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Non-invasive prenatal testing (NIPT) and pregnant women’s views on good motherhood: a qualitative study


Women’s views on responsible motherhood influence decision-making regarding participation in prenatal screening. Previous studies showed that the probabilistic nature of the first-trimester combined test and the potential requirement for subsequent invasive diagnostics serve as legitimate reasons for women to exclude prenatal screening from their moral responsibilities. These moral barriers might now be less relevant with the introduction of the non-invasive prenatal test (NIPT) resulting in women feeling a moral duty to use NIPT screening as part of responsible motherhood. This qualitative study explores the impact of NIPT on women’s moral beliefs about the meaning of prenatal screening in relation to responsible motherhood. We performed semi-structured interviews with 29 pregnant women who were offered NIPT as a first-tier screening test within a Dutch nationwide study (TRIDENT-2). Results show that the inherent uncertainty about the fetus’s health despite improved accuracy and the lack of treatment for a detected disorder, combined with the possibility to obtain information about actionable anomalies through the fetal anomaly scan, support women’s perspectives that NIPT is not an obligation of responsible motherhood. Acceptance of NIPT is considered to be a free decision related to the information each woman needs to be a good mother for her child and her family. Women’s views may change when NIPT has expanded to include treatable or preventable conditions.

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Data availability

The interviews (datasets) generated during and/or analyzed during the current study are not publicly available due them containing information that could compromise research participant privacy/consent, but are available from the corresponding author on reasonable request.


  1. Wilkinson S. Prenatal screening, reproductive choice, and public health. Bioethics. 2015;29:26–35.

    PubMed  Article  Google Scholar 

  2. Rothman BK. The tentative pregnancy: prenatal diagnosis and the future of motherhood. New York: Vikin; 1986.

  3. Rapp R. Testing women, testing the fetus: the social impact of amniocentesis in America. New York: Routledge; 1999.

  4. Tremain S. Reproductive freedom, self-regulation, and the government of impairment in utero. Hypatia: J Fem Philos. 2006;21:35–53.

    Article  Google Scholar 

  5. Savulescu J. In defense of procreative beneficence. J Med Ethics. 2007;33:284–8.

    PubMed  PubMed Central  Article  Google Scholar 

  6. Davis D. Genetic dilemmas: reproductive technologies parental choices, and children’s futures. New York: Oxford University Press; 2001.

    Google Scholar 

  7. Rapp R. Refusing prenatal diagnosis: the meanings of bioscience in a multicultural world. Sci Techol Human Values 1998;23:45–70.

    Article  Google Scholar 

  8. Shakespeare T. Disability rights and wrongs. Routledge, Oxon, Great Britain, 2006.

  9. Crombag NM, Boeije H, Iedema-Kuiper R, Schielen PCJI, Visser GHA, Bensing JM. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics: a qualitative study. BMC Pregnancy Childbirth. 2016;16:121.

    PubMed  PubMed Central  Article  Google Scholar 

  10. Carroll FE, Al-Janabi H, Flynn T, Montgomery AA. Women and their partners’ preferences for Down’s syndrome screening tests: a discrete choice experiment. Prenat Diagn. 2013;33:449–56.

    PubMed  Article  Google Scholar 

  11. van Bruggen J, Henneman L, Timmermans DRM. Women’s decision making regarding prenatal screening for fetal aneuploidy: a qualitative comparison between 2003 and 2016. Midwifery. 2018;64:93–100.

    PubMed  Article  Google Scholar 

  12. Garcia E, Timmermans DR, van Leeuwen E. Rethinking autonomy in the context of prenatal screening decision-making. Prenat Diagn. 2008;28:115–20.

    PubMed  Article  Google Scholar 

  13. Garcia E, Timmermans DR, van Leeuwen E. Parental duties and prenatal screening: does an offer of prenatal screening lead women to believe that they are morally compelled to test? Midwifery. 2012;28:e837–43.

    PubMed  Article  Google Scholar 

  14. Crombag NMTH, Vellinga YE, Kluijfhout SA, Bryant LD, Ward PA, Iedema-Kuiper R, et al. Explaining variation in Down’s syndrome screening uptake: comparing the Netherlands with England and Denmark using documentary analysis and expert stakeholder interviews. BMC Health Serv Res. 2014;14:437.

    PubMed  PubMed Central  Article  Google Scholar 

  15. Remennick L. The quest for the perfect baby: why do Israeli women seek prenatal genetic testing? Socio Health Illn. 2006;28:21–53.

    Google Scholar 

  16. Gil MM, Quezada MS, Revello R, Akolekar R, Nicolaides KH. Analysis of cell-free DNA in maternal blood in screening for fetal aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol. 2015;45:249–66.

    CAS  PubMed  Article  Google Scholar 

  17. Fairbrother G, Burigo J, Sharon T, Song K. Prenatal screening for fetal aneuploidies with cell-free DNA in the general pregnancy population: a cost-effectiveness analysis. J Matern Fetal Neonatal Med. 2016;29:1160–4.

