All pregnant American women should be offered screening for Down syndrome in their first trimestre, not just over-35s, according to guidelines from the American College of Obstetricians and Gynecologists. Although women over 35 have a much higher chance of bearing Down syndrome children, younger women actually give birth to most of them. Appropriate counselling should be given to women if the test proves positive. If it is, most women abort the child. Hence, widespread screening will eventually eliminate most Down syndrome children.

The guidelines are already being followed in most academic centres, but not in private practices, especially smaller ones and those in rural areas. The reason for the change of policy lies in the greater safety and accuracy of the tests which are now available. In the past, confirmation of a Down syndrome diagnosis involved invasive tests which killed 1 in 200 foetuses. This risk has declined sharply over the past 10 years.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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