The recent article by Fang et al comparing Down syndrome screening in 2001 and 2007 reported a substantial increase in the number of women who screen positive for Down syndrome but declined invasive diagnostic genetic tests. In 2001, an estimated 46% of women who screened positive declined invasive diagnostic testing. In 2007, this number increased significantly to 66%. Even with the low false-positive rates reported for the quad screen, more than 90% of women who screen positive will not actually have a child with Down syndrome.

This raises some important questions about the counseling that is offered before and after serum screening and the psychologic and physiologic consequences of screening positive but not obtaining the reassurance of an invasive diagnostic test. Have the pre- and postscreen counseling changed significantly between 2001–2007? Has there been a change in the behavior of women who screen positive? Or have there been changes in both counseling and behavior?