    PubMed  Article  Google Scholar 

  18. Gekas J, Langlois S, Ravitsky V, Audibert F, van den Berg DG, Haidar H, et al. Non-invasive prenatal testing for fetal chromosome abnormalities: review of clinical and ethical issues. Appl Clin Genet. 2016;9:15–26.

    PubMed  PubMed Central  Article  Google Scholar 

  19. Dondorp W, de Wert G, Bombard Y, Bianchi DW, Bergmann C, Borry P, et al. Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening. Eur J Hum Genet. 2015;23:1438–50.

    PubMed  PubMed Central  Article  Google Scholar 

  20. Vanstone M, King C, de Vrijer B, Nisker J. Non-invasive prenatal testing: ethics and policy considerations. J Obstet Gynaecol Can. 2014;36:515–26.

    PubMed  Article  Google Scholar 

  21. Schmitz D, Netzer C, Henn W. An offer you can’t refuse? Ethical implications of non-invasive prenatal diagnosis. Nat Rev Genet. 2009;10:515.

    CAS  PubMed  Article  Google Scholar 

  22. Ravitsky V. The shifting landscape of prenatal testing: between reproductive autonomy and public health. Hastings Cent Rep. 2017;47:S34–40.

    PubMed  Article  Google Scholar 

  23. Ravitsky V. Non-invasive prenatal diagnosis: an ethical imperative. Nat Rev Genet. 2009;10:733.

    CAS  PubMed  Article  Google Scholar 

  24. Reinsch S, König A, Rehmann-Sutter C. Decision-making about non-invasive prenatal testing: women’s moral reasoning in the absence of a risk of miscarriage in Germany. New Gen Soc. 2021;40:199–215.

  25. Farrell RM, Mercer MB, Agatisa PK, Smith MB, Philipson E. It’s more than a blood test: patients’ perspectives on noninvasive prenatal testing. J Clin Med. 2014;3:614–31.

    PubMed  PubMed Central  Article  Google Scholar 

  26. Lewis C, Silcock C, Chitty L. Non-invasive prenatal testing for Down’s syndrome: pregnant women’s views and likely uptake. Public Health Genom. 2013;16:223–32.

    CAS  Article  Google Scholar 

  27. Vanstone M, Cernat A, Nisker J, Schwartz L. Women’s perspectives on the ethical implications of non-invasive prenatal testing: a qualitative analysis to inform health policy decisions. BMC Med Ethics. 2018;19:27.

    PubMed  PubMed Central  Article  Google Scholar 

  28. van Schendel RV, Page‐Christiaens GC, Beulen L, Bilardo CM, de Boer MA, Coumans ABC, et al. Trial by Dutch laboratories for evaluation of non‐invasive prenatal testing. Part II—women’s perspectives. Prenat Diagn. 2016;36:1091–8.

    PubMed  PubMed Central  Article  Google Scholar 

  29. Bowman-Smart H, Savulescu J, Mand C, Gyngell C, Pertile MD, Lewis S, et al. Is it better not to know certain things?: views of women who have undergone non-invasive prenatal testing on its possible future applications. J Med Ethics. 2019;45:231–8.

    PubMed  Article  Google Scholar 

  30. van Schendel RV, Kleinveld JH, Dondorp WJ, Pajkrt E, Timmermans DR, Holtkamp KC, et al. Attitudes of pregnant women and male partners towards non-invasive prenatal testing and widening the scope of prenatal screening. Eur J Hu Genet. 2014;22:1345–50.

    Article  Google Scholar 

  31. van der Meij KRM, Sistermans EA, Macville MVA, Stevens SJC, Bax CJ, Bekker MN, et al. TRIDENT-2: national implementation of genome-wide non-invasive prenatal testing as a first-tier screening test in the Netherlands. Am J Hum Genet. 2019;5:1091–101.

    Article  CAS  Google Scholar 

  32. van Schendel RV, van El CG, Pajkrt E, Henneman L, Cornel MC. Implementing non-invasive prenatal testing for aneuploidy in a national healthcare system: global challenges and national solutions. BMC Health Serv Res. 2017;17:670.

    PubMed  PubMed Central  Article  Google Scholar 

  33. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  34. de Jong A, de Wert GM. Prenatal screening: an ethical agenda for the near future. Bioethics. 2015;29:46–55.

  35. Shakespeare T, Hull RJ. Termination of pregnancy after non-invasive prenatal testing (NIPT): ethical considerations. J Pr Ethics. 2018;6:32–54.

    Google Scholar 

  36. McDougall R. Parental virtue: a new way of thinking about the morality of reproductive actions. Bioethics. 2007;21:181–90.

