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Lee HYD, Chan LW. Evaluation of pre-test counselling offered for non-invasive prenatal testing (NIPT) as a primary screening tool. J OBSTET GYNAECOL 2023; 43:2204959. [PMID: 37154788 DOI: 10.1080/01443615.2023.2204959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The increasing popularity and expansion of non-invasive prenatal testing (NIPT) to screen for rare conditions beyond common trisomies prompts evaluation of pre-test counselling currently offered. We conducted a prospective survey to assess women's knowledge of NIPT in those who had undergone NIPT (study group) and those who were planning to have NIPT (control group). Out of the 189 questionnaires analysed, the study group did not show a higher knowledge score compared to the control group (P = 0.097). 44% misunderstood that NIPT can identify more conditions than invasive testing, 69.8% were unaware of the recommended need for nuchal translucency measurement and 52.6% were unaware of the possibility of incidental findings. 31% even considered discussing termination of pregnancy as one of the next steps if NIPT shows high risk for Down syndrome. This study shows that current pre-test counselling is inadequate. Service providers should address these knowledge gaps and assist women to make informed choices.Impact StatementWhat is already known on this subject? Pre-test counselling for non-invasive prenatal testing (NIPT) should be conducted to assist women in making an informed consent.What do the results of this study add? Our results show that a significant proportion of women are unaware of the limitations of NIPT.What are the implications of these findings for clinical practice and/or further research? Service providers should improve their pre-test counselling focusing on areas of knowledge deficiencies and misunderstanding on NIPT identified in this study.
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Affiliation(s)
- Ho Yin Diana Lee
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Lin Wai Chan
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Choi H. Informed choice of pregnant women regarding noninvasive prenatal testing in Korea: a cross-sectional study. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2022; 28:235-249. [PMID: 36403575 PMCID: PMC9619159 DOI: 10.4069/kjwhn.2022.09.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study explored the degree to which pregnant women in Korea made informed choices regarding noninvasive prenatal testing (NIPT) and investigated factors influencing whether they made informed choices. METHODS In total, 129 pregnant women in Korea participated in a web-based survey. Multidimensional measures of informed choice regarding NIPT and decisional conflict were used to measure participants' levels of knowledge, attitudes, deliberation, uptake, and decisional conflict related to NIPT. Additional questions were asked about participants' NIPT experiences and opinions. RESULTS All 129 pregnant women were recruited from an online community. Excluding those who expressed neutral attitudes toward NIPT, according to the definition of informed choice used in this study, only 91 made an informed choice (n=63, 69.2%) or an uninformed choice (n=28, 30.8%). Of the latter, 75.0% had insufficient knowledge, 39.3% made a value-inconsistent decision, and 14.3% did not deliberate sufficiently. No difference in decisional conflict was found between the two groups. A significant difference was found between the two groups in the reasons why NIPT was introduced or recommended (p=.021). Multiple logistic regression analysis showed that pregnant women who were knowledgeable (odds ratio [OR], 4.77; 95% confidence interval [CI], 2.17- 10.47) and deliberated (OR, 0.74; 95% CI, 0.57-0.98) were significantly more likely to make an informed choice. CONCLUSION The results of this study help healthcare providers, including nurses in maternity units, understand pregnant women's experiences of NIPT. Counseling strategies are needed to improve pregnant women's knowledge of NIPT and create an environment that promotes deliberation regarding this decision.
