Working Paper: NBER ID: w16306
Authors: Eduardo Fajnzylber; Joseph Hotz; Seth G. Sanders
Abstract: Medical practitioners typically utilize the following protocol when advising pregnant women about testing for the possibility of genetic disorders: Pregnant women over the age of 35 should be tested for Down syndrome and other genetic disorders; for younger women, such tests are discouraged since they can cause a miscarriage. The logic appears compelling. The rate at which amniocentesis causes a miscarriage is constant while genetic disorders rise over a woman's reproductive years. Hence the potential benefit from testing - being able to terminate a fetus with a genetic disorder - rises with maternal age. We argue that this logic is incomplete. While the benefits to testing rise with age, so do the costs. While undergoing an amniocentesis always entails the risk of miscarriage of a healthy fetus, these costs are lower at early ages, because there is a higher probability of being able to replace a miscarried fetus with a healthy birth at a later age. We develop and calibrate a dynamic model of amniocentesis choice to explore this tradeoff. For parameters that characterize realistic age patterns of chromosomal abnormalities, fertility rates and miscarriages following amniocentesis, our model implies a falling, rather than rising, rate of amniocentesis as women approach menopause.
Keywords: Amniocentesis; Prenatal Testing; Decision Making; Maternal Age; Genetic Disorders
JEL Codes: J1; J13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Maternal age increases (J13) | Probability of choosing amniocentesis increases (J13) |
| Maternal age increases (J13) | Probability of chromosomal abnormalities increases (J11) |
| Maternal age increases (J13) | Costs associated with amniocentesis increase (J32) |
| Probability of chromosomal abnormalities increases (J11) | Perceived benefits of testing increase (H43) |
| Costs associated with amniocentesis increase (J32) | Perceived costs of testing increase (J32) |
| Maternal age increases (J13) | Rate of amniocentesis may decline (J13) |
| Costs associated with amniocentesis increase (J32) | Rate of amniocentesis may decline (J13) |
| Maternal age increases (J13) | Expected utility of undergoing amniocentesis changes (D81) |