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To the Editor I had a few concerns about the study by Dr Kuppermann and colleagues.1 First, although the randomized design strengthened the study, the lack of baseline knowledge or values testing means the conclusion that “…this approach improved patient knowledge regarding prenatal testing and understanding of amniocentesis-related miscarriage and age-adjusted risk of Down syndrome” is too strong. Without pretesting, it is impossible to say that the intervention was the reason for the improvement. Conclusions should only be drawn from the postintervention comparisons of the 2 groups.
Crooke H. Decision-Support Guide and Use of Prenatal Genetic Testing. JAMA. 2015;313(2):199-200. doi:10.1001/jama.2014.16476