Prenatal screening for Down’s syndrome

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b140 (Published 13 February 2009) Cite this as: BMJ 2009;338:b140
  1. Zarko Alfirevic, professor of fetal and maternal medicine
  1. 1University of Liverpool, Liverpool Women’s Hospital, Liverpool L8 7SS
  1. zarko{at}liv.ac.uk

    A range of options that provide reliable and reproducible results is essential

    Screening for Down’s syndrome is the most controversial aspect of antenatal care offered to pregnant women, and it is a highly emotionally charged subject. In a recent editorial, two senior executives of Down Syndrome Education International claimed that current public health policies leading to an estimated annual loss of 400 normal fetuses to prevent the birth of 600 babies with Down’s syndrome were “shocking.”1 Both the estimated numbers and the tone of the statement were disputed by—among others—members of the editorial board of the journal published by Down Syndrome Education International.2

    Two BMJ papers provide additional information for the debate. In the first, Ekelund and colleagues (doi:10.1136/bmj.a2547) described real life data from Denmark after the introduction of the first trimester combined screening programme in 2005.3 In the second (doi:10.1136/bmj.b138), Gekas and colleagues calculated the cost effectiveness of 19 different screening algorithms using data generated by computer simulations.4

    Can prospective parents and clinicians make any sense of all this information? The language currently used to describe the …

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