ABBY LIPPMAN AND RICHARD T. HULL
Researchers claim that prenatal diagnosis was first used for conditions generally regarded by physicians as serious and having no effective treatments. It is now available for conditions with little or uncertain impact on postnatal health and functioning; for conditions that will appear, if at all, only in adulthood; and for conditions for which treatment exists. The speed with which these new technologies have been adopted into clinical practice and the growing number of women to whom they are applied are staggering, and unfortunately there has been insufficient consideration of the many important issues implicit in, and raised by, their availability and use.
In North America, amniocentesis and chorionic villus sampling have been generally restricted for use by women whose age (usually thirty- five years and older, an arbitrary criterion) is said to put them at increased risk for Down syndrome and by women known to be at risk for having a child with some specific condition that can be diagnosed via fetal cells or amniotic fluid. Neither of the tests is done routinely among other groups of women. By contrast, almost all women experience another form of prenatal testing (even if it is not so labeled) when they receive what has become a seemingly ordinary part of prenatal care: ultrasound examination.
Maternal serum alpha-fetoprotein analysis, which is offered routinely in some U.S. states and Canadian provinces, is a screening, not a diagnos-