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Haddad-Halloun J, Wexler A, Echar M, Harari-Shaham A, Polager-Modan S, Zaatry R, Maayouf R, Assadi M, Krivoruk O, Peleg A, Sagi-Dain L. The effect of opting-in versus opting-out forming on the rate of reported variants of questionable significance in prenatal microarray. Int J Gynaecol Obstet 2024. [PMID: 39031025 DOI: 10.1002/ijgo.15805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To examine the effect of patient-selected opt-in versus opt-out option on the rate of reported variants of uncertain clinical significance (VOUS) and high-frequency low-penetrant (HFLP) findings in prenatal microarray testing. METHODS A standard microarray consent form in Israel includes a requirement to note patient choice to be or not to be informed about the presence of VOUS and HFLP variants. The original form was designed as an opting-out method, in which the women had to actively mark if they did not want to be informed about questionable findings. In the authors' Genetic Institute, the form was changed for an opting-in option in October 2019. In this study we have compared the rates of reported VOUS and HFLP variants between the opt-in and opt-out periods. RESULTS Of the 1014 prenatal CMA tests, 590 (58.2%) were performed in the opt-out period. A significant decrease in the rate of women requesting to be informed of VOUS findings was noted (66.8% in opt-out period vs 34.0% in opt-in period), yielding a relative risk (RR) of 0.46 (95% confidence interval [CI] 0.39-0.53). Rate of women preferring to be informed of HFLP variants decreased from 75.3% to 48.1% (RR 0.52, 95% CI 0.45-0.60). DISCUSSION We present a simple and effective method to decrease the rate of reported findings of questionable significance in the prenatal setting. These results are important not only for microarray results, but also for next-generation sequencing techniques, such as whole exome or genome sequencing.
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Affiliation(s)
| | - Ava Wexler
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Moran Echar
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | | | | | - Rawan Zaatry
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | - Rasha Maayouf
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | - Maisa Assadi
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | - Olga Krivoruk
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | - Amir Peleg
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
| | - Lena Sagi-Dain
- The Human Genetic Institute, Carmel Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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2
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Lu D, Yang J, Shen W, Chen M. Attitudes toward uncertain results from prenatal exome sequencing: a national survey among healthcare professionals working in the prenatal setting. Front Med (Lausanne) 2024; 11:1335649. [PMID: 38813373 PMCID: PMC11133618 DOI: 10.3389/fmed.2024.1335649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
Objective The objective of this study was to investigate the attitudes of healthcare professionals (HPs) working in the prenatal setting toward uncertain results (UR) from prenatal exome sequencing (pES) in China. Methods We conducted a national survey among HPs working in the prenatal setting. UR in our study include variants of uncertain significance (VUS), variants with variable penetrance/expressivity (VVPE), and secondary findings unrelated to the indication for testing (SFs). A total of 285 questionnaires that met the inclusion criteria were collected. Data were analyzed using IBM SPSS Statistics 26. Results When performing the pre-test counseling, only 7.4% of HPs mentioned the possibility of VUS, 6.3% discussed the possibility of VVPE, and 7.4% introduced the SFs with parents with the option to not report these variants. In post-test counseling, 73.0-82.8% HPs discussed with the parents but did not make any recommendations for managing the pregnancy after reporting UR (73.0% for VUS, 82.8% for VVPE, 74.7% for SFs, respectively). Conclusion Most parents did not have the option of opting out of reporting UR from pES in pre-test counseling. UR did not influence the pregnancy recommendation made by most HPs. Establishing national guidelines for reporting UR from pES and developing strategies to improve counseling skills may help HPs manage UR.
