Communicating Down syndrome risk according to maternal age: "1-in-X" effect on perceived risk

Objective: The appropriateness of the 1-in-X numerical format to convey quantitative medical probabilities is currently under discussion because of its distortive effect on subjective probability assessment. Previous research, however, always asked participants to imagine a hypothetical scenario. The aim of the present research is to support the existence of the 1-in-X effect in a real setting: when pregnant women have to evaluate their personal risk of Down syndrome according to their maternal age. Method: During the first prenatal visit, pregnant women were asked to evaluate their own risk of having a child with Down syndrome according to their age, when such risk was presented either in the 1-in-X or in the N-in-NX format. Then, they were asked to assess their risk of having a child with Down syndrome. Results: Results showed a systematic higher risk assessment when pregnant women were presented with the 1-in-X format (mean=3.57, standard deviation=1.4) than with the N-in-NX format (mean=3.03, standard deviation=1.4), P=0.007. Whereas the effect was shown to be not moderated by a differential comprehension of the two numerical formats, women with a low educational level and those who were at their first pregnancy were shown to be significantly more vulnerable. Conclusion: The present findings corroborate the existence of the 1-in-X effect in a real-world setting, showing that, in pregnant women, the 1-in-X format actually elicits a higher perceived risk of Down syndrome, compared with the N-in-NX format.