Awareness and attitudes of pregnant women about prenatal screening and diagnostic tests from Türkiye

Abstract

Prenatal screening and diagnostic tests are complex procedures that have to be conducted within a limited timeframe and require pregnant women to make rapid decisions. This study aimed to evaluate the knowledge and attitude of pregnant women by posing particular questions on screening and diagnostic tests, and to determine the correlation with sociodemographic and obstetric factors. A total of 259 pregnancies were enrolled to evaluate their knowledge of prenatal screening and diagnostic tests. Participants were categorized into groups and were presented with 5-point Likert-type questions. Based on the responses, each question was evaluated individually and scored. The mean age was 29.97 ± 5.63, the mean duration of marriage was 6.06 ± 5 years, and 32.8% of participants had a university degree or above. Among them, 52.1% (135/259) had not undergone prenatal screening tests. The percentage of recommended prenatal diagnostic testing was 37.1% (96/259). Demographic and obstetric characteristics were compared between those who underwent screening tests and those who did not. The percentage of screening tests was higher among employed women and those in consanguineous marriages. A statistically significant correlation was found between participants’ consent for diagnostic testing, gestational week, employment status, and the type of screening test administered (p < 0.05). Questionnaire scores were significantly higher in both screened and unscreened groups among those with a university degree or higher. These findings emphasize the importance of informing pregnant women effectively, which may be achieved through a well-organized counseling network.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12687-025-00821-3.

Introduction

The screening refers to the initial finding of an undiagnosed disease or condition by the use of tests, exams, or other procedures. The objective of this is to identify individuals who may physically seem healthy but could have an underlying disease or condition that might potentially develop into a disease. Individuals displaying positive or questionable findings are subsequently referred for additional assessment or therapy (Karakaya et al. 2020). Prenatal screening tests utilize biochemical markers from maternal serum and ultrasonographic measurements to assess the risks of aneuploidies such as trisomy 21 (Down syndrome), trisomy 18 (Edward syndrome), trisomy 13 (Patau syndrome), and open neural tube defects in the fetus during the prenatal period (Nicolaides 2003). Prenatal screening tests assess the probability of chromosomal abnormalities, and prenatal diagnostic testing provide a definitive diagnosis. The prenatal period involves the use of diagnostic techniques such as chorionic villus sampling (CVS), amniocentesis (AS), and fetal blood sampling (FBS) (ACOG 2007). These procedures pose the potential for fetal loss and infection due to their invasive nature. Hence, those who exhibit elevated risk identified by screening tests or abnormal ultrasound results frequently undergo diagnostic procedures. Other often seen symptoms include a previous diagnosis of a child with a chromosomal abnormality or a chromosomal abnormality in the individual themselves (ACOG 2007).

The duration of pregnancy is a narrow window of time to identify a condition in the developing fetus. It is important to individually assess each pregnancy, providing pregnant women with comprehensive information regarding screening tests, and promptly referring them to prenatal diagnostic tests if needed. There are studies that assess the awareness of pregnant women regarding prenatal screening and diagnostic tests in various countries (Öcal et al. 2016; Pop-Tudose et al. 2018; Case et al. 2007; Sadlecki et al. 2018). The common view is that acceptance of prenatal screening test and high awareness are related to education level (Öcal et al. 2016; Pop-Tudose et al. 2018; Case et al. 2007; Sadlecki et al. 2018). The objective of this study was to evaluate the knowledge and attitude of pregnant women by posing particular questions on screening and diagnostic tests, and to determine the correlation with sociodemographic and obstetric factors.

Methods

Study group

This study included 259 participants who were informed about the study and gave their consent among women who applied to the Obstetrics and Gynecology Outpatient Clinic of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine for follow-up between May 2022 and August 2022 and whose pregnancy was confirmed by ultrasound. Participants between 11 and 25 weeks of gestation who agreed to take part in the study were recruited consecutively using a non-random sampling method. Inclusion criteria were: confirmed viable intrauterine pregnancy, age ≥ 18 years, and willingness to provide informed consent. Women with severe mental or cognitive impairment, language barrier, or ongoing pregnancy complications requiring emergency intervention were excluded. Permission for the study was given by the ethics committee.

