Faced with potential exposure to Zika virus, most pregnant women desire additional clinical information in the form of repeat ultrasonography and amniocentesis, according to results of a patient survey. These findings highlight the importance of patient preferences in algorithms for managing exposure to Zika virus.
James M. Edwards, MD, of the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology at Duke University, presented results from the survey at the 37th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine held January 23 to 28, 2017, in Las Vegas, NV.
Guidelines from the Centers for Disease Control and Prevention (CDC) are rapidly evolving to keep pace with advances in the science of Zika virus transmission. Current CDC recommendations for pregnant women who may have been exposed to Zika virus include serum testing, serial ultrasonography screening, and consideration of amniocentesis. Although the CDC advocates testing, little is known about patient preferences regarding prenatal Zika virus screening and risk management.
“As providers, it is very easy for us to tell a patient what to do based on guideline recommendations,” said Edwards. “The challenge is to help the patient decide what she should do for herself and her family,” he said.
The study was designed to better understand the factors that contribute to patient decision-making regarding prenatal Zika virus screening and testing. In particular, Edwards and colleagues examined whether fear of the unknown played a role in patient preferences.
A total of 463 pregnant women participated in the study between June and July 2016. Most participants were born in the United States (87%), were Caucasian (71%), and aged between 26 and 35 years (67%).
The first step was to assess patient tolerance for uncertainty. Participants completed the 12-item Intolerance of Uncertainty questionnaire, a validated tool for gauging patient anxiety and discomfort around unknown outcomes. Patients who scored in the highest quartile of scores were classified as having a high tolerance for uncertainty (n = 133), whereas those scoring in the lowest quartile were classified as having a low tolerance for uncertainty (n = 120).
Next, the study participants considered 4 hypothetical scenarios that began with travel to an area of Zika virus transmission. Each scenario proceeded with increasing levels of risk based on serum test results and ultrasonographic findings at 18 weeks of gestation. Given the information provided in each scenario, the participants described their preferences for further prenatal screening, invasive testing, and pregnancy termination.
The survey results showed that most women desired further prenatal screening and testing across all clinical scenarios, regardless of their level of tolerance for uncertainty (Table).
Table. Patient Preferences Following Hypothetical Travel Exposure and Preliminary Screening Results According to Tolerance for Uncertainty
|Patient Preference||High Tolerance
(n = 133), %
(n = 120), %
|Scenario 1: Normal findings on US; serum results unavailable|
|Desires repeat US||80||90||.03|
|Desires no further testing||12||9||NS|
|Considers pregnancy termination||17||21||NS|
|Scenario 2: Microcephaly seen on US; serum results unavailable|
|Desires repeat US||89||92||NS|
|Desires no further testing||9||10||NS|
|Considers pregnancy termination||35||42||NS|
|Scenario 3: Normal findings on US; positive finding on serum study|
|Desires repeat US||95||95||NS|
|Desires no further testing||5||9||NS|
|Considers pregnancy termination||22||19||NS|
|Scenario 4: Microcephaly seen on US; positive finding on serum study|
|Desires repeat US||87||87||NS|
|Desires no further testing||14||12||NS|
|Considers pregnancy termination||36||51||.02|
NS = nonsignificant, US = ultrasonography.
Although most responses were consistent between the groups, women with a low tolerance for uncertainty were more likely to desire additional screening ultrasonography despite a low risk for Zika virus transmission (P = .03). In addition, women with a low tolerance for uncertainty were more likely to consider pregnancy termination when the risk of Zika virus transmission was high (P = .02).
“Patients are very anxious about Zika virus,” Edwards said. “Even in low-risk scenarios, patients want a lot of tests to be performed to help them understand what’s happening.”
In a separate study, the research team found a significant correlation between patient knowledge of Zika virus infection and their preferences regarding prenatal Zika virus screening and testing.
“Overall, our research shows that patient preferences for testing and diagnosis should factor strongly into Zika virus management algorithms,” Edwards said.
Source: Edwards J, Villers MS, Heine RP, Small MJ. Zika virus screening and testing: preferences for prenatal diagnosis and tolerance of uncertainty. Presented at: Society for Maternal-Fetal Medicine 37th Annual Pregnancy Meeting; January 23-28, 2017; Las Vegas, NV. Abstract 370.