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Affiliation(s)
- Dongfang Lu
- Department of Obstetrics, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jing Yang
- Department of Obstetrics, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Wei Shen
- Department of Obstetrics, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Min Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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3
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Popa ZL, Margan MM, Petre I, Bernad E, Stelea L, Chiriac VD, Craina M, Ciuca IM, Bina AM. A Cross-Sectional Study of the Marital Attitudes of Pregnant Women at Risk for Cystic Fibrosis and Psychological Impact of Prenatal Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8698. [PMID: 35886548 PMCID: PMC9317754 DOI: 10.3390/ijerph19148698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 12/04/2022]
Abstract
Cystic fibrosis (CF) is one of the most frequent genetic disorders in those with Northern European ancestry. Prenatal testing for cystic fibrosis may be used to plan and prepare for the birth of a child with the disease or to determine whether to terminate the pregnancy. The accessibility of prenatal detection for women with a high genetic risk of delivering a child with cystic fibrosis is determined by CF carriers and those affected by the disease. Moreover, prenatal testing for CF is mainly dependent on invasive diagnostic tests that can influence the mental health of the pregnant woman, and it is assumed that the birth of a CF child will have a serious influence on the couple's subsequent family planning and marital behavior. The purpose of this research was to examine the marital attitudes of women at risk for cystic fibrosis and the psychological effect of screening for CF among pregnant women. The study followed a cross-sectional design with five questionnaires comprising Prenatal Attachment Interview (PAI), Maternal Antenatal Attachment Scale (MAAS), Pregnancy-Related Anxiety Questionnaire (PRAQ-R2), the Prenatal Psychosocial Profile (PPP), and the Marital Intimacy Questionnaire (MIQ). A total of 84 pregnant women were included in the "carriers" group for CFTR and 91 in the "non-carrier" group. CFTR-carrier mothers were likely to be more affectionate to the fetus, with better maternal-fetal quality and intensity of attachment. The same group of pregnant women was less scared of giving birth or worried about bearing a physically or mentally handicapped child compared to women who were expecting the prenatal diagnosis test for being at risk of delivering a newborn with malformations. CFTR-carrier pregnant women did not score significantly different results in the Prenatal Psychosocial Profile regarding stress levels, social support, and self-esteem. It was also found that intimacy and consensus problems inside the marriage were significantly more often experienced by CFTR carriers. Based on the current findings, it is likely that CFTR-carrier mothers have a better perception of the possible pregnancy outcomes by knowing their abnormal gene carrier status. Therefore, the psychological impact of invasive diagnostic tests is lower in this category compared with those who are unaware of the possible pregnancy outcomes. However, we promote a future analysis for pregnant women with moderate risk of giving birth to a child with single-gene mutations such as cystic fibrosis or other congenital malformations that undergo noninvasive prenatal diagnosis tests, as they become more accurate and might cause lower pre-diagnosis stress levels.
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Affiliation(s)
- Zoran Laurentiu Popa
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
- Centre for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Madalin-Marius Margan
- Department of Microscopic Morphology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Izabella Petre
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Elena Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Lavinia Stelea
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Veronica Daniela Chiriac
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Marius Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (Z.L.P.); (I.P.); (E.B.); (L.S.); (V.D.C.); (M.C.)
| | - Ioana Mihaela Ciuca
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Anca Mihaela Bina
- Centre for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department III Functional Sciences, Discipline Pathophysiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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4
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Cancer patients' understandings of genetic variants of uncertain significance in clinical care. J Community Genet 2022; 13:381-388. [PMID: 35616809 PMCID: PMC9134724 DOI: 10.1007/s12687-022-00594-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Genetic variants of uncertain significance (VUSs) pose a growing challenge for patient communication and care in precision genomic medicine. To better understand patient perspectives of VUSs, we draw on qualitative analysis of semi-structured interviews with 22 cancer patients and individuals with cancer family history who received a VUS result. The majority of patients did not recall receiving VUS results and those who remembered expressed few worries, while respondents who were tested because of a family history of cancer were more concerned about the VUS results. Personal characteristics, medical condition, family history, expectations prior to testing, and motivations for pursuing testing influence the ways patients came to terms with the uncertainty of the VUS result. We conclude by discussing the relevance of the findings to the debate on the responsibility of the patient in checking back for VUS reclassification and to implications for genetic counseling that emphasizes tailoring the pre- and post-test discussion of VUS as appropriate to the patients’ informational as well as emotional needs.