Assessment of participants and submission of forms

During the initial stage, we requested that all participants who consented to participate in the study complete a form (Form 1) that included questions on socio-demographic and obstetric characteristics such as age, educational background, occupation, underlying medical conditions, pregnancy history, and consanguinity. The participants were divided into three groups: those who underwent prenatal screening tests, those who did not undergo prenatal screening tests, and those who were recommended for prenatal diagnostic tests. The group recommended for prenatal diagnostic testing was divided into two groups: those who agreed to undergo the diagnostic test and those who did not.

In the second stage, participants who underwent a prenatal screening test were required to complete a 17-question form called Form 2 to evaluate their attitudes and knowledge regarding screening tests. Form 3, which consisted of four questions, was completed by patients who had not undergone a prenatal screening test to inquire about the reasons for their decision not to undergo a screening test. For patients who were recommended for a prenatal diagnostic test, a distinct form was completed, which stipulated the diagnostic test and its indications (Form 4). Indications for recommending diagnostic tests included ultrasonographic detection of fetal anomalies, high-risk screening test results, and history of a child with a chromosomal or genetic disorder. Individuals who accepted the examination completed Form 5, which consisted of five questions, while those who declined completed Form 6, which contained four questions (Fig. 1). Participants who were offered a diagnostic test were questioned regarding their understanding of the test and the reasons for declining it in these forms. The questions were generated using a 5-point Likert scale. The completed documents were digitally recorded.

Fig. 1.

Distribution of participants

Evaluation of likert scale

The questions in the forms were prepared with options for participants to indicate their level of agreement, ranging from “strongly agree” (5 points), “agree” (4 points), “neutral” (3 points), “disagree” (2 points), to “strongly disagree” (1 point). Participants marked one option for each question. High and low scores were evaluated separately for each item, and negative questions were entered as reverse coding for data entry. The encoded questions were determined as follows: in Form 2, questions 6, 7, 8, 9, 10, 11, 13, 14, and 15; in Form 3, questions 1, 2, and 4; in Form 5, questions 1 and 4; and in Form 6, question 1.

Statistical analysis

The data obtained in the study were analyzed using the SPSS (Statistical Package for Social Sciences) Windows 25.0 application. During the evaluation of the data, descriptive statistical methods (such as numbers, percentages, minimum-maximum values, median, mean, standard deviation) were utilized.

Chi-square analysis was conducted to assess the relationship between participants’ screening test participation status and their demographic and obstetric characteristics. When comparing quantitative data in datasets that follow a normal distribution (such as when evaluating Likert-type questions), an independent t-test is used to determine the difference between two independent groups. For comparisons involving more than two independent groups, one-way analysis of variance (ANOVA) is applied. In cases where a significant difference is found, the Bonferroni method is used to identify the group that is responsible for the difference.

Results

The sociodemographic and obstetric characteristics of all participants are shown in Table 1. The average age was 29.97 ± 5.63, the mean time of marriage was 6.06 ± 5, and the percentage of individuals with a university degree or above was reported as 32.8%. Upon evaluation of the obstetric data, it was documented that 34.7% of the participants had their first pregnancy, 25.5% had a history of abortion, and 2.5% obtained pregnancy by in vitro fertilization (IVF). Among the 259 participants, it was found that 52.1% (135/259) did not undergo prenatal screening tests. The percentage of recommended prenatal diagnostic testing among all participants was 37.1% (96/259). The demographic and obstetric characteristics of all participants who underwent prenatal screening tests and those who did not were compared. The results indicated that the percentage of screening tests was higher in pregnant women who were employed than in those who were unemployed, and in those who were consanguineous marriage than in those who were not (p < 0.05) (Table 1).

