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Xi H, Xie W, Chen J, Tang W, Deng X, Li H, Peng Y, Wang D, Yang S, Zhang Y, Duan R, Fang J, Wang H. Implementation of fragile X syndrome carrier screening during prenatal diagnosis: A pilot study at a single center. Mol Genet Genomic Med 2021; 9:e1711. [PMID: 34057320 PMCID: PMC8372084 DOI: 10.1002/mgg3.1711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Fragile X syndrome (FXS) is the most common inherited form of intellectual disability. Prenatal screening of FXS allows for early identification and intervention. The present study explored the feasibility of FXS carrier screening during prenatal diagnosis for those who were not offered screening early in pregnancy or prior to conception. Methods Pregnant women to be offered amniotic fluid testing were recruited for the free voluntary carrier screening at a single center between August, 2017 and September, 2019. The number of CGG repeats in the 5’ un‐translated region of the fragile X mental retardation gene 1 (FMR1) was determined. Results 4286 of 7000 (61.2%) pregnant women volunteered for the screening. Forty (0.93%), five (0.11%), and three (0.07%) carriers for intermediate mutation (45–54 repeats), premutation (55–200 repeats) and full mutation (>200 repeats) of the FMR1 gene were identified respectively. None of the detected premutation alleles were inherited by the fetuses. Of the three full mutation carrier mothers, all had a family history and one transmitted a full mutation allele to her male fetus. Conclusion Implementation of FXS carrier screening during prenatal diagnosis may be considered for the need to increase screening for FXS.
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Affiliation(s)
- Hui Xi
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.,NHC Key Laboratory of Birth Defects for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Wanqin Xie
- NHC Key Laboratory of Birth Defects for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jing Chen
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Wanglan Tang
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Xiuli Deng
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Hua Li
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Ying Peng
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.,NHC Key Laboratory of Birth Defects for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Dan Wang
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Shuting Yang
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yanan Zhang
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences & Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Junqun Fang
- Department of Health Care, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Hua Wang
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.,NHC Key Laboratory of Birth Defects for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Metcalfe SA, Martyn M, Ames A, Anderson V, Archibald AD, Couns GDG, Carter R, Cohen J, Cotter M, GenCouns M, Dang W, Delatycki MB, Donath S, Edwards S, Educ PGD, Couns GDG, Forbes R, Couns GDG, Gavrila M, MedSci M, Halliday J, Hickerton C, Hill M, Couns GDG, Jacobs L, Ultrasound PGD, Petrou V, Couns GDG, Plunkett L, GenCouns M, Sheffield L, Racp F, Thornton A, Couns GDG, Younie S, Econ PGDH, Emery JD. Informed decision making and psychosocial outcomes in pregnant and nonpregnant women offered population fragile X carrier screening. Genet Med 2017; 19:1346-1355. [PMID: 28661491 DOI: 10.1038/gim.2017.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/05/2017] [Indexed: 01/13/2023] Open
Abstract
PurposePopulation-based carrier screening for fragile X syndrome (FXS) is still not universally endorsed by professional organizations due to concerns around genetic counseling for complex information and potential for psychosocial harms.MethodsWe determined uptake levels, decision making, and psychosocial impact in a prospective study of pregnant and nonpregnant Australian women offered FXS carrier screening in clinical settings. Women received pretest genetic counseling, and completed questionnaires when deciding and one month later.ResultsOf 1,156 women recruited, 83.1% returned the first questionnaire with 70.6% nonpregnant and 58.8% pregnant women choosing testing (χ2=16.98, P<0.001). Overall, informed choice was high in both nonpregnant (77.4%) and pregnant (72.9%) women (χ2=0.21, P=0.644), and more tested (76.0%) than not-tested (66.7%) women (χ2=6.35, P=0.012) made an informed choice. Measures of depression, stress, and anxiety were similar to population norms for ~85% of women. Decisional conflict and regret were generally low; however, decisional uncertainty and regret were greater in pregnant than nonpregnant women, and not-tested than tested women (uncertainty: χ2=18.51, P<0.001 and χ2=43.11, P<0.001, respectively; regret: χ2=6.61, P<0.037 and χ2=35.54, P<0.001, respectively).ConclusionWe provide evidence to inform guidelines that population FXS carrier screening can be implemented with minimal psychosocial harms following appropriate information and prescreening genetic counseling.
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Affiliation(s)
- Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Martyn
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Alice Ames
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Grad Dip Gen Couns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Rob Carter
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Cohen
- Fragile X Alliance Clinic and Centre for Developmental Disability Health Victoria, Monash University, Melbourne, Victoria, Australia
| | - Megan Cotter
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - M GenCouns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - William Dang
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - Martin B Delatycki
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Susan Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Edwards
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - PGrad Dip Educ
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Grad Dip Gen Couns
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Robin Forbes
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | | | - Mioara Gavrila
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - M MedSci
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Melissa Hill
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Great Ormond Street Hospital for Children, London, UK
| | - Grad Dip Gen Couns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Great Ormond Street Hospital for Children, London, UK
| | - Lorilli Jacobs
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - PGrad Dip Ultrasound
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Vicki Petrou
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Loren Plunkett
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - M GenCouns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Leslie Sheffield
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,MyDNA Life Australia, Melbourne, Victoria, Australia
| | - F Racp
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,MyDNA Life Australia, Melbourne, Victoria, Australia
| | - Alison Thornton
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Sandra Younie
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - PGrad Dip Hlth Econ
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Jon D Emery
- School of Primary Aboriginal and Rural Health Care, University of Western Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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