe deficits. The findings of this review portend similar negative consequences to be experienced by women who are subject to stricter abortion laws in the U.S.
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Affiliation(s)
- Madison Mellquist
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Megan Hoedt
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Kellie N Fusco
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Rachel Alef
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Kaitlyn Dittmer
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Henry Ash
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Wamika Shoukat
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Lorenzo Fonteyn
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Salome Herzstein
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Allie Heineman
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Bakst S, Romano-Zelekha O, Ostrovsky J, Shohat T. Determinants associated with making prenatal screening decisions in a national study. J OBSTET GYNAECOL 2018; 39:41-48. [PMID: 30244627 DOI: 10.1080/01443615.2018.1463977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study sought to evaluate the associations between background exposures and psychological determinants, among postpartum Jewish and Arab women, relative to actual prenatal test endorsement. The independent and aggregative effects of contextual features and the subjective opinions and attitudes relative to a prenatal testing were evaluated, using logistic regressions. After accounting for contextual features, Jews with positive vs. negative opinions on screening were significantly more likely to undergo a prenatal screening. Specifically, having more favourable ideas on pregnancy termination, among Jews, was associated with a greater likelihood of triple test, nuchal translucency and ultrasound uptake as compared with those that refused. Similarly, Arabs who were more inclined to abort the pregnancy had a greater chance of using nuchal translucency and ultrasound vs. those that declined testing. As the preferences for prenatal test outcomes are multifaceted and vary according to population group, a better understanding of the factors involved in making testing choices could help ease the decision-making process. Impact Statement What is already known on this subject? The choice to undergo prenatal screening tests is influenced by various determinants, which include: social, demographic and emotional factors that vary by cultural preferences. Indeed, women integrate (subjective) beliefs and values that extend beyond rational (objective) reasoning when estimating whether or not to undergo testing. It may then be that, prenatal test choices might be, influenced less by actual risk status and more so by emotional factors. And while, the latter are more likely to be amendable, and thus influence changes in perception, the effect of psychological exposures on the decision making process in the genetic testing context, especially among Israeli Jews and Arabs, has been understudied. What the results of this study add? The current study extends the focus by addressing the role of evaluative beliefs and emotional factors involved with formulating prenatal screening judgments relative to actual testing among individuals with diverse profiles (Israeli Jews and Arabs). What was clarified was that background factors and psychological perceptions, such as having supportive attitudes on screening and a willingness to undergo abortion were, for the most part, related to prenatal test uptake. Concomitantly, these involve dense decision-making practices that can be difficult to approximate, as cultural settings and individual preferences often have an impact on intention-to-test. What the implications are of these findings for clinical practice and/or further research? Culturally appropriate counselling that would account for personal preferences alongside actual risk appraisals could enable pregnant women to make informed and autonomous prenatal testing choices. The integration of socio-demographics, psychological correlates and other contextual factors into a theoretical framework, studied uniquely by sub-populations, could enrich future research. Such research can, in turn, provide a clearer picture of the social need for genetic counselling, help customise local interventions, and on a broader scale inform national policy.
