Utilisation of Prenatal Diagnostics During Pregnancy in Germany: Cross-sectional Study Using Data From the KUNO Kids Health Study

Background: Appropriate health system utilisation during pregnancy is fundamental for maintaining maternal and child’s health. This study provides comprehensive data on supplementary prenatal diagnostics use and its influencing factors in Germany. Methods: : We obtained data from a recently established prospective German birth cohort study, the KUNO Kids Health Study, with a study sample of 1886 participating mothers. Analyses are based on Andersen’s Behavioural Model of health system use, which distinguishes between predisposing, enabling and need factors. We examined bi- and multivariate association with the use of supplementary prenatal diagnostics using logistic regression. Results: : One fifth of the mothers investigated did not use any supplementary prenatal diagnostics. Notably, the chance of using supplementary prenatal diagnostics more than doubled if the pregnant woman had a private health insurance. Higher maternal age and environmental tobacco smoke exposure increased the use of supplementary prenatal diagnostics. However, regarding need factors only having a risk-pregnancy showed an independent association. Conclusion: Although a shift in the importance of need factors towards enabling factors for preventive health services has been described before, the important role of the type of health insurance and the relatively small influence of need factors was surprising and worrisome. Especially with respect to equity in accessing health care, this needs further attention.