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5
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Buchanan J, Hill M, Vass CM, Hammond J, Riedijk S, Klapwijk JE, Harding E, Lou S, Vogel I, Hui L, Ingvoldstad-Malmgren C, Soller MJ, Ormond KE, Choolani M, Zheng Q, Chitty LS, Lewis C. Factor's that impact on women's decision-making around prenatal genomic tests: An international discrete choice survey. Prenat Diagn 2022; 42:934-946. [PMID: 35476801 PMCID: PMC9325352 DOI: 10.1002/pd.6159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We conducted a survey-based discrete-choice experiment (DCE) to understand the test features that drive women's preferences for prenatal genomic testing, and explore variation across countries. METHODS Five test attributes were identified as being important for decision-making through a literature review, qualitative interviews and quantitative scoring exercise. Twelve scenarios were constructed in which respondents choose between two invasive tests or no test. Women from eight countries who delivered a baby in the previous 24 months completed a DCE presenting these scenarios. Choices were modeled using conditional logit regression analysis. RESULTS Surveys from 1239 women (Australia: n = 178; China: n = 179; Denmark: n = 88; Netherlands: n = 177; Singapore: n = 90; Sweden: n = 178; UK: n = 174; USA: n = 175) were analyzed. The key attribute affecting preferences was a test with the highest diagnostic yield (p < 0.01). Women preferred tests with short turnaround times (p < 0.01), and tests reporting variants of uncertain significance (VUS; p < 0.01) and secondary findings (SFs; p < 0.01). Several country-specific differences were identified, including time to get a result, who explains the result, and the return of VUS and SFs. CONCLUSION Most women want maximum information from prenatal genomic tests, but our findings highlight country-based differences. Global consensus on how to return uncertain results is not necessarily realistic or desirable.
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Affiliation(s)
- James Buchanan
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,RTI Health Solutions, Manchester, UK
| | - Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Eleanor Harding
- BSc Paediatrics and Child Health, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stina Lou
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Hui
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Northern Health, Epping, Victoria, Australia
| | - Charlotta Ingvoldstad-Malmgren
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Maria Johansson Soller
- Department of Clinical Genetics, Karolinska Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kelly E Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Health Sciences and Technology, Health Ethics and Policy Lab, ETH Zurich, Zurich, Switzerland
| | - Mahesh Choolani
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qian Zheng
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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6
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Levin Fridman A, Raz A, Timmermans S, Shkedi-Rafid S. Views of Israeli healthcare professionals regarding communication of genetic variants of uncertain significance to patients. J Genet Couns 2022; 31:912-921. [PMID: 35122362 PMCID: PMC9541910 DOI: 10.1002/jgc4.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/21/2022]
Abstract
While genomic medicine is becoming an important part of patient care with an ever‐increasing diagnostic yield, communicating variants of uncertain clinical significance (VUSs) remains a major challenge. We draw on qualitative analysis of semi‐structured interviews conducted in 2020 with 20 Israeli healthcare professionals and stakeholders involved in communicating the results of genome‐wide sequencing to patients. Respondents described four main strategies of communicating VUSs to patients: preparing the patient pre‐test for uncertainty; adapting the level of detail to the patient's needs; upgrading versus downgrading the VUS; and following up on the possible reclassification of VUSs. These strategies were expressed differently by physicians and genetic counselors, varying according to their specialty and perception of the patient's situation. We discuss the strategic management and communication of uncertain genomic test results with patients in the context of meeting patients' expectations and working toward genetic causality through genomic narration and designation.
