Should Genetic Tests Be More Widespread?

CVS may carry a slightly higher risk of miscarriage than amniocentesis because the procedure is done in earlier in pregnancy. Infection is also a risk. Rare cases of defects in baby's fingers or toes have been reported, especially when CVS was done before nine weeks.

Should Genetic Testing Policies Be Changed?

Study authors do not recommend mandatory genetic testing, but rather point out that some of the current guidelines are arbitrary. A pregnant woman of 29 can get just as much benefit (without added cost) from testing as a 35-year-old woman.

"We are neither pushing for testing nor recommending withholding of testing," Kuppermann says. "It's a highly personal decision. We are simply saying the cost of the procedure not justify withholding it from any woman who wants to have the test."

Some question whether any real barrier to testing even exists. "Near as I can tell, there isn't a lot of preauthorization currently related to amniocentesis," says Susan Pisano of the American Association of Health Plans.

But some doctors are concerned about hidden costs.

"There is no estimate of the medicolegal costs," says John T. Repke, professor and chairman of the Department of Obstetrics and Gynecology at the Penn State College of Medicine in Hershey, Pa. "A public health policy change of this magnitude, introducing so many additional procedures, will undoubtedly result in procedure related complications, specimen mishandling, mis-diagnosis and the costs of litigation that will follow."

Some are also concerned that widespread genetic testing may create opportunities for abuse, such as parents selectively aborting a baby based on its gender.

But Kuppermann says her model is meant solely to update the cost/benefit analysis from the one was done in the 1970s so health-care experts could reevaluate their policies.

She concludes: "I think any woman who wants this kind of testing should be able to obtain it."

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