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Affiliation(s)
- Hyunkyung Choi
- Corresponding author: Hyunkyung Choi College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-200-4791 E-mail:
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Libotte F, Carpineto SL, Dello Russo C, Viola A, Margiotti K, Restaldi F, Novelli A, Mesoraca A, Giorlandino C. Cytogenetics and Molecular Investigations detect a Mosaic Variant of Turner Syndrome only Suspected by Non-Invasive Prenatal Testing: Two Case Reports with Negative Ultrasound Examinations. J Med Life 2021; 13:624-628. [PMID: 33456614 PMCID: PMC7803325 DOI: 10.25122/jml-2020-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prenatal testing has been moving towards non-invasive methods to determine fetal risk for genetic disorders. Numerous studies have focused the attention on common trisomies; although the detection rate (DR) for trisomy 21 is high (over 95%), the accuracy regarding the DR for trisomies 13 and 18 has come under scrutiny. The testing has been applied to sex chromosome aneuploidies, but many studies have shown that it is not as effective as it is for common trisomies. Although non-invasive prenatal test (NIPT) has become a standard screening procedure for all pregnant women, invasive sampling procedures remain important in confirming NIPT-positive findings. In the present study, we report discordant results of Turner syndrome (TS) mosaicism between NIPT and karyotyping. A 35-year-old pregnant woman underwent NIPT, and a probable risk for Xp deletion was indicated. Subsequently, amniocentesis was performed. The karyotype was identified as mos 45,X [28]/46,X,i(X)(q1.0)[5]. In the second case, a 33-year-old woman underwent amniocentesis after a positive NIPT that indicated a probable risk for monosomy X. The result was mos 45,X [8]/46,XY[8]. Since NIPT is a screening test, the possibility of false-positive or false-negative results should always be considered. We underline the importance of pre/post detailed counseling. Furthermore, women with abnormal NIPT results should undergo immediate amniocentesis that remains the only tool for a correct diagnosis of sex chromosome aneuploidies.
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Affiliation(s)
- Francesco Libotte
- Department of Genetics, Altamedica Fetal Medical Centre, Rome, Italy
| | | | | | - Antonella Viola
- Department of Genetics, Altamedica Fetal Medical Centre, Rome, Italy
| | - Katia Margiotti
- Department of Genetics, Altamedica Fetal Medical Centre, Rome, Italy
| | - Fabrizia Restaldi
- Department of Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Novelli
- Department of Genetics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alvaro Mesoraca
- Department of Genetics, Altamedica Fetal Medical Centre, Rome, Italy
| | - Claudio Giorlandino
- Department of Prenatal Diagnosis, Altamedica Fetal Medical Centre, Rome, Italy
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He Y, Wang Y, Li Z, Chen H, Deng J, Huang H, He X, Zeng W, Liu M, Huang B, Chen P. Clinical performance of non-invasive prenatal testing for trisomies 21, 18 and 13 in twin pregnancies: A cohort study and a systematic meta-analysis. Acta Obstet Gynecol Scand 2020; 99:731-743. [PMID: 32166736 DOI: 10.1111/aogs.13842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The objective of this study was to report on the clinical performance of non-invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 in twin pregnancies and to define the performance of NIPT by combining our cohort study results with published studies in a systematic meta-analysis. MATERIAL AND METHODS A cohort study was carried out in the First Affiliated Hospital of Sun Yat-sen University and Kanghua Hospital. Meanwhile, searches of PubMed, EMBASE, The Cochrane Library and Web of Science for all relevant peer-reviewed articles were performed with a restriction to English language publication before 15 June 2019. Quality assessments were conducted with the Quality Assessment Tool for Diagnostic Accuracy Studies-2 checklist. Data analysis, heterogeneity, subgroup analysis and publication bias were carried out using META-DISC 1.4 and STATA 12.0. RESULTS In all, 141 twin pregnancies included in our cohort study; confirmation revealed one true-positive case for trisomy 21 and 140 true-negative cases. The sensitivity and specificity for trisomy 21 by NIPT were both 100%. Twenty-two eligible studies were enrolled in this meta-analysis together with our study. There were 199 cases of trisomy 21, 58 cases of trisomy 18, 14 cases of trisomy 13 and 6347 cases of euploids in total. For trisomy 21, NIPT showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.99, 1.00, 145.81, 0.06 and 1714.09, respectively. For trisomy 18, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.88, 1.00, 200.98, 0.19 and 483.68, respectively. CONCLUSIONS The performance of NIPT for trisomy 21 in twin pregnancy was excellent and it was similar to that reported in singleton pregnancy. However, due to publication bias (trisomy 18) and small number of cases (trisomy 13), accurate assessment of the predictive performance of NIPT for trisomies 18 and 13 could not be achieved.
