PREGNANT WOMEN’S ATTITUDES TOWARD AMNIOCENTESIS BEFORE RECEIVING DOWN SYNDROME SCREENING RESULTS Bojana Brajenovic ´-Milic ´ a *, Ivana Babic ´ b , Smiljana Ristic ´ a , Jadranka Vranekovic ´ a , Gordana Brumini b , and Miljenko Kapovic ´ a a Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Rijeka, Croatia b Department of Medical Informatics, School of Medicine, University of Rijeka, Rijeka, Croatia Received 2 May 2007; revised 5 October 2007; accepted 5 October 2007 Objectives. We sought to evaluate pregnant women’s knowledge about features of second- trimester screening for Down syndrome and to assess whether knowledge and educational level influence their attitude toward amniocentesis before receiving test results. Methods. Pregnant Caucasian women (n  300) <35 years old with no personal or family history of Down syndrome were surveyed. Women were randomized to 2 groups. One group of women (n  150) were surveyed by questionnaire before consultation with specially trained midwives; the other group of women (n  150) were surveyed after consultation. The questionnaire consisted of 3 sections: 1) participants’ demographic data, 2) knowledge about prenatal screening for Down syndrome, and 3) readiness to undergo amniocentesis if there was an increased risk of Down syndrome. Results. Women surveyed after consultation had greater total knowledge scores than those surveyed before consultation (p < .001). A statistically significant difference in knowledge scores in relation to educational levels was observed only in women who were surveyed before consultation (p  .007). Significantly more women were prepared to accept amniocen- tesis in the group surveyed after consultation (74%) than before consultation (53%; p < .001). Conclusion. Knowledge gained during a prescreening consultation influenced pregnant women’s attitudes toward further diagnostic investigation. A smaller proportion of women who were indecisive was observed in the group surveyed after prescreening consultation. Indecisiveness was not affected by poor knowledge about screening, but rather by difficulty in knowing how they will feel and what they will do if their screening result is positive. S econd-trimester maternal serum screening for Down syndrome has become a widely accepted component of antenatal care in many countries. Women who have positive results in the screening have the option of undergoing amniocentesis, a procedure that may cause miscarriage and could lead to planned termi- nation of affected pregnancies. Adequate prescreening education is important in enabling pregnant women to make informed decisions about Down syndrome screening and diagnostic testing (Priest et al., 1998). Many authors have studied factors that predict a woman’s decision to undergo prenatal screening and amniocentesis (Markens, Browner, & Press, 1999; Mar- teau et al., 1991; Mavrou, Metaxotou & Trichopoulos, 1998; Michie, Dormandy, & Marteau, 2003; Santalahti, Aro, Hemminki, Helenius, & Ryynänen, 1998; van den Berg et al., 2005b; Tercyak, Johnson, Roberts, & Cruz, 2001). The most frequently mentioned reason for un- dergoing screening is to gain knowledge or reassur- ance about the health of the fetus; the most frequent reason for choosing amniocentesis is to determine Supported by a grant (No. 062-0000000-1349) from the Ministry of Science, Education and Sports, Zagreb, Croatia. * Correspondence to: Professor Bojana Brajenovic ´-Milic ´, Depart- ment of Biology and Medical Genetics, School of Medicine, Univer- sity of Rijeka, Brac ´e Branchetta 22 51000 Rijeka, Croatia. Phone: 385-51-651 128; fax: 385-51-678 896. E-mail: bojana@medri.hr Women’s Health Issues 18 (2008) 79 – 84 Copyright © 2008 by the Jacobs Institute of Women’s Health. 1049-3867/08 $-See front matter. Published by Elsevier Inc. doi:10.1016/j.whi.2007.10.003