This prospective cohort observational study was conducted among pregnant females who were scheduled for AGGC at the Antenatal Outpatient Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University in Bangkok, Thailand, between May and December, 2021. Exclusion criteria were fetal malformation detected before the AGGC and pregnant individuals who could not read or write Thai and pregnant women who denied to participation. The study was approved by the institute’s ethics committee (SWUEC/E-471/2563) and was registered with the Thai Clinical Trials Registry (TCTR 20210324002). Informed consent from all the participants was obtained. All of them received a self-administrated questionnaire and were asked to complete that questionnaire two times -- prior to and immediately after attending the AGGC, which was conducted face-to-face in group sessions using PowerPoint. The content of the slides and the counseling script were created by the team of the Maternal Fetal Medicine staff at the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University. Crucial information for pregnant females was included in the questionnaire. Each AGGC took approximately 30 minutes. The AGGC was conducted by a second-year resident (the first author listed in this study) in the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, under the Royal Thai College of Obstetricians and Gynecologists’ curriculum. The counselor was standardized by the team of the Maternal Fetal Medicine staff at the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University. Everyone in the AGGC was given the opportunity to ask questions at end of the counseling section. The participants’ demographic data and possible factors influencing her knowledge of key medical factors were collected, including her maternal age, occupation, race, religion, education, gravida, parity, history of abortion, history of receiving information about genetic or antenatal care (previous attendance in genetic or antenatal counseling or reading relevant information by themselves), history of receiving pre-conceptional health service (laboratory testing or folic supplements), and history of child anomalies or genetic disease. Visual analogue scales (VAS) were examined to subjectively demonstrate the level of the participant’s attitudes and the level of cost-effectiveness perception regarding the AGGC.
The questionnaire consisted of five items. Each item consisted of 10 true-or-false questions (total score = 50) that were described as follows: (i) General knowledge focused on general obstetric health care such as nutrition, exercise, vaccinations, defecation, sexual intercourse, sleep, and relaxation. (ii) Ultrasonographic knowledge focused on information about antenatal ultrasonographic examinations, including a fetal- structural-abnormality-detection rate, accuracy, limitations, and safety. (iii) Trisomy-21 knowledge focused on various methods of prenatal trisomy-21 screening and diagnosis, such as the individual trisomy-21 risks of each individual, the screening and diagnostic-procedures options, the limitations of the screening test, and any diagnostic, procedures-related risks. (iv) As regards thalassemia, we focused on their basic knowledge of this disease, the carrier incidence in Thailand, the screening and diagnostic processes, and the adverse pregnancy outcomes if a fetus is affected by severe thalassemia disease. (v) Delivery knowledge focused on the route of delivery preparation, the benefits and risks of each delivery route, especially involving immediate and long-term cesarean delivery-related risks. Our questionnaire was created by our researchers’ team especially for this study. The validity of the questionnaire was evaluated by six Maternal Fetal Medicine staff experts in the Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinworot University. The content validity was calculated as 96%. Using Cronbach’s alpha coefficient, the reliability of the questionnaire was calculated from a pilot study with 30 volunteers at 0.80. The difficulty and discrimination were calculated as 0.7 and 0.26, respectively.
The required sample size was estimated by using the two-independent-means formula, with the expectation that the participants had attended the AGGC either with or without their partner at an equal 1:1 ratio. From a pilot study, we found that the mean overall knowledge scores among those who attended the AGGC with or without their partner were 29.13 and 30.46, respectively. The standard deviations for the overall knowledge scores of those who attended the AGCC with or without their partner were 5.04 and 5.68, respectively. To achieve an alpha of 0.05, a beta of 0.20, and allowing for 5% lost or missing data, it was determined that at least 538 participants were required.
The demographic and clinical characteristics of the patients within each group were examined by tabulating the percentages or medians and interquartile range (IQR) and comparing the differences between both groups by using the Mann-Whitney U and Chi-square test. Changes in their overall knowledge scores were categorized into increased or no increase, according to the differences in those scores prior to and immediately after the AGCC. An increase was defined as the difference in the overall knowledge score, prior to and immediately after the AGCC, being more than or equal to 1, while no increase was defined as the difference between the overall knowledge score prior to and immediately after the AGCC as being less than or equal to 0. Then, the ratio of the participants who had a score increase or no increases were compared using the Chi-square test according to their demographic data, including that they had attended the AGCC either with or without their partner. We used logistical-regression analysis to identify possible factors behind the score improvements to estimate the odds ratios and their 95% confidence intervals (CI). A p value < 0.05 was considered statistically significant.