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Affiliation(s)
- Yuting He
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yichong Wang
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuyu Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haitian Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiankai Deng
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Huang
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohong He
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wentao Zeng
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Liu
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Huang
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peisong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Farrell RM, Agatisa PK, Michie MM, Greene A, Ford PJ. The personal utility of cfDNA screening: Pregnant patients' experiences with cfDNA screening and views on expanded cfDNA panels. J Genet Couns 2019; 29:88-96. [PMID: 31680382 DOI: 10.1002/jgc4.1183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 01/13/2023]
Abstract
Prenatal cell-free DNA screening (cfDNA) provides more genetic risk information about the fetus than has ever been possible. At the same time, the rapid expansion of new cfDNA panels raises important questions about how to structure patient-centered discussions that best support patients' decision-making about its use. To address this question, we conducted interviews with pregnant patients to identify decision-making needs and preferences with respect to cfDNA in patient-centered healthcare discussions, given its evolving capability to identify a range of fetal variants. Personal utility was a core concept guiding decision-making. Participants spoke of how their deeply personal values and beliefs about maternal responsibility, actionability, and tolerance of uncertainty framed their view of the personal utility of cfDNA screening. While discussing their notions of personal utility with their healthcare provider, participants also had concerns about potential ramifications for the provider-patient relationship and shared decision-making when disclosing values and preferences regarding disability, quality of life, and termination-particularly as it becomes possible to identify variants with different disease-associated severity and outcomes. The complexities associated with the introduction of genomics in prenatal care present unique challenges to structuring effective shared decision-making discussions between patients and their healthcare providers. While efforts are underway to determine how to best educate patients about the medical aspects of cfDNA, it is equally important to develop approaches in healthcare communication that enable patients to make informed, values-based decisions about the use of cfDNA and its impact on their pregnancy.
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Affiliation(s)
- Ruth M Farrell
- OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
| | | | - Marsha M Michie
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio
| | - Amy Greene
- Center for Spiritual Care, Cleveland Clinic, Cleveland, Ohio
| | - Paul J Ford
- Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
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Bowman-Smart H, Savulescu J, Mand C, Gyngell C, Pertile MD, Lewis S, Delatycki MB. 'Is it better not to know certain things?': views of women who have undergone non-invasive prenatal testing on its possible future applications. JOURNAL OF MEDICAL ETHICS 2019; 45:231-238. [PMID: 30679192 PMCID: PMC6582742 DOI: 10.1136/medethics-2018-105167] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 05/21/2023]
Abstract
Non-invasive prenatal testing (NIPT) is at the forefront of prenatal screening. Current uses for NIPT include fetal sex determination and screening for chromosomal disorders such as trisomy 21 (Down syndrome). However, NIPT may be expanded to many different future applications. There are a potential host of ethical concerns around the expanding use of NIPT, as examined by the recent Nuffield Council report on the topic. It is important to examine what NIPT might be used for before these possibilities become consumer reality. There is limited research exploring views of women on possible future uses of NIPT, particularly those of women who have undergone NIPT. In this study, we examined the views of women who undertook NIPT previously on the acceptability of and interest levels in using NIPT for a number of current and possible future applications. These included several medical conditions encompassing psychiatric, neurodevelopmental and adult-onset conditions as well as non-medical traits such as intelligence. One thousand women were invited to participate and 235 eligible surveys were received. Women generally reported an interest in using NIPT for medical conditions that severely impacted quality of life and with an onset earlier in life and stressed the importance of the accuracy of the test. Concerns were raised about the use of NIPT for non-medical traits. Respondents indicated that termination of pregnancy was not their only reason for testing, particularly in the case of sex. These results can further inform the ethical debate around the increasing integration of NIPT into healthcare systems.
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Affiliation(s)
- Hilary Bowman-Smart
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Cara Mand
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Mark D Pertile
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia
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Stefanovic V. The importance of pre- and post-test counseling for prenatal cell-free DNA screening for common fetal aneuploidies. Expert Rev Mol Diagn 2019; 19:201-215. [PMID: 30657716 DOI: 10.1080/14737159.2019.1571912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Prenatal cell-free DNA screening for common fetal aneuploidies has rapidly changed the paradigm of prenatal care. Despite its advantages compared to conventional screening methods, its unexpectedly rapid implementation in clinical practice has generated several ethical and medical issues and misconceptions. Aggressive commercial marketing of cell-free DNA screening and media dissemination of misleading information have added confusion. Areas covered: This review provides an extensive update and will focus on the importance of pre-and post-test counseling for prenatal cell-free DNA screening not previously discussed extensively in the available literature. Additionally, we report cell-free DNA screening implementation in the largest obstetrical tertiary unit in Finland which is one of few countries that provides all prenatal screening methods free of charge for all women and has a very high uptake of first-trimester screening. This is not a systematical review, but rather a narrative overview which includes the most relevant and recent original publications and reviews covering this issue. Expert opinion: Despite being the most accurate method for screening of common fetal aneuploidies, the knowledge and counseling should be substantially improved. Cell-free DNA screening is not a replacement for diagnostic testing and its use in prenatal testing is complex and limited.