    PubMed  Article  Google Scholar 

  37. Savulescu J. Abortion, infanticide and allowing babies to die, 40 years on. J Med Ethics. 2005;39:257–9.

    Article  Google Scholar 

  38. Irving C, Richmond S, Wren C, Longster C, Embleton ND. Changes in fetal prevalence and outcome for trisomies 13 and 18: a population based study over 23 years. J Mater Fetal Neonatal Med. 2011;24:137–41.

    Article  Google Scholar 

  39. Antonarakis SE, Lyle R, Dermitzakis ET, Reymond A, Deutsch S. Chromosome 21 and down syndrome: from genomics to pathophysiology. Nat Rev Genet. 2004;5:725–38.

    CAS  PubMed  Article  Google Scholar 

  40. Korenromp MJ, Page-Christiaens GCML, van den Bout J, Mulder EJH, Visser GHA. Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol. 2007;196:149.e1–11.

    Article  Google Scholar 

  41. Lou S, Carstensen K, Petersen O, Palmhøj Nielsen C, Hvidman L, Retpen Lanther M, et al. Termination of pregnancy following a prenatal diagnosis of Down syndrome: a qualitative study of the decision-making process of pregnant couples. Acta Obstet Gynecol Scand. 2018;97:1228–36.

    PubMed  Article  Google Scholar 

  42. Skotko BG. With new prenatal testing, will babies with Down syndrome slowly disappear? Arch Dis Child. 2009;94:823–6.

    PubMed  Article  Google Scholar 

  43. de Graaf G, Buckley F, Skotko BG. Estimation of the number of people with Down syndrome in Europe. Eur J Hum Genet. 2021;29:402–10.

    PubMed  Article  Google Scholar 

  44. van El CG, Pieters T, Cornel M. Genetic screening and democracy: lessons from debating genetic screening criteria in the Netherlands. J Community Genet. 2012;3:79–89.

    PubMed  Article  Google Scholar 

  45. Bunnik EM, Kater-Kuipers A, Galjaard RJH, de Beaufort ID. Should pregnant women be charged for non-invasive prenatal screening? Implications for reproductive autonomy and equal access. J Med Ethics. 2020;46:194–8.

    PubMed  Article  Google Scholar 

  46. Dondorp WJ, Page-Christiaens GCM, de Wert GMWR. Genomic futures of prenatal screening: ethical reflection. Clin Genet. 2016;89:531–8.

    CAS  PubMed  Article  Google Scholar 

  47. Neufeld-Kaiser WA, Cheng EY, Liu YJ. Positive predictive value of non-invasive prenatal screening for foetal chromosome disorders using cell-free DNA in maternal serum: independent clinical experience of a tertiary referral center. BMC Med. 2015;13:129.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  48. Gauthier C. Moral responsibility and respect for autonomy: Meeting the communitarian challenge. Kennedy Inst Ethics J. 2000;10:337–52.

    Article  Google Scholar 

  49. Cernat A, De Freitas C, Majid U, Trivedi F, Higgins C, Vanstone M. Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women’s experiences. BMC Pregnancy Childbirth. 2019;19:27.

    PubMed  PubMed Central  Article  Google Scholar 

  50. Gitsels-van der Wal JT, Verhoeven PS, Manniën J, Martin L, Reinders HS, Spelten E, et al. Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study. BMC Pregnancy Childbirth. 2014;14:264.

    PubMed  PubMed Central  Article  Google Scholar 

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We wish to thank all women and men who participated in this study. We thank the midwifery practices for their help with recruitment, and Elsbeth van Vliet-Lachotzki (VSOP Patient Alliance for Rare and Genetic Diseases) for her feedback on the interview guide and protocol. We thank all members of the Dutch NIPT Consortium (see Supplementary Appendix) for discussion and feedback on this study.


Supported by a grant from the Netherlands Organization for Health Research and Development (ZonMw, No. 543002001).

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Authors and Affiliations



LH, DRMT contributed to the design and implementation of the research, to the analysis of the results and to the writing of the manuscript. They supervised the findings of this work. EG (first author) contributed to the design and implementation of the research. She developed the interview guide, performed some of the interviews and analysed all the interviews together with IK. IK contributed to the development of the interview guide, performed some of the interviews and contributed to the analysis of the results. JTGvdW contributed to the developed of the interview guide and to the analysis of the results. LM and MNB contributed to the developed of the interview guide. All authors discussed the results, provided critical feedback and contributed to the final manuscript.

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Correspondence to Elisa Garcia.

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The authors declare no competing interests.

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Ethical approval for this interview study was obtained from the Medical Ethical Committee of the VU University Medical Center Amsterdam (no. 2017.165 (A2018.069)).

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Garcia, E., Henneman, L., Gitsels-van der Wal, J.T. et al. Non-invasive prenatal testing (NIPT) and pregnant women’s views on good motherhood: a qualitative study. Eur J Hum Genet 30, 669–675 (2022).

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