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Affiliation(s)
- Alma Levin Fridman
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Aviad Raz
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Shiri Shkedi-Rafid
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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7
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Stock SJ, Horne M, Bruijn M, White H, Heggie R, Wotherspoon L, Boyd K, Aucott L, Morris RK, Dorling J, Jackson L, Chandiramani M, David A, Khalil A, Shennan A, Baaren GJV, Hodgetts-Morton V, Lavender T, Schuit E, Harper-Clarke S, Mol B, Riley RD, Norman J, Norrie J. A prognostic model, including quantitative fetal fibronectin, to predict preterm labour: the QUIDS meta-analysis and prospective cohort study. Health Technol Assess 2021; 25:1-168. [PMID: 34498576 DOI: 10.3310/hta25520] [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: 11/22/2022] Open
Abstract
BACKGROUND The diagnosis of preterm labour is challenging. False-positive diagnoses are common and result in unnecessary, potentially harmful treatments (e.g. tocolytics, antenatal corticosteroids and magnesium sulphate) and costly hospital admissions. Measurement of fetal fibronectin in vaginal fluid is a biochemical test that can indicate impending preterm birth. OBJECTIVES To develop an externally validated prognostic model using quantitative fetal fibronectin concentration, in combination with clinical risk factors, for the prediction of spontaneous preterm birth and to assess its cost-effectiveness. DESIGN The study comprised (1) a qualitative study to establish the decisional needs of pregnant women and their caregivers, (2) an individual participant data meta-analysis of existing studies to develop a prognostic model for spontaneous preterm birth within 7 days in women with symptoms of preterm labour based on quantitative fetal fibronectin and clinical risk factors, (3) external validation of the prognostic model in a prospective cohort study across 26 UK centres, (4) a model-based economic evaluation comparing the prognostic model with qualitative fetal fibronectin, and quantitative fetal fibronectin with cervical length measurement, in terms of cost per QALY gained and (5) a qualitative assessment of the acceptability of quantitative fetal fibronectin. DATA SOURCES/SETTING The model was developed using data from five European prospective cohort studies of quantitative fetal fibronectin. The UK prospective cohort study was carried out across 26 UK centres. PARTICIPANTS Pregnant women at 22+0-34+6 weeks' gestation with signs and symptoms of preterm labour. HEALTH TECHNOLOGY BEING ASSESSED Quantitative fetal fibronectin. MAIN OUTCOME MEASURES Spontaneous preterm birth within 7 days. RESULTS The individual participant data meta-analysis included 1783 women and 139 events of spontaneous preterm birth within 7 days (event rate 7.8%). The prognostic model that was developed included quantitative fetal fibronectin, smoking, ethnicity, nulliparity and multiple pregnancy. The model was externally validated in a cohort of 2837 women, with 83 events of spontaneous preterm birth within 7 days (event rate 2.93%), an area under the curve of 0.89 (95% confidence interval 0.84 to 0.93), a calibration slope of 1.22 and a Nagelkerke R 2 of 0.34. The economic analysis found that the prognostic model was cost-effective compared with using qualitative fetal fibronectin at a threshold for hospital admission and treatment of ≥ 2% risk of preterm birth within 7 days. LIMITATIONS The outcome proportion (spontaneous preterm birth within 7 days of test) was 2.9% in the validation study. This is in line with other studies, but having slightly fewer than 100 events is a limitation in model validation. CONCLUSIONS A prognostic model that included quantitative fetal fibronectin and clinical risk factors showed excellent performance in the prediction of spontaneous preterm birth within 7 days of test, was cost-effective and can be used to inform a decision support tool to help guide management decisions for women with threatened preterm labour. FUTURE WORK The prognostic model will be embedded in electronic maternity records and a mobile telephone application, enabling ongoing data collection for further refinement and validation of the model. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027590 and Current Controlled Trials ISRCTN41598423. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah J Stock
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Margaret Horne
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Merel Bruijn
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen White
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lisa Wotherspoon
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Rachel K Morris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon Dorling
- Department of Neonatology, IWK Health Centre, Halifax, NS, Canada
| | - Lesley Jackson
- Department of Neonatology, Queen Elizabeth Hospital, Glasgow, UK
| | - Manju Chandiramani
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Asma Khalil
- Department of Fetal Medicine, St George's Hospital, St George's, University of London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Tina Lavender
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ben Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Richard D Riley
- Centre for Prognosis Research, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Jane Norman
