Knowledge, acceptance, and willingness to pay for expanded carrier screening among obstetric patients in China: Implications for genetic counseling practice.

Expanded carrier screening (ECS) enables the identification of couples at increased risk of having offspring affected by serious inherited disorders; however, its effective implementation depends on individuals' understanding, acceptance, and access. This study aimed to assess knowledge, attitudes, acceptance, and willingness to pay (WTP) for ECS among individuals receiving obstetric care, and to examine the implications for genetic counseling practice. We conducted a cross-sectional survey among 2964 reproductive-age individuals attending preconception counseling and antenatal care clinics. The questionnaire assessed sociodemographic characteristics, reproductive history, knowledge of ECS, perceived stigma related to carrier status, screening preferences, and the WTP. Multinomial logistic regression was used to identify factors associated with the acceptance of ECS, and ordered logistic regression was used to examine determinants of the WTP. Overall, acceptance of ECS was high, with most participants preferring screening either before conception or during pregnancy. Substantial knowledge gaps were identified, particularly regarding the scope and limitations of ECS, including misconceptions that ECS could exclude chromosomal abnormalities or fully eliminate residual genetic risk following a negative result. After multivariable adjustment, perceived stigma related to carrier status and higher educational attainment were independently associated with acceptance of ECS, whereas household income, age group, and family history of genetic disorders were not. Knowledge accuracy showed a directional but imprecise association with acceptance. WTP for ECS varied across socioeconomic groups. Higher knowledge accuracy, higher educational attainment, and higher household income were independently associated with greater WTP. In contrast, perceived stigma showed only a modest association with WTP and was not independently associated with high WTP in sensitivity analyses. These findings suggest that psychological factors, particularly perceived stigma, are significantly associated with decisions regarding ECS, whereas cognitive understanding and socioeconomic capacity are more closely linked to monetary valuation. Genetic counseling strategies that address misconceptions, mitigate stigma-related concerns, and consider affordability may be essential for promoting the informed and equitable implementation of ECS in obstetric settings.