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Affiliation(s)
- Shelly Bakst
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel
| | - Orly Romano-Zelekha
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel
| | - Jenny Ostrovsky
- b Department of Community Genetics , Public Health Services, Tel Aviv University , Tel Aviv , Israel
| | - Tamy Shohat
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel.,c Department of Epidemiology, Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
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Goulart VV, Liao AW, Carvalho MHBD, Brizot MDL, Francisco RPV, Zugaib M. Intrauterine death in singleton pregnancies with trisomy 21, 18, 13 and monosomy X. Rev Assoc Med Bras (1992) 2016; 62:162-70. [DOI: 10.1590/1806-9282.62.02.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 11/22/2022] Open
Abstract
Summary A retrospective study from November 2004 to May 2012, conducted at the Obstetric Clinic of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), which included 92 singleton pregnancies with prenatal diagnosis of trisomy of chromosome 21 (T21), 18, 13 (T13/18) and monosomy X (45X), with diagnosis performed until the 26th week of pregnancy. The aim of the study was to describe the frequency and to investigate predictors of spontaneous fetal death (FD). Diagnosis (T21, n=36; T13/18, n=25; 45X, n=31) was made at a mean gestational age of 18.3±3.7 weeks, through chorionic villus biopsy (n=22,24%), amniocentesis (n=66, 72%) and cordocentesis (n=4, 4%). Major malformations were present in 45 (49%); with hydrops in 32 (35%) fetuses, more frequently in 45X [n=24/31, 77% vs. T21 (n=6/36, 17%) and T13/18 (n=2/25, 8%), p<0.001]. Specialized fetal echocardiography was performed in 60% (55/92). Of these, 60% (33/55) showed changes in heart morphology and/or function. Fetuses with T13/18 had a higher incidence of cardiac anomalies [60 vs. 25% (T21) and 29% (45X), p= 0.01]. FD occurred in 55 (60%) gestations, being more frequent in 45X [n=26/31, 84% vs. T21 (n=13/36, 36%) and T13/18 (n=16/25, 64%), p<0.01]. Stepwise analysis showed a correlation between hydrops and death in fetuses with T21 (LR= 4.29; 95CI=1.9-8.0, p<0.0001). In fetuses with 45X, the presence of echocardiographic abnormalities was associated with lower risk of FD (LR= 0.56; 95CI=0.27- 0.85, p=0.005). No predictive factors were identified in the T13/18 group. Intra- uterine lethality of aneuploid fetuses is high. Occurrence of hydrops increases risk of FD in pregnancies with T21. In pregnancies with 45X, the occurrence of echocardiographic changes reduces this risk.
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Maiz N, Burgos J, Barbazán MJ, Recio V, Martínez-Astorquiza T. Maternal attitude towards first trimester screening for fetal abnormalities. Prenat Diagn 2016; 36:449-55. [DOI: 10.1002/pd.4802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Nerea Maiz
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces, University of the Basque Country (UPV/EHU); Baracaldo Spain
| | - Jorge Burgos
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces, University of the Basque Country (UPV/EHU); Baracaldo Spain
| | - Maria José Barbazán
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces, University of the Basque Country (UPV/EHU); Baracaldo Spain
| | - Virginia Recio
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces, University of the Basque Country (UPV/EHU); Baracaldo Spain
| | - Txanton Martínez-Astorquiza
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces, University of the Basque Country (UPV/EHU); Baracaldo Spain
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Campaña H, Ermini M, Aiello HA, Krupitzki H, Castilla EE, López-Camelo JS. Prenatal sonographic detection of birth defects in 18 hospitals from South America. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:203-212. [PMID: 20103790 DOI: 10.7863/jum.2010.29.2.203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the accuracy of prenatal sonographic diagnosis of birth defects and the gestational age at detection according to the health insurance schemes of mothers in 450 malformed neonates from 18 South American hospitals on the basis of prenatal sonographic records. METHODS Between July 2000 and December 2003, 18 hospitals included in the Latin American Collaborative Study of Congenital Malformations (13 from Argentina [8 public and 5 nonpublic], 3 from Brazil [2 public and 1 nonpublic], 1 from Chile [nonpublic], and 1 from Venezuela [public]) voluntarily participated in this prospective observational study, recording fetuses with sonographically detected malformations. Prenatal sonographic descriptions of anomalies were compared with those recorded at birth. RESULTS Of 812 anomalies detected at birth, 457 had been prenatally detected (detection rate, 56.3%; 95% confidence interval, 52.8%-59.8%). Before 24 gestational weeks, anencephaly had the highest detection rate. Cleft lip and clubfoot were more easily detected when associated with other anomalies. The detection rates for central nervous system and renourinary malformations were greater than 80%. Detection rates between both health insurance schemes (public and nonpublic) did not show significant differences, but anencephaly, spina bifida, renourinary defects, and cleft lip with or without cleft palate were detected earlier in patients from nonpublic rather than in public hospitals. CONCLUSIONS For specific anomalies, South America shows similar levels of prenatal sonographic detection as developed countries. Detection rates during pregnancy were similar for public and nonpublic hospitals, whereas cases were diagnosed earlier in patients from nonpublic hospitals.
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Affiliation(s)
- Hebe Campaña
- Laboratory of Genetic Epidemiology, Instituto Multidisciplinario de Biología Celular, CC 403-1900 La Plata, Argentina.
