Harris, JM; (2015) Assessing the psychological impact and acceptability of a first-trimester screening test for pre-eclampsia. Doctoral thesis , UCL (University College London).

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Abstract

BACKGROUND: A first-trimester prenatal screening test for pre-eclampsia was launched in 2010. It differs from previously assessed prenatal screening tests. AIMS: (i) To assess the psychological benefits and consequences of providing a first trimester screening test for pre-eclampsia. (ii) To assess the acceptability of the test amongst pregnant women and healthcare professionals. METHODS: A mixed methods approach was taken. Five consecutive studies using primary and secondary data from UK pregnant women and their healthcare providers were conducted: (i) a systematic review, (ii) a qualitative study (pregnant women); (iii) a qualitative study (healthcare professionals); (iv) a case control study; (v) a discrete choice experiment. RESULTS: A first trimester screening test for pre-eclampsia has the potential to positively change health behaviours, but could also decrease self-monitoring. The impact appears to differ depending on whether the woman is concerned with the potential consequences to herself or her fetus. Health professionals are concerned with the clinical utility of the prenatal screening test, and on its potential to medicalise the pregnancy pathway. However, there does not appear to be an association between the amount of technological monitoring and birthplace preference. A discrete choice experiment showed overwhelming support for the introduction of this test. CONCLUSIONS: There is no evidence that this new prenatal screening test will cause harm to pregnant women. Women appear to welcome the additional information it provides. Receiving a positive pre-eclampsia screening test result presents potential opportunities for health-promotion interventions. To make the most of these opportunities, it will be important for clinicians to understand how women perceive and respond to this screening test; the self-regulation model provides a useful framework in which to do this. This work provides a framework for assessing the psychological impacts of the many emerging prenatal screening tests that lack a diagnostic test or risk-reduction intervention.

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