TABLE 2.

Supplemental data

Theme	Illustrative quote
Perceptions of risk for a fetal genetic condition	“I felt like it was something I really did not need. So I wasn’t looking into it.” (100-03) “Fortunately, my partner and I were not genetic predisposed to what they were looking for either. So, we felt like ok, given our family history…” (50-09) “So my husband and I had decided that we did not want to go through with a lot of the testing we had available to us in terms of the blood work because were both healthy …” (120-06) “I knew it was required or highly recommended if you were over 35 and optional if you were younger and that’s pretty much it.” (120-03)
Considering risks of prenatal genetic screening and testing	“I just wanted something that was non-invasive that was not gonna be a health risk to me or the baby.” (30-10) “The NIPT testing was the big one- I think it was the amniocentesis was the other one and that was more like I really did not want to do it unless I absolutely had to just given the higher chances of risk involved with doing something like that versus the NIPT testing just drawing the blood form the mom’s arm and like the amniocentesis is more heavily involved for the child.” (120-06) “So I really had not thought about much about any kind of genetic testing except that (amnio) and I knew I would reject that (amnio) since it was invasive.” (10-15) “I think the risks for me were the most important like if they were an invasive procedure or not.” (10-15)
Financial risks as a component of decision-making	“It wasn’t gonna make a difference [for the pregnancy outcome. […] The cost of the testing alone is very expensive. […] So that kind of sealed my decision.” (30-09) “But I had to pay out of pocket for it then and so now and because I’m older, it was covered by my insurance, so it was like free to me. So why not just do it?” (30-11) “Not knowing exactly what the cost of the testing was going to be … We knew we were probably going to do it. We had made the decision going in that we were going to do it regardless, but that was one of the things that was kind of like, well, we are not exactly sure how much even before insurance paid in. Just not knowing we could be on the hook for this amount to this amount depending on this or that. That information wasn’t available.” (120-03) “One of the factors was like if insurance would cover it. That was a big factor of us getting it ‘cause I knew it was expensive.” (120-02) “It was a couple of things. One was insurance coverage just because we were not terribly worried about it but it was nice to have the peace of mind about it, the insurance coverage. And then the risk to the baby. I’d say were like the two main things.” (10-24)
Priorities at the first visit and challenges to developing a collaborative agenda	“This is my second pregnancy. The first pregnancy I believe they kind of went over everything but … being first time pregnancy and mom, a lot of it seemed kind of foreign.” (30-08) “I mean, when you first find out your pregnant, I do not think that that’s a thing that people think about… a possibility of any genetic issues.” (100-02) “When you are in the beginning of the pregnancy and you have to make all of those decisions and you are still all excited or maybe unsure, or like just getting use to this new part of your life, I think it can be like a lot of pressure to make all those decisions at once.” (10-02) “I think just continuing to keep it simple. I really think a handout, like I said just really simple and you could go over it together and ask any questions at that point. And making sure the doctor reiterates that it’s ok to ask questions ‘cause some people are nervous at that first appointment. Kind of a nerve-racking appointment for sure.” (120-02) “The first visit, I think you kinda just wanna know there’s a heartbeat is the big thing.” (10-11) “I was a bit surprised by the pregnancy even. Just because like the duration of my first pregnancy, like you know trying to have a baby and this one I was just a surprise … I was pregnant. […] I had a toddler so that was part of it. I do not know if I thought about too much in advance like with the first one [first pregnancy] […] cause I had a lot of other things going on.” (10-11) “You know when you are pregnant your brain’s not always working 100%.” (10-08)