Genetic counseling utilization by families with offspring affected by birth defects, Hawaii, 1986-2003.

Information on the genetic counseling facility utilization by families with offspring affected by birth defects in the United States is limited. The intent of this study was to report on genetic counseling utilization in Hawaii. Cases were all infants and fetuses of any pregnancy outcome with major birth defects included in a Hawaii birth defects registry and delivered during 1986-2003. The genetic counseling facility utilization rates were determined for various factors and evaluated for significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 15,104 total cases, genetic counseling facilities were utilized in 1,596 (10.6%). Utilization rates were higher with the presence of multiple major birth defects (RR 3.06, 95% CI 2.75-3.42), chromosomal abnormalities (RR 4.25, 95% CI 3.82-4.73), and malformation syndromes (RR 6.83, 95% CI 5.85-7.93). Among 54 specific birth defects, the utilization rate varied from 1.5% for pyloric stenosis to 55.3% for holoprosencephaly and was significantly higher for 31 (57.4%) of the defects. Greater utilization rates were found with live births that had expired within 1 year after delivery (RR 2.86, 95% CI 2.42-3.36), fetal deaths (RR 1.59, 95% CI 1.23-2.03), elective terminations (RR 5.76, 95% CI 5.06-6.55), and maternal age > or =35 years (RR 1.59, 95% CI 1.41-1.78). Genetic counseling facility utilization rates were much higher with the presence of multiple major birth defects, chromosomal abnormalities, and malformation syndromes, certain specific birth defects, death of the fetus or infant, and older maternal age.