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 鈥溾��this approach improved patient knowledge regarding prenatal testing and understanding of amniocentesis-related miscarriage and age-adjusted risk of Down syndrome鈥� 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.

Second, little information was provided on how individual risk for each woman was calculated. A recent meta-analysis on the risk of miscarriage after amniocentesis found a range of values reported in different studies.² Which prior studies did the authors use in their estimations of risk and how were personalized risk scores calculated? Also, details regarding the 鈥済eneral information about prenatal testing and role of values and preferences in prenatal testing decisions鈥�¹ that were given to women in the intervention group were not provided, even in the supplemental materials or previously published articles.^3,4