On being at higher risk: a qualitative study of prenatal screening for chromosomal anomalies.

This paper explores the meaning of higher risk status to women undergoing prenatal maternal screening for chromosomal anomalies. Quotations from lightly structured interviews and transcripts of pre-screening consultations in suburban London are used to illustrate pregnant women's diverse responses to the offer of screening, and to entering, living with and exiting from higher risk status. Some women reject screening in order to avoid the psychosocial and medical risks associated with higher risk status, or because they rule out pregnancy termination. They may question the risk selection implicitly built into the provision of preventative systems for some health problems but not others. Women who screen at higher risk may challenge this designation by questioning the system-specific probability used to separate them from the lower risk population. However, some experience distress even when they appreciate the precautionary basis on which their higher risk designation is based. They may find disengagement from higher risk status difficult after a diagnostic test has ruled out chromosomal anomalies. The findings highlight the complexity of communicating risk information to pregnant women and other screened populations, and emphasise the need to support those living with higher risk status and the benefits of keeping the time lived with this status as short as possible.