Patient perceptions of multiple gestations: An assessment of knowledge and risk aversion

OBJECTIVE: To determine whether knowledge of the increased risk of certain pregnancy complications affects a woman's desire to achieve a multifetal gestation. STUDY DESIGN: Women who attended an infertility clinic were given an interviewer-administered survey that ascertained how intensely they desired a multifetal pregnancy and how accurately they perceived the risks of multifetal complications. In addition, 5-point Likert scales were used to assess how different perceptions of risk affected the desire for gestations of different plurality. RESULTS: Most respondents (67%) expressed the desire to conceive a twin pregnancy, although they could not accurately estimate the probability of risks associated with this type of pregnancy. Nevertheless, their desire was affected by perceptions of pregnancy-associated risk. On the basis of ordinal regression, desire for twins was more likely after in vitro fertilization (P < .01) but less likely as a woman's estimation of the risk of pregnancy complications increased (P < .05). When women were presented with scenarios of differing pregnancy-associated risk magnitudes, their desire for twin pregnancy decreased as risk magnitudes increased (median Likert score decrease from 4 to 3 to 2, P < .01). After being confronted with the actual probabilities of specified perinatal complications associated with a twin pregnancy, women were less desirous of having a twin pregnancy (median Likert score decrease from 4 to 3, P < .001) than they had originally expressed. CONCLUSION: Women who undergo treatment for infertility are not well aware of the risks of perinatal complications associated with multiple gestations. Moreover, these women are risk sensitive and change their desires on the basis of their perception of overall risk.