Table 1.

Demographic and obstetric characteristics of all participants and distribution according to screening test status

Demographic and obstetric characteristics				Undergoing Prenatal screening test		Not undergoing prenatal screening test		p
		n	%	n	%	n	%
Age (year) (Mean ± SD 29.97 ± 5.63)	< 30	132	51	63	50.8	69	51.1	0.961
	> 30	127	49	61	48.9	66	48.9
Partner age (year) (Mean ± SD 33.52 ± 6.03)	< 34	132	51	63	50.8	69	51.1	0.961
	> 34	127	49	61	49.2	66	48.9
Duration of marriage (year) (Mean ± SD 6.06 ± 5)	< 6	150	57.9	72	58.1	78	57.8	0.963
	> 6	109	42.1	52	41.9	57	42.2
Education status	High school and lower	174	67.2	80	64.5	94	69.6	0.427
	College and above	85	32.8	44	35.5	41	30.4
Occupation	Yes	84	32.4	65	52.4	19	14.1	< 0.001*
	No	175	67.6	59	47.6	116	85.9
Consanguinity	Yes	35	13.5	28	22.6	7	5.2	< 0.001*
	No	224	86.5	98	77.4	128	94.8
In vitro fertilization	Yes	9	3.5	4	3.2	5	3.7	0.834
	No	250	96.5	120	96.8	130	96.3
Nulliparity	Yes	106	40.9	53	42.7	53	39.3	0.569
	No	153	59.1	71	57.3	82	60.7
Abortion	Yes	66	25.5	27	21.8	39	28.9	0.189
	No	193	74.5	97	78.2	96	71.1
Iuex history	Yes	11	4.2	2	1.6	9	6.7	0.044*
	No	248	95.8	122	98.4	126	93.3
History of children with chromosomal abnormalities	Yes	10	3.9	4	3.2	6	4.4	0.611
	No	249	96.1	120	96.8	129	93.7
Family history of genetic disease	Yes	12	4.6	5	4.0	7	5.2	0.659
	No	247	95.4	119	96	128	94.8
Co-morbidity	Yes	16	6.2	8	6.5	8	5.9	0.861
	No	243	93.8	116	93.5	127	94.1
N %		259	100.0	124	100.0	135	100.0

*p < 0,05-Chi-kare analysis, SD: standard deviation

The sociodemographic and obstetric characteristics of the participants who were recommended prenatal diagnostic testing are shown in Table 2. Indications for prenatal diagnosis were recorded as fetal anomaly detection on ultrasonography in 46.9% (45/96), high risk of screening test in 35.4% (34/96), and history of children with chromosomal anomalies or genetic diseases in 6.3% (6/96). Table 2 illustrates the distribution of participants who underwent prenatal diagnostic tests and those who did not, as determined by their demographic and obstetric characteristics. The participants’ consent of undergoing a diagnostic test, gestational week, employment status, and the screening test that was administered were statistically significantly correlated (p < 0.05). The percentage of prenatal diagnostic tests was found to be higher in individuals who were recommended for prenatal diagnosis before to the 20th week of pregnancy (p < 0.05). Participants who were employed had a higher percentage of prenatal diagnostic procedures than those who were unemployment.

Table 2.

Demographic and obstetric characteristics of recommended prenatal diagnostic tests and distribution according to the acceptance status

