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To investigate pregnant women's decisions about and attitudes towards Down syndrome screening, i.e. ultrasound at 11-14 weeks, Maternal Serum Markers (MSM) at 11-14 or 15-17 weeks and possibly invasive testing.Women having given birth to a non-affected child were asked to fill in a self-administered questionnaire during their stay at the maternity unit. In order to characterize women's decision-making behaviour, a hierarchical cluster analysis was conducted and logistic regressions were performed.Four hundred women were invited to participate in the study, and 391 returned the questionnaire. Both ultrasound and biochemical screening had been proposed to 88.3% of the women. Three clusters of women who were offered ultrasound and MSM were identified. Two clusters (52% and 42% of women) differed in active versus passive involvement in decision-making. Passively involved women frequently reported unawareness of the possibility of having to make decisions about invasive testing and/or termination of pregnancy. The third cluster (6% of women) consisted of women who declined MSM. Most of the women showed a preference for first-trimester screening, but actively involved women were willing to pay more for MSM.Providing information about the sequence of decision possibly involved in screening could contribute to better informed decisions.