ORIGINAL ARTICLE To Take or Not to Take Genetic Carrier Tests: Personal Characteristics Associated with Taking Recommended and Nonrecommended Tests Sivia Barnoy, 1 Lilian Zelikaman, 2 and Yoram Bar-Tal 1 Aims: Genetic testing has become a routine part of prenatal care, the test being offered according to ethnic origin. However, not all clients take the offered tests while others take unnecessary tests. The present study aimed at examining the effects of risk perception, hypochondria, trait anxiety, and attitudes to genetic testing on the uptake of genetic carrier tests. Methods: One hundred and six pregnant Israeli women completed a six-part questionnaire covering demographic details, hypochondria, trait anxiety, risk perception, attitudes, and the uptake of genetic carrier tests. The uptake of recommended and nonrecommended tests (according to origin) was analyzed separately. Results: Women underwent many unnecessary tests. The uptake of recommended and nonrecommended tests is highly intercorrelated. Attitude was the only predictor for taking the recommended tests, but attitudes, trait anxiety, and hypochondria predicted the uptake of nonrecommended tests. Risk per- ception was not significantly related to the dependent variables. Conclusions: Attitudes toward genetic testing is an important factor in the decision to take genetic carrier tests. It is important to understand the different causal factors for taking recommended and nonrecommended tests. Introduction G enetic testing has become a routine part of prenatal care, the rationale being either to identify an abnormal fetus and avoid the birth of a disabled child or to prepare for the birth of a sick child (Wang et al., 2004). In Israel, genetic carrier testing is offered prior to, or at the onset of, pregnancy. Some recessive genetic conditions are more prevalent in spe- cific ethnic groups, but those who do not belong to those ethnicities have extremely low chances of having an affected child. The Israeli Association of Medical Geneticists has published recommendations regarding the genetic carrier tests suggested to the public according to ethnic origin. These recommendations take into account the prevalence and se- verity of the disease in question (Ministry of Health, 2008). Yet, the final decision to take the test or not is the woman’s. In Israel, usually a health care worker informs clients as to the availability of tests. With this knowledge, couples apply to a clinic where specific genetic tests consistent with their ethnic origin (Ashkenazi Jews, North African–Middle Eastern Jews, etc.) are recommended. Other tests are offered universally regardless of origin. However, not all couples follow these suggestions: some women do not take the tests and others take even tests not recommended (according to their origin). When women do not take recommended tests they put themselves at risk of giving birth to a sick or disabled child, and when they take unnecessary tests they waste resources and cause system overload. The main objective of taking genetic carrier tests is to identify carriers for recessive diseases (an exception is Fragile- X, an X-linked dominant condition where the chances for an affected child may be as high as 25% for a female child and 50% for a male child, depending on the size of the permuta- tion). Carriers are not themselves sick, but when both spouses are carriers for the same disease they have a 25% risk of having a child affected by a genetic condition. This is why many couples take tests prior to or during pregnancy. The number of genetic carrier tests offered to the public is in- creasing rapidly. In Israel today more than 20 tests are avail- able, whereas when the data for this study was collected (2006) only 14 tests were on offer. Most studies conducted in Israel (Sher et al., 2003; Barnoy et al., 2006) and worldwide (Hartley et al., 1997; Colah et al., 2008) that examined the up- take of genetic carrier tests have focused on universally re- commended tests as being most indicative of uptake. The present study, by contrast, examined 10 tests, of which two were recommended to all parents and the rest according to ethnic origin. Genetic testing in Israel is not obligatory. The tests are ex- pensive and are not included in the basic basket of services 1 Nursing Department, School of Health Professions, Tel Aviv University, Tel Aviv, Israel. 2 Yizre’el-Afula Sub-District Health Office, Ministry of Health Afula, Afula, Israel. GENETIC TESTING AND MOLECULAR BIOMARKERS Volume 13, Number 4, 2009 ª Mary Ann Liebert, Inc. Pp. 453–458 DOI: 10.1089=gtmb.2008.0141 453