BACKGROUND: A newly introduced cell-free fetal DNA sequencing based non-invasive 
prenatal testing (DNA-NIPT) detects Down syndrome with sensitivity of 99% at 
early gestational stage without risk of miscarriage. Attention has been given to 
its public health implications; little is known from consumer perspectives. This 
qualitative study aimed to explore women's motivations for using, and 
perceptions of, DNA-NIPT in Hong Kong.
METHODS AND FINDINGS: In-depth interviews were conducted with 45 women who had 
undertaken DNA-NIPT recruited by purposive sampling based on socio-demographic 
and clinical characteristics. The sample included 31 women identified as 
high-risk from serum and ultrasound based Down syndrome screening (SU-DSS). 
Thematic narrative analysis examined informed-decision making of the test and 
identified the benefits and needs. Women outlined a number of reasons for 
accessing DNA-NIPT: reducing the uncertainty associated with risk 
probability-based results from SU-DSS, undertaking DNA-NIPT as a comprehensive 
measure to counteract risk from childbearing especially at advanced age, 
perceived predictive accuracy and absence of risk of harm to fetus. Accounts of 
women deemed high-risk or not high-risk are distinctive in a number of respects. 
High-risk women accessed DNA-NIPT to get a clearer idea of their risk. This 
group perceived SU-DSS as an unnecessary and confusing procedure because of its 
varying, protocol-dependent detection rates. Those women not deemed high-risk, 
in contrast, undertook DNA-NIPT for psychological assurance and to reduce 
anxiety even after receiving the negative result from SU-DSS.
CONCLUSIONS: DNA-NIPT was regarded positively by women who chose this method of 
screening over the routine, less expensive testing options. Given its perceived 
utility, health providers need to consider whether DNA-NIPT should be offered as 
part of universal routine care to women at high-risk for fetal aneuploidy. If 
this is the case, then further development of guidelines and quality assurance 
will be needed to provide a service suited to patients' needs.