Impact of Structured Prenatal Counseling on Decision-making and Psychological Outcomes in Indian Women with High-risk Aneuploidy Screening Results: A Prospective Cohort Study

Abstract Introduction: Pregnant women receiving a high- or intermediate-risk result on first-trimester/second-trimester aneuploidy screening often face anxiety, decisional conflict, and confusion. We evaluated whether structured prenatal counseling improves their knowledge, decision-making confidence, anxiety, and uptake of invasive diagnostic testing. Settings and Design: This was a prospective cohort study conducted at a tertiary-level fetal medicine unit in India over 18 months. Materials and Methods: Sixty-seven eligible women with singleton pregnancies (≤22 weeks) and high/intermediate risk screening results underwent a standardized 30–45 min counseling session by a fetal medicine specialist/genetic counselor. Outcomes measured pre- and postcounseling included knowledge (0–10 scale), decisional conflict (Decisional Conflict Scale, 0–100), and anxiety (STAI-State, 0–100). Diagnostic test uptake was also assessed. Statistical analysis was done by Paired t-tests with Cohen’s d effect sizes for pre-/postcomparisons. Results: Knowledge significantly improved (5.93 → 8.86, P < 0.001, d = 5.91). Decisional conflict (43.1 → 23.5, P < 0.001, d = −6.39) and anxiety (49.7 → 36.4, P < 0.001, d = −4.55) decreased substantially. Diagnostic uptake was 94%, identifying 8 aneuploidy cases in the high-risk group. Conclusions: Structured prenatal counseling significantly enhances knowledge, reduces decisional conflict and anxiety, and promotes high uptake of invasive diagnostic testing. Its effectiveness across varying educational backgrounds suggests it is a robust, equitable strategy for supporting informed decision-making in pregnant women with abnormal screening results. It is an effective, scalable intervention with potential for integration into national maternal healthcare strategies.