Demographic and obstetric characteristics				Undergoing Prenatal diagnostic test		Not undergoing prenatal diagnostic test			p
		n	%	n	%	n		%
Age (year) (Mean ± SD 30.77 ± 5.93)	< 31	132	51	19	44.2	32		60.4	0.114
	> 31	127	49	24	55.8	21		39.6
Partner age (year) (Mean ± SD 34.12 ± 6.14)	< 34	132	51	20	46.5	26		49.1	0.804
	> 34	127	49	23	53.5	27		50.9
Duration of marriage (year) (Mean ± SD 5.57 ± 4.98)	< 6	150	57.9	26	60.5	33		62.3	0.857
	> 6	109	42.1	17	39.5	20		37.7
Education status	High school and lower	59	62.5	26	60.5	33		62.5	1.000
	College and above	37	38.5	17	39.5	20		37.7
Occupation	Yes	40	41.7	24	55.8	16		30.2	0.011*
	No	56	58.3	19	44.2	37		69.8
Consanguinity	Yes	9	9.4	2	4.7	7		13.2	0.153
	No	87	90.6	41	95.3	46		86.8
In vitro fertilization	Yes	2	2.1	1	2.3	1		1.9	0.881
	No	94	97.9	42	97.7	52		98.1
Nulliparity	Yes	42	43.8	17	39.5	25		47.2	0.752
	No	54	57.2	26	60.5	28		52.8
Abortion	Yes	21	21.9	9	20.9	12		22.6	0.840
	No	75	78.1	34	79.1	41		77.4
Iuex history	Yes	3	3.1	3	7.0	0		0.0	0.051
	No	93	96.6	40	93.0	53		100.0
History of children with chromosomal abnormalities	Yes	6	6.3	2	4.7	4		7.5	0.560
	No	90	93.8	41	95.3	49		92.5
Family history of genetic disease	Yes	5	5.2	1	2.3	4		7.5	0.252
	No	91	94.8	42	97.7	49		92.5
Co-morbidity	Yes	1	1.0	0	0.0	1		1.9	0.365
	No	95	99.0	43	100.0	52		98.1
Gestational weeks (Mean ± SD 20.31 ± 6.05)	< 20	55	57.3	32	74.4	23		43.4	0.002*
	> 20	41	42.7	11	25.6	30		56.6
Screening test	First trimester	35	36.5	12	27.9	23		43.4	0.031*
	Second trimester	7	7.3	6	14.0	1		1.9
	Fetal DNA	5	5.2	4	9.3	1		1.9
	None	49	51	21	48.8	28		52.8
Indication of prenatal diagnostic test	Other, advanced maternal age	8	8.4	4	9.3	4		7.5	0.992
	Parent with chromosomal abnormality, History of children with chromosomal abnormalities	9	9.4	4	9.3	5		9.4
	Elevated risk in screening tests	34	35.4	15	34.9	19		35.8
	Fetal anomaly	45	46.9	20	46.5	25		47.2
Accepting prenatal diagnostic testing	Yes	43	44.8
	No	53	55.2
Toplam		96	100.0	43	100.0	53	100.0

*p < 0,05-Chi-kare analysis, SD: standard deviation

The data from individuals who received prenatal screening tests were analyzed based on their responses to 5-Point Likert-type questions. The statistical analysis revealed that those with a university degree or above had significantly higher scores compared to others (Table 3) (Supplement 1). The scores of individuals who did not undergo prenatal screening tests were found to be statistically higher among those who had a university degree or higher, were employed, and had a family history of genetic disease, based on the responses to 5-Point Likert-type questions (Table 4) (Supplement 2). There was no significant difference in the scores based on sociodemographic and obstetric variables between the groups that had prenatal diagnostic testing and those that did not (Supplement 3–4).

Table 3.

Scoring participants that underwent prenatal screening tests on a 5-point likert scale