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Ballantyne A, Newson A, Luna F, Ashcroft R. Prenatal diagnosis and abortion for congenital abnormalities: is it ethical to provide one without the other? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:48-56. [PMID: 19998163 DOI: 10.1080/15265160902984996] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms.
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Affiliation(s)
- Angela Ballantyne
- Donaghue Initiative in Biomedical and Behavioral Research Ethics, Interdisciplinary Center for Bioethics, Yale University/ISPS, 77 Prospect Street, New Haven, CT 06520, USA.
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Sperling D. From Iran to Latin America: must prenatal diagnosis necessarily be provided with abortion for congenital abnormalities? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2009; 9:61-63. [PMID: 19998166 DOI: 10.1080/15265160902939982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Daniel Sperling
- Federmann School of Public Policy and Government; Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel.
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Paolini CI, Gadow A, Petracchi F, Igarzabal L, Quadrelli R, Gadow EC. Prenatal screening for chromosome abnormalities in a region with no access to termination of pregnancy. Prenat Diagn 2009; 29:659-63. [PMID: 19360812 DOI: 10.1002/pd.2270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze the different variables that affect couples' decision-making about prenatal screening of chromosome abnormalities in a population with limited access to prenatal diagnosis and no legal termination of pregnancy (TOP). METHODS From February through August 2004, 79 couples who requested for prenatal screening at centers from Argentina and Uruguay participated in a study. A cross-sectional survey was administered to assess attitudes toward prenatal screening, the decision-making process, and knowledge and attitudes toward TOP. RESULTS Mean maternal age was 32.8 +/- 0.4 years. Among the couples, 88.61% knew that TOP due to fetal anomalies is not legal in their countries. When asked about the possibility of TOP in case of a serious fetal anomaly, 53% would contemplate this option. CONCLUSION Prenatal screening is a common practice worldwide. However, unlike most developed countries, our region has a limited access to prenatal diagnosis and no legal TOP. Those couples who stated that 'reassurance about fetal well-being' was the most important reason to perform prenatal screening had more positive attitudes toward TOP than those who considered this screening important 'to be better prepared to receive the baby'. Our findings can be used to inform and revise current health-care policies.
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Affiliation(s)
- Cynthia I Paolini
- Department of Psychiatry, Center for Medical Education and Clinical Research CEMIC. University Hospital, Buenos Aires, Argentina
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quadrelli R, Quadrelli A, Mechoso B, Laufer M, Jaumandreu C, Vaglio A. Parental decisions to abort or continue a pregnancy following prenatal diagnosis of chromosomal abnormalities in a setting where termination of pregnancy is not legally available. Prenat Diagn 2007; 27:228-32. [PMID: 17191256 DOI: 10.1002/pd.1651] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To learn about parental decisions to abort or continue a pregnancy after prenatal diagnosis of chromosomal abnormalities among the population in Uruguay. METHODS Between 1982 and 2003, 14 656 amniocentesis and 2740 chorionic villus samplings were performed in a referral Genetic Unit. Chromosomal anomalies were found in 376 cases (2.16%) and included Down syndrome, aneuploidies in which a severe prognosis was expected, sex chromosome aneuploidy and aneuploidies with a low risk of an abnormal clinical phenotype. The couples that received abnormal results were contacted by phone and asked if they had continued or interrupted the pregnancy after the diagnosis and genetic counseling. RESULTS We contacted 207 couples (55%). When confronted with Down syndrome or an aneuploidy in which a severe prognosis was expected, 89% and 96% of patients, respectively, decided to terminate the pregnancy. When confronted with sex chromosome aneuploidy or aneuploidies with a low risk of an abnormal clinical phenotype, 79% and 90% of patients, respectively, decided to continue the pregnancy. CONCLUSIONS The present study shows that when faced with an anomaly such as Down syndrome and aneuploidies in which a severe prognosis was expected, most of the couples decided to terminate the pregnancy, although TOP is not legally available in Uruguay.
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Affiliation(s)
- Roberto Quadrelli
- Instituto de Genética Médica, Hospital Italiano, Montevideo, Uruguay.
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