In 2001, the Health Council reviewed several screening test methods. A triple test to be offered in

the second trimester of pregnancy was considered as a suitable risk assessment screening for both Down syndrome and neural tube defects and should be aimed at all pregnant women, regardless of age. According to the Heath Council, when certain conditions were met, such as an adequate procedure for informed consent, risk assessment #buy NVP-BSK805 randurls[1|1|,|CHEM1|]# for Down syndrome would be ‘such a superior alternative to the existing practice of maternal age-based screening that there should be no reason to delay its introduction any longer’. The Council argued that screening FG-4592 in vivo based on the triple test would lead to considerably fewer invasive tests and increased detection of Down syndrome pregnancies, while a far larger group would be allowed to benefit from having individual risk assessment. The introduction of screening for neural tube defects was considered a desirable step (Health Council of the Netherlands 2001, 28–29).

At the end of 2001, the Ministry of Health organised a Consultation round inviting several groups, such as obstetricians and patient representatives, to voice their opinions on serum screening (Toom and van Berkel 2003). In the same year, several obstetricians criticised the Health Council’s report in a medical journal. An important point of contention was that the birth prevalence of Down syndrome was higher in the maternal age group over 36 years of age. According to these obstetricians, by setting an age limit, potential psychological harm from screening younger women could be prevented (Hamerlynck and Knuist 2001). Another argument was that test characteristics

for the group of older women were better than for the group of younger women. The number of false negatives in women under 36 years of age was found unacceptably high: approximately half of the cases of Down syndrome in pregnancies of younger women would not be detected, thereby giving false reassurance. In addition, the false positives in the younger age group would require further www.selleck.co.jp/products/Gefitinib.html testing. Based on figures from the Health Council, the obstetricians calculated that via invasive testing about the same number of cases of Down syndrome would be detected (115) as healthy foetuses would be lost because of test-induced iatrogenic abortions (111). Medicalisation of pregnancy was deemed undesirable (Kleiverda and Vervest 2001). The Health Council Committee had based its arguments on calculations for all age groups together. Representatives of the Committee responded by stating that compared to the current age-related diagnostic testing, the total number of invasive tests would drop.