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Affiliation(s)
- Vedran Stefanovic
- a Department of Obstetrics and Gynecology , Fetomaternal Medical Center, Helsinki University and Helsinki University Hospital , Helsinki , Finland
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8
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Agatisa PK, Mercer MB, Coleridge M, Farrell RM. Genetic Counselors' Perspectives About Cell-Free DNA: Experiences, Challenges, and Expectations for Obstetricians. J Genet Couns 2018; 27:1374-1385. [PMID: 29951719 DOI: 10.1007/s10897-018-0268-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 06/04/2018] [Indexed: 12/18/2022]
Abstract
The expansion of cell-free fetal DNA (cfDNA) screening for a larger and diverse set of genetic variants, in addition for use among the low-risk obstetric population, presents important clinical challenges for all healthcare providers involved in the delivery of prenatal care. It is unclear how to leverage the different members of the healthcare team to respond to these challenges. We conducted interviews with 25 prenatal genetic counselors to understand their experience with the continued expansion of cfDNA screening. Participants supported the use of cfDNA screening for the common autosomal aneuploidies, but noted some reservations for its use to identify fetal sex and microdeletions. Participants reported several barriers to ensuring that patients have the information and support to make informed decisions about using cfDNA to screen for these different conditions. This was seen as a dual-sided problem, and necessitated additional education interventions that addressed patients seeking cfDNA screening, and obstetricians who introduce the concepts of genetic risk and cfDNA to patients. In addition, participants noted that they have a professional responsibility to educate obstetricians about cfDNA so they can be prepared to be gatekeepers of counseling and education about this screening option for use among the general obstetric population.
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Affiliation(s)
- Patricia K Agatisa
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA
| | - Mary Beth Mercer
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ruth M Farrell
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, A81, Cleveland, OH, 44195, USA.
- Center for Bioethics, Cleveland Clinic, Cleveland, OH, USA.
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Chen A, Lillrank PM, Tenhunen H, Peltokorpi A, Torkki P, Heinonen S, Stefanovic V. Context-based patient choice management in healthcare. Int J Health Care Qual Assur 2018; 31:52-68. [DOI: 10.1108/ijhcqa-01-2017-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
In healthcare, there is limited knowledge of and experience with patient choice management. The purpose of this paper is to focus on patient choice, apply and test demand-supply-based operating (DSO) logic integrated with clinical setting in clarifying choice contexts, investigate patient’s choice-making at different contexts and suggest context-based choice architectures to manage and develop patient choice.
Design/methodology/approach
Prenatal screening and testing in the Helsinki and Uusimaa Hospital District (HUS), Finland, was taken as an example. Choice points were contextualized by using the DSO framework. Women’s reflections, behaviors and experience at different choice contexts were studied by interviewing women participating in prenatal screening and testing. Semi-structured interview data were processed by thematic analysis.
Findings
By applying DSO logic, four choice contexts (prevention, cure, electives and continuous care) were relevant in the prenatal screening and testing episode. Women had different choice-making in prevention and cure mode contexts regarding choice activeness, information needs, social influence, preferences, emotion status and choice-making difficulty. Default choice was widely accepted by women in prevention mode and individual counseling can help women make informed choice in cure mode.
Originality/value
The authors apply the DSO model to contextualize the patient choice in one care episode and compare patient choice-making at different contexts. The authors also suggest the possible context-based choice architectures to manage and promote patient choice
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Lau J, Yi H, Ahmed S. Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individualvsrelational autonomy. Clin Genet 2016; 89:550-6. [DOI: 10.1111/cge.12743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 01/31/2023]
Affiliation(s)
- J.Y.C. Lau
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
| | - H. Yi
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
- CUHK Centre for Bioethics; The Chinese University of Hong Kong; Hong Kong SAR China
| | - S. Ahmed
- Leeds Institute of Health Sciences; University of Leeds; Leeds United Kingdom
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Krauskopf AL, Knippel AJ, Verde PE, Kozlowski P. Predicting SGA neonates using first-trimester screening: influence of previous pregnancy's birthweight and PAPP-A MoM. J Matern Fetal Neonatal Med 2015; 29:2962-7. [PMID: 26551433 DOI: 10.3109/14767058.2015.1109622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Investigating the proportions of anamnestic and biochemical variables of the previous and current pregnancies for the prediction of small for gestational age (SGA) neonates in the current pregnancy. METHODS In this observational retrospective study, 45 029 pregnancies were examined, including 3862 patients with more than one pregnancy. Odds ratios for SGA using anamnestic parameters and pregnancy-associated plasma protein A (PAPP-A) values from all pregnancies were estimated by using a logistic regression model. RESULTS There were 2552 (5.7%) SGA neonates. Two threshold PAPP-A values were identified at 0.15 MoM and 0.33 MoM with probabilities for SGA of 23% and 17%, respectively. A previous SGA < 10th centile and a current PAPP-A MoM value < 5th centile result in odds ratios of 4.8 (95% CI: 3.5-6.5) and 3.0 (95% CI: 1.8-5.0), respectively. The parameters' combined odds ratio is 14.1 (95% CI: 3.9-50.3) with a number needed to screen of ten for one SGA neonate at a detection rate of 37%. CONCLUSION Information on previous pregnancies affected by SGA and a current pregnancy's low PAPP-A value are reliable predictors for a SGA delivery. First-trimester biochemical analysis should be maintained to detect women at risk for delivering a SGA neonate.
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Affiliation(s)
| | | | - Pablo Emilio Verde
- b Coordination Center for Clinical Trials, University of Düsseldorf , Düsseldorf, NRW , Germany
| | - Peter Kozlowski
- a Praenatal-Medizin Und Genetik Düsseldorf , Düsseldorf, NRW , Germany and
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Soft markers for aneuploidy following reassuring first trimester screening: what should be done? Curr Opin Obstet Gynecol 2015; 27:151-8. [PMID: 25689239 DOI: 10.1097/gco.0000000000000157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW The present article aims to review the current role of the soft markers on the second trimester ultrasound (STUS) in women after reassuring first trimester screening (FTS) in singleton pregnancies. RECENT FINDINGS Improvements in the FTS and the recent implementation of noninvasive prenatal testing (NIPT) for common aneuploidies have important impact on the prevalence of these conditions in the STUS. Some studies suggest that soft markers in the second trimester of the fetus without structural anomalies have a minor or no role in Down syndrome detection in a prescreened population with reassuring results. However, NIPT could be offered as a next step in the management of such pregnancies if the calculated new composite risk (NCR) for aneuploidy is increased. In the case of reassuring results, pregnancy follow-up for certain markers is advised. SUMMARY NIPT has emerged as a new method of prenatal testing and is feasible in the second trimester in women with increased NCR. However, apart from the Down syndrome screening, STUS screening remains a powerful tool in screening for other fetal aneuploidies, structural anomalies and pathological placental conditions and detection of specific soft markers that require pregnancy follow-up.
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Prenatal aneuploidy screening using cell free DNA. Am J Obstet Gynecol 2015; 213:596-7. [PMID: 26071919 DOI: 10.1016/j.ajog.2015.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022]
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Kou KO, Poon CF, Tse WC, Mak SL, Leung KY. Knowledge and future preference of Chinese women in a major public hospital in Hong Kong after undergoing non-invasive prenatal testing for positive aneuploidy screening: a questionnaire survey. BMC Pregnancy Childbirth 2015; 15:199. [PMID: 26330276 PMCID: PMC4557816 DOI: 10.1186/s12884-015-0636-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/24/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the non-invasive nature of non-invasive prenatal testing (NIPT), there is still a need for a separate informed consent process before testing. The objectives of this study are to assess (a) knowledge and preferences of Chinese women in a major public hospital in Hong Kong who underwent NIPT, and (b) whether their knowledge and preferences differ depending on womens' characteristics and sources of information. METHODS Setting: Prenatal diagnosis and counselling clinic. Between February 2012 and September 2013, a questionnaire survey was distributed to all women who underwent NIPT after positive aneuploidy screening. As a pilot study, ten knowledge questions were designed based on the rapid response statement on Prenatal Detection of Down Syndrome using Massively Parallel Sequencing from the International Society for Prenatal Diagnosis in 2011. The source of women's knowledge and their preferences were also evaluated. While conventional screening was publicly funded, NIPT was not. Differences between subgroups were compared using chi square tests and logistic regression analysis. RESULTS Of 152 women who underwent NIPT, 135 (88.8%) completed their questionnaires. More than 90% of women recognised the possibility of false positive and false negative results. Slightly more than 70% of women knew the inferior sensitivity of NIPT compared to an invasive test, and the possibility of an uninformative test result, but were not aware of the complicated aspects of NIPT. Pregnant women with an advanced level of education or those who underwent NIPT before 15 weeks provided answers that was more accurate by around 10-20% in two to three knowledge questions than those without. These associations were confirmed by multivariate logistic regression analysis. The women received information on NIPT largely from their private doctors (47.4%) and web (41.5%). In their future pregnancies, more women would opt for NIPT (a self-financed item) after positive screening ('free' in a public hospital) (57.8%) than as a primary screening (30.4%). CONCLUSIONS It is feasible to use a questionnaire based on the ISPD statement on NIPT to assess women's knowledge of the test. The Chinese women who underwent NIPT recognised the limitations, but did not understand the complicated aspects. More information should be provided by health care professionals in order to facilitate an informed choice by patients. More women preferred NIPT as a contingent test than as a primary screening probably because of its high cost.
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Affiliation(s)
- Kam On Kou
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Chung Fan Poon
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Wai Ching Tse
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, SAR, China.
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15
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Walser SA, Kellom KS, Palmer SC, Bernhardt BA. Comparing genetic counselor's and patient's perceptions of needs in prenatal chromosomal microarray testing. Prenat Diagn 2015; 35:870-8. [PMID: 25995037 DOI: 10.1002/pd.4624] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/13/2015] [Accepted: 05/17/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Chromosome microarray analysis is poised to take a significant place in the prenatal setting given its increased yield over standard karyotyping, but concerns regarding ethical and counseling challenges remain, especially associated with the risk of uncertain and incidental findings. Guidelines recommend patients receiving prenatal screening to undergo genetic counseling prior to testing, but little is known about women's specific pre-testing and post-testing informational needs, as well as their preference for return of various types of results. METHODS The present study surveys 199 prenatal genetic counselors who have counseled patients undergoing chromosome microarray analysis testing and 152 women who have undergone testing on the importance of understanding pre-test information, return of various types of results, and resources made available following an abnormal finding. RESULTS Counselors and patients agree on many aspects, although findings indicate patients consider all available information very important, while genetic counselors give more varying ratings. CONCLUSION Counseling sessions would benefit from information personalized to a patient's particular needs and a shared decision-making model, to reduce informational overload and avoid unnecessary anxiety. Additionally, policies regarding the return of various types of results are needed. © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sarah A Walser
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine S Kellom
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Palmer
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara A Bernhardt
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Everett TR, Chitty LS. Cell-free fetal DNA: the new tool in fetal medicine. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:499-507. [PMID: 25483938 PMCID: PMC5029578 DOI: 10.1002/uog.14746] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/31/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Affiliation(s)
- T R Everett
- Fetal Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
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17
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Van Lith JMM, Faas BHW, Bianchi DW. Current controversies in prenatal diagnosis 1: NIPT for chromosome abnormalities should be offered to women with lowa prioririsk. Prenat Diagn 2015; 35:8-14. [DOI: 10.1002/pd.4530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/06/2014] [Accepted: 11/07/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Jan M. M. Van Lith
- Department of Obstetrics and Fetal Medicine; Leiden University Medical Center, LUMC; Leiden The Netherlands
| | - Brigitte H. W. Faas
- Department of Human Genetics; Radboud university medical center; Nijmegen The Netherlands
| | - Diana W. Bianchi
- Mother Infant Research Institute; Floating Hospital for Children and Tufts Medical Center; Boston Massachusetts USA
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18
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Han CS, Platt LD. Noninvasive prenatal testing: need for informed enthusiasm. Am J Obstet Gynecol 2014; 211:577-80. [PMID: 25459560 DOI: 10.1016/j.ajog.2014.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Christina S Han
- Center for Fetal Medicine & Women's Ultrasound and the Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA.
| | - Lawrence D Platt
- Center for Fetal Medicine & Women's Ultrasound and the Department of Obstetrics and Gynecology, UCLA, Los Angeles, CA
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