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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8
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Macarov M, Meiner V, Chalk M, Hochner H, Shkedi-Rafid S. Clinicians' attitudes towards parental choice in the era of advanced genomic tests in pregnancy. Prenat Diagn 2021; 41:1066-1073. [PMID: 34259341 DOI: 10.1002/pd.6010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Israel is one of the first countries to incorporate chromosomal microarray analysis into routine prenatal care. We explored attitudes of Israeli healthcare professionals (HCPs) towards the disclosure of challenging findings: variants of uncertain clinical significance (VUS), susceptibility loci (SL) for neurodevelopmental disorders and variants associated with adult-onset (AO) conditions. Particularly, we sought their views on providing parental choice regarding the disclosure of these findings. METHODS Twenty-nine in-depth interviews were conducted with genetic counselors (n = 19), medical geneticists (n = 4), medical geneticists that are trained in and practice fetal medicine (n = 3), and fetal medicine experts (n = 3). RESULTS Most participants (n = 24) supported parental choice regarding uncertain genetic information. Engaging parents in disclosure decisions allows avoidance from potentially anxiety-provoking information, practicing parental autonomy, and better preparation in cases where uncertain findings are identified. HCPs believed that given appropriate preparation, parents can make informed decisions. Four participants believed that disclosure should be based on professional judgment and one supported full-disclosure. Unlike VUS or SL, all interviewees agreed that in cases of medically actionable AO conditions, the benefit of disclosure outweighs the damage. CONCLUSION HCPs attitudes are largely in-line with the Israeli practice of involving parents in disclosure decisions regarding uncertain information. This may mitigate disclosure dilemmas and allow personalized disclosure based on parents' views.
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Affiliation(s)
- Michal Macarov
- Department of Genetics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vardiella Meiner
- Department of Genetics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Chalk
- Department of Genetics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagit Hochner
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shiri Shkedi-Rafid
- Department of Genetics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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9
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Lou S, Jensen AH, Vogel I. How are uncertain prenatal genetic results perceived and managed two years after they were received? A qualitative interview study. J Genet Couns 2021; 30:1191-1202. [PMID: 33830585 DOI: 10.1002/jgc4.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/18/2020] [Accepted: 02/06/2021] [Indexed: 11/05/2022]
Abstract
Chromosomal microarray has considerably improved our ability to identify or dismiss genetic conditions in the unborn child. However, this detailed analysis also reveals copy number variants (CNVs) of unknown or uncertain significance, in which the specific child's prognosis can be difficult to predict. Little is known about the longer-term impacts of receiving an uncertain prenatal CNV result. Our qualitative study explored how such a result was perceived and managed in everyday life, 2 years after it was received. From an original sample of 16 couples, nine women participated in a semi-structured follow-up phone interview. Transcripts were analyzed using thematic analysis. The results show that these women did not perceive the CNV result to be a part of their everyday lives. They managed the CNV result by focusing on the child's positive development, by not sharing the CNV information in wider social networks, and by emphasizing parental values such as taking life as it comes, welcoming human variation, and accepting that dealing with a child's struggles is an inherent part of parenthood. Overall, the women expressed a positive attitude toward prenatal genetic information about serious disorders but considered 'their' CNV to be close to normal; several women suggested that such findings should not be reported. However, they also recognized the difficulties in making such decisions, given variable penetrance and that couples' definitions of 'serious' could vary significantly. The diagnostic process during pregnancy was remembered as being highly stressful, and many expressed a need for more control in a future pregnancy. Our study provides insight into how mothers reconfigure CNV results to fit their values and everyday lives. When delivering uncertain CNV results in a prenatal setting, genetics healthcare providers should present and discuss long-term coping strategies with expecting parents.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Amalie Hahn Jensen
- DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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10
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Hayeems RZ, Luca S, Assamad D, Bhatt A, Ungar WJ. Utility of Genetic Testing from the Perspective of Parents/Caregivers: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:259. [PMID: 33801725 PMCID: PMC8067127 DOI: 10.3390/children8040259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
