Objective: To determine the influence of various factors on the prenatal diagnosis and elective termination of neural tube defects (NTDs) in Hawaii in 1986–1997. Methods: Data from a birth defects registry were analyzed and included 245 cases. Results: 74% of the cases were prenatally diagnosed and 48% were terminated. Anencephaly was more likely to be prenatally diagnosed and electively terminated than spina bifida or encephalocele. Other factors such as maternal age, race/ethnicity, place of residence, and elevated maternal serum α-fetoprotein influenced the prenatal diagnosis and/or elective termination of NTD-affected pregnancies. However, a given factor may influence prenatal diagnosis and elective termination in different ways. Conclusions: Various diagnostic and demographic factors can influence the prenatal diagnosis and the subsequent termination of NTD-affected pregnancies.