Demographic and obstetric characteristics N:77
		Mean ± SD	p
Age (year) (Mean ± SD 30.38 ± 5.40)	< 30	3.22 ± 0.32	0.891
	> 30	3.23 ± 0.35
Partner age (year) (Mean ± SD 34.18 ± 5.74)	< 34	3.27 ± 0.36	0.360
	> 34	3.20 ± 0.32
Duration of marriage (year) (Mean ± SD 6.46 ± 5.17)	< 6	3.27 ± 0.30	0.319
	> 6	3.19 ± 0.38
Education status	High school and lower	3.09 ± 0.27	0.000*
	College and above	3.45 ± 0.33
Occupation	Yes	3.32 ± 0.35	0.095
	No	3.18 ± 0.32
Consanguinity	Yes	3.12 ± 0.39	0.307
	No	3.24 ± 0.33
In vitro fertilization	Yes	3.31 ± 0.16	0.578
	No	3.22 ± 0.35
Nulliparity	Yes	3.30 ± 0.31	0.087
	No	3.17 ± 0.35
Abortion	Yes	3.33 ± 0.34	0.157
	No	3.20 ± 0.34
History of children with chromosomal abnormalities	Yes	3.23 ± 0.11	0.997
	No	3.23 ± 0.39
Family history of genetic disease	Yes	3.13 ± 0.34	0.619
	No	3.23 ± 0.53
Co-morbidity	Yes	3.32 ± 0.30	0.382
	No	3.22 ± 0.34

*p < 0,05-Independent T-test analysis, SD: standard deviation

Table 4.

Scoring participants that not underwent prenatal screening tests on a 5-point likert scale

Demographic and obstetric characteristics N:86
		Mean ± SD	p
Age (year) (Mean ± SD 28.72 ± 5.33)	< 28	3.53 ± 0.71	0.808
	> 28	3.50 ± 0.70
Partner age (year) (Mean ± SD 32.25 ± 6.03)	< 32	3.50 ± 0.69	0.884
	> 32	3.52 ± 0.73
Duration of marriage (year) (Mean ± SD 6.22 ± 4.86)	< 6	3.51 ± 0.66	0.965
	> 6	3.19 ± 0.38
Education status	High school and lower	3.34 ± 0.65	0.000*
	College and above	4.11 ± 0.59
Occupation	Yes	3.90 ± 0.60	0.009*
	No	3.41 ± 0.70
Consanguinity	Yes	3.83 ± 0.61	0.036*
	No	3.43 ± 0.71
In vitro fertilization	Yes	3.50 ± 1.41	0.972
	No	3.51 ± 0.69
Nulliparity	Yes	3.63 ± 0.69	0.269
	No	3.45 ± 0.71
Abortion	Yes	3.44 ± 0.75	0.520
	No	3.55 ± 0.68
Family history of genetic disease	Yes	2.68 ± 0.62	0.015*
	No	3.55 ± 0.68
Co-morbidity	Yes	3.70 ± 0.41	0.556
	No	3.50 ± 0.72

*p < 0,05-Independent T-test analysis, SD: standard deviation

Discussion

Prenatal screening and diagnostic tests are medical examinations conducted to evaluate the physiological condition of the fetus during pregnancy. They assist in identifying potential risks to the developing fetus and allow the implementation of required preventative steps. The acceptance of prenatal screening and diagnostic tests varies according to health legislation, availability of healthcare services, cultural norms, and economic conditions across different regions. (Palomaki et al. 2013). There has been a notable rise in the frequency of prenatal screening due to growing interest in the prenatal period, advancements in screening tests and ultrasonography, and the growing focus of health policy on this era. The prevalence of prenatal screening tests in the United States rose from 22% in 1988 to 70% in 2012 (Palomaki et al. 2013). Due to the implementation of national policies, the percentage for achievement in Europe is between 80 and 90% (Najafi and Akrami 2019). The research conducted by Wongkrajang et al. in 2023 found a percentage of 30% in a referral hospital in Thailand (Wongkrajang et al. 2023). The prevalence of prenatal screening tests in our research was 47.9%. The lower incidence was hypothesized to be associated with the study’s single-center design and the inadequate participant number. The publications from Italy and Saudi Arabia revealed that the prevalence of prenatal screening tests was greater among employed women compared to unemployed women. This outcome was anticipated to potentially correlate with the availability and knowledge of prenatal screening tests (Chiavarini et al. 2014; Santos et al. 2013). Our study revealed a greater prevalence of prenatal screening tests among women who are employed. Research has indicated that employed women often have higher levels of finances, which therefore provides them greater opportunities to use prenatal healthcare treatments. Moreover, the elevated degree of education among employed women often empowers them to exhibit greater awareness about prenatal health care and to utilize screening tests more extensively (Chiavarini et al. 2014). Our study revealed no statistically significant difference in educational level between those who received screening exams and those who did not. This occurrence can be attributed to cultural issues, as well as the lack of individuals with higher education degrees. Nevertheless, we observed a significant increase in awareness and attitude scores among pregnant women with a university education or above, regardless of whether they had screening tests or not. Education level is a significant factor in comprehending screening examinations, irrespective of the choice to undergo such tests.

Consanguineous marriages lead to an increased risk of autosomal recessive diseases and congenital abnormalities (Fareed et al. 2017). Although prenatal screening tests during the first and second trimester are useful in assessing the likelihood of aneuploidies, they do not provide information on the risk of inheriting recessive disorders. During the first trimester, an increased nuchal translucency measurement may indicate the presence of rare single-gene disorders such autosomal recessive metabolic diseases, neuromuscular and skeletal diseases, as well as aneuploidies. This finding is particularly significant in consanguineous marriages (Choy et al. 2019). Alternatively, elevated levels of AFP in second trimester screening tests may indicate the presence of neural tube abnormalities. There have been reports of autosomal recessive mutations that can lead to neural tube defects (Greene et al. 2009). In our study, the prevalence of consanguineous marriage was 13.5%. Upon evaluating all participants in our study, we observed a higher incidence of prenatal screening tests among those who were in consanguineous marriages. This conclusion may be coincidental alternatively, it might suggest that individuals in consanguineous marriages had a greater chance of keeping to prenatal follow-ups.

The study conducted by Öcal et al. reported that 41.9% of participants did not undergo a prenatal screening test. Additionally, 27.6% of participants believed that the screening test would yield a definitive diagnosis for the fetus. Same study reported that 60.2% of the patients underwent the 1st and 2nd trimester screening tests to ascertain the overall health of the fetus (Öcal et al. 2016). In our study, 23.4% of the 77 pregnant women who had a screening test answered ‘Agree’ and 3.9% answered ‘Strongly agree’ to the statement ‘The screening test includes the capability to determine the possibility of any genetic problems in the fetus’. Similarly, the statement, " If the screening test shows results within the normal range, it can be assumed that the a fetus is not affected with any disease. " received ‘Agree’ and ‘Strongly agree’ responses of 42.9% and 5.2%, respectively. These comments demonstrate the lack of accurate comprehension among pregnant women regarding prenatal screening testing.

In our study, prenatal diagnosis tests were recommended to 96 pregnant women and the acceptance percentage of prenatal diagnostic testing was determined as 44.7%. The study conducted by Sadlecki et al. revealed that women with low education levels had a lower percentage of accepting invasive procedures. Additionally, it was shown that the frequency of diagnostic testing reduced as the number of abortions increased among those who previously had abortions (Sadlecki et al. 2018). In our study, although the level of education was not found to be statistically significant, it was determined that the percentage of having prenatal diagnostic tests was similarly higher in employing women. In the study by Sadlecki et al., no relationship was observed between gestational week and acceptance of prenatal diagnostic test (Sadlecki et al. 2018). In our study, it was observed that those who were offered diagnostic test before the 20th gestational week had a higher percentage of having the test. This association demonstrates that the identification of abnormalities or high-risk conditions within the early gestational weeks might significantly influence the choice of performing invasive procedures. The main drawback of prenatal diagnostic testing is the potential for fetal loss. It varies between 0.1% and 2% depending on the procedure performed (Ghi et al. 2016). The potential for fetal loss may be an important factor when considering the acceptance of invasive procedures. In our study, among the participants who did not accept the prenatal diagnosis test, 30.2% of them responded ‘Strongly agree’ and 49.1% responded ‘Agree’ to the statement ‘I decline prenatal diagnostic because of the potential hazard of fetal loss, as informed to me ’and 37.4% of them responded ‘Strongly agree’ and 43.4% responded ‘Agree’ to the statement ‘I decline to have a prenatal diagnostic test as I am determined to proceed with my pregnancy regardless of the conditions’. There are factors such as the method of conception, age, parity, consanguineous marriage, genetic disease in the family, miscarriage history, twin pregnancy, socioeconomic background and religious belief in the decision to have prenatal diagnostic testing, but still little is known about this issue and most of the available data is not evidence-based or reflects the pregnant woman’s own personal experience (Johnson et al. 2017). According to the results of our study, the main reasons for not having diagnostic testing were the risk of fetal loss and the desire to continue the pregnancy under all circumstances. In contrast, participants who were offered and accepted prenatal diagnostic testing responded to the statement, “I want prenatal diagnosis because I think the disease in the fetus can be treated in utero” with a percentage of 30.2% as “ Strongly agree” and 44.2% as “Agree.” The results suggest that individuals who underwent prenatal diagnostic testing lacked a comprehensive understanding of the mechanisms behind the tests and the spectrum of disorders that could have been identified.

Study limitations

Our study has limitations, including the use of different question sets across participant subgroups and a relatively small sample size due to group stratification. Nonetheless, the results highlight the crucial role of individualized counseling before and after prenatal screening and diagnostic testing to ensure equitable access and understanding. In addition, data regarding the gestational age at the first antenatal visit and the total number of antenatal visits were not collected. These factors may have influenced participants’ access to and decisions regarding prenatal screening and diagnostic tests, and should be taken into account in future research. Moreover, since data on participants’ ethnicity, cultural background, and religious beliefs—which may affect decision-making—were not collected, their potential impact could not be evaluated. Incorporating such sociocultural variables would enhance the depth and generalizability of subsequent studies.

Conclusion

Prenatal screening and diagnostic tests are procedures conducted during pregnancy to detect diseases within a specific timeframe. These tests require pregnant women to make prompt decisions, as they do not offer any treatment options. It is necessary for individuals to quickly understand the logic of screening tests and be quickly directed to diagnostic tests in case of high risk or detection of anomalies. This study found that more than half of the participants (52.1%) had not undergone prenatal screening tests, and only 44.7% of those recommended for prenatal diagnostic testing accepted the procedure. Higher education level and employment status were significantly associated with greater participation in both screening and diagnostic testing, as well as better knowledge scores. Gestational age also played a key role in diagnostic test acceptance, with earlier recommendations (before 20 weeks) linked to higher uptake. The main reasons for declining diagnostic testing included fear of fetal loss and the desire to continue the pregnancy regardless of the outcome. These findings underscore the critical need for timely and effective prenatal counseling tailored to the sociodemographic background of each patient. In particular, additional support should be directed toward women with lower educational attainment or those not in the workforce. Integrating standardized counseling protocols into routine antenatal care may improve informed decision-making and reduce disparities in prenatal test utilization.

Electronic supplementary material

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Author contributions

Concept: DK, GYS, TK; Design: DK, GYS, TK, BK, SB; Supervision: BK, SB, RM; Resources: DK, CÇ, BT, RM; Materials: DK, CÇ, BT, RM; Data Collection and/ or Processing: DK, CÇ, BT.; Analysis and/ or Interpretation: DK, GYS, TK, BK, SB; Literature search: DK, GYS, TK; Writing Manuscript: DK, TK; Critical Review: DK, TK, RM.

Funding

No external funding was used in this conduct of this study.

Data availability

Data is available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Permission for the study was given by the Department of Obstetrics and Gynecology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine (dated 23.03.2022 and numbered E-5285153-199-344755) and its ethical suitability was approved by the Ethics Committee of Istanbul University, Istanbul Faculty of Medicine (dated 22.04.2022 and numbered 890314). Informed consent was obtained from all individual participants included in the study.

Consent for publication

There is no video or picture of any individual in our study.

Competing interests

The authors declare no competing interests.