In genomics, perceived and personal utility have been proposed as constructs of value that include the subjective meanings and uses of genetic testing. Precisely what constitutes these constructs of utility and how they vary by stakeholder perspective remains unresolved. To advance methods for measuring the value of genetic testing in child health, we conducted a scoping review of the literature to characterize utility from the perspective of parents/caregivers. Peer reviewed literature that included empiric findings from parents/caregivers who received genetic test results for an index child and was written in English from 2016-2020 was included. Identified concepts of utility were coded according to Kohler's construct of personal utility. Of 2142 abstracts screened, 33 met inclusion criteria. Studies reflected a range of genetic test types; the majority of testing was pursued for children with developmental or neurodevelopmental concerns. Coding resulted in 15 elements of utility that mapped to Kohler's four domains of personal utility (affective, cognitive, behavioural and social) and one additional medical management domain. An adapted construct of utility for parents/caregivers may enable specific and standardized strategies for researchers to use to generate evidence of the post-test value of genetic testing. In turn, this will contribute to emerging methods for health technology assessment and policy decision making for genomics in child health.
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Affiliation(s)
- Robin Z. Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Stephanie Luca
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
| | - Daniel Assamad
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
| | - Ayushi Bhatt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Wendy J. Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (S.L.); (D.A.); (A.B.); (W.J.U.)
- Institute of Health Policy Management and Evaluation, The University of Toronto, Toronto, ON M5T 3M6, Canada
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11
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Tanner LM, Alitalo T, Stefanovic V. Prenatal array comparative genomic hybridization in a well-defined cohort of high-risk pregnancies. A 3-year implementation results in a public tertiary academic referral hospital. Prenat Diagn 2020; 41:422-433. [PMID: 33340112 DOI: 10.1002/pd.5877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/17/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To find out whether the diagnostic yield of prenatal array comparative genomic hybridization (aCGH) can be improved by targeting preselected high-risk pregnancies. METHOD All the in-house arrays ordered by the Fetomaternal Medical Center from February 2016 until December 2018 were retrospectively analyzed. The indications for array analysis included fetal structural abnormalities, increased nuchal translucency ≥3.5 mm and a chromosomal abnormality in a parent or a sibling. Common aneuploidies were excluded. RESULTS Diagnostic yield was 15.1% in the entire patient cohort and as high as 20% in fetuses with multiple structural anomalies. The diagnostic yield was lowest in the group with isolated growth retardation. A total of 76 copy number variants (CNVs) were reported from a total of 65 samples, including 16 CNVs associated with a well-described microdeletion/microduplication syndrome, six autosomal trisomies in mosaic form, and three pathogenic single-gene deletions with dominant inheritance and 12 CNVs known to be risk factors for eg developmental delay. CONCLUSION The diagnostic yield of aCGH was higher than what has previously been reported in less defined patient cohorts. However, the number of CNVs with unclear correlation to the fetal ultrasound findings was still relatively high. The importance of adequate pre- and posttest counseling must therefore be emphasized.
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Affiliation(s)
- Laura M Tanner
- HUSLAB Department of Clinical Genetics, Helsinki University Hospital, Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Alitalo
- HUSLAB Genetics Laboratory, Helsinki University Hospital, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Fernández-Ávalos MI, Pérez-Marfil MN, Ferrer-Cascales R, Cruz-Quintana F, Fernández-Alcántara M. Feeling of grief and loss in parental caregivers of adults diagnosed with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:712-723. [PMID: 33244855 DOI: 10.1111/jar.12842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of intellectual disability in children can produce complex grief-related feelings in their parents. Previous studies have focused on the moment of the diagnosis or the early life of the children, and little research has been conducted on their feelings of grief in adulthood. The objective was to analyse the process of grief/loss in parents of adult offspring with intellectual disability. METHOD The intentional sampling included sixteen parents who responded to semi-structured interviews. A qualitative study was conducted based on grounded theory. RESULTS Five categories were identified: "Reception of the diagnosis", "Emotional bonds with the child", "Experience of loss and feelings in response to intellectual disability diagnosis", "Recurrent grief" and "Coping strategies". CONCLUSIONS Recurring feelings of loss experienced by parents in relation to their child's diagnosis persist over time. Specialized emotional interventions are needed to help parents to reduce the intensity of their feelings of grief.
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Affiliation(s)
| | - María Nieves Pérez-Marfil
- Faculty of Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain.,End-of-Life Research Network (EOL), Granada, Spain
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Francisco Cruz-Quintana
- Faculty of Psychology, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain.,End-of-Life Research Network (EOL), Granada, Spain
| | - Manuel Fernández-Alcántara
- Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Alicante, Spain.,End-of-Life Research Network (EOL), Granada, Spain
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13
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Quality of Life and Concerns in Parent Caregivers of Adult Children Diagnosed with Intellectual Disability: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228690. [PMID: 33238511 PMCID: PMC7709017 DOI: 10.3390/ijerph17228690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Background: Previous studies have confirmed that parenting a child diagnosed with an intellectual disability (ID) can negatively affect the parents’ quality of life in several dimensions. However, fewer have assessed its impact years after the initial diagnosis. The objective of this work was to carry out an in-depth analysis of the current quality of life and concerns of both mothers and fathers of adults diagnosed with ID, having as a reference the moment of the diagnosis. Methods: 16 parents of adult children with ID were evaluated using a semi-structured interview format. A thematic qualitative analysis was carried out by employing ATLAS.ti software. Results: The results suggested that both the emotional and physical well-being of parents, as well as their interpersonal relationships, had declined. In addition, the multiple life changes that had occurred over the time considered in this study, as well as day-to-day worries, had prevented improvements in their quality of life. Conclusions: Several dimensions of the parents’ quality of life were affected years after a child is diagnosed with ID. These included poor physical and psychological health, economic difficulties, lack of social and family support, and lack of time for self-care.
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14
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Millo T, Douiev L, Popper D, Shkedi-Rafid S. Personalized prenatal genomic testing: Couples' experience with choice regarding uncertain and adult-onset findings from chromosomal-microarray-analysis. Prenat Diagn 2020; 41:376-383. [PMID: 33128404 DOI: 10.1002/pd.5856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chromosomal-microarray-analysis (CMA) can identify variants of uncertain clinical significance, susceptibility-loci for neurodevelopmental conditions, and risk for adult-onset conditions. We explored choices made by couples undergoing prenatal CMA, their understanding of these findings, reasons for and against receiving them, and whether they believe parents or professionals should decide which are disclosed. METHODS Semi-structured interviews were conducted with women (n = 27) or their partners (n = 15) during the week following prenatal CMA testing and analyzed using grounded theory. RESULTS Over half the interviewees (55%) recalled at least two of the three types of CMA results they chose whether to receive. Sixty-four percent found the choice simple, whereas 36% found it difficult. All participants could clearly explain their choices, which were based on the perceived actionability and psychological impact of the information. Sixty percent viewed their choice favorably, whereas ~21% would have preferred clinicians to decide for them. More women than men, and more decisive than indecisive participants supported parental choice. CONCLUSION Overall, expectant parents can make informed choices about which uncertain findings about their fetuses they wish to receive, and value the opportunity to tailor results to their values and wishes. Arguments presented provide the basis for a decision-aid tool for expecting parents.
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Affiliation(s)
- Talya Millo
- Genetics Department, Hadassah Medical Center, Jerusalem, Israel
| | - Liza Douiev
- Genetics Department, Hadassah Medical Center, Jerusalem, Israel
| | - Dov Popper
- Genetics Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shiri Shkedi-Rafid
- Genetics Department, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Institute for Medical Research Israel-Canada, The Hebrew University of Jerusalem, Israel
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15
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Muys J, Jacquemyn Y, Blaumeiser B, Bourlard L, Brison N, Bulk S, Chiarappa P, De Leener A, De Rademaeker M, Désir J, Destrée A, Devriendt K, Dheedene A, Duquenne A, Fieuw A, Fransen E, Gatot J, Jamar M, Janssens S, Kerstjens J, Keymolen K, Lederer D, Menten B, Pichon B, Rombout S, Sznajer Y, Van Den Bogaert A, Van Den Bogaert K, Vermeesch J, Janssens K. Prenatally detected copy number variants in a national cohort: A postnatal follow‐up study. Prenat Diagn 2020; 40:1272-1283. [DOI: 10.1002/pd.5751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Joke Muys
- Department of Gynaecology University Hospital Antwerp Edegem Belgium
- Center for Medical Genetics, Universiteit Antwerpen Antwerpen Belgium
| | - Yves Jacquemyn
- Department of Gynaecology University Hospital Antwerp Edegem Belgium
- ASTARC and Global Health Institute Universiteit Antwerpen Antwerpen Belgium
| | - Bettina Blaumeiser
- Department of Gynaecology University Hospital Antwerp Edegem Belgium
- Center for Medical Genetics, Universiteit Antwerpen Antwerpen Belgium
| | - Laura Bourlard
- Center for Medical Genetics Université Libre de Bruxelles Bruxelles Belgium
| | - Nathalie Brison
- Center for Medical Genetics Katholieke Universiteit Leuven Leuven Belgium
| | - Saskia Bulk
- Center for Medical Genetics Centre Hospitalier Universitaire de Liège Liege Belgium
| | - Patrizia Chiarappa
- Center for Medical Genetics Université Catholique de Louvain Louvain‐la‐Neuve Belgium
| | - Anne De Leener
- Center for Medical Genetics Université Catholique de Louvain Louvain‐la‐Neuve Belgium
| | | | - Julie Désir
- Center for Medical Genetics Université Libre de Bruxelles Bruxelles Belgium
| | - Anne Destrée
- Center for Medical Genetics Institut de Pathologie et de Génétique Gosselies Gosselies Belgium
| | - Koenraad Devriendt
- Center for Medical Genetics Katholieke Universiteit Leuven Leuven Belgium
| | | | - Armelle Duquenne
- Center for Medical Genetics Université Catholique de Louvain Louvain‐la‐Neuve Belgium
| | - Annelies Fieuw
- Center for Medical Genetics Vrije Universiteit Brussel Brussel Belgium
| | - Erik Fransen
- Center for Medical Genetics, Universiteit Antwerpen Antwerpen Belgium
| | - Jean‐Stéphane Gatot
- Center for Medical Genetics Centre Hospitalier Universitaire de Liège Liege Belgium
| | - Mauricette Jamar
- Center for Medical Genetics Centre Hospitalier Universitaire de Liège Liege Belgium
| | | | - Jorien Kerstjens
- Faculty for Medical Sciences Rijksuniversteit Groningen Groningen The Netherlands
| | | | - Damien Lederer
- Center for Medical Genetics Institut de Pathologie et de Génétique Gosselies Gosselies Belgium
| | - Björn Menten
- Center for Medical Genetics Universiteit Gent Gent Belgium
| | - Bruno Pichon
- Center for Medical Genetics Université Libre de Bruxelles Bruxelles Belgium
| | - Sonia Rombout
- Center for Medical Genetics Institut de Pathologie et de Génétique Gosselies Gosselies Belgium
| | - Yves Sznajer
- Center for Medical Genetics Université Catholique de Louvain Louvain‐la‐Neuve Belgium
| | | | | | - Joris Vermeesch
- Center for Medical Genetics Katholieke Universiteit Leuven Leuven Belgium
| | - Katrien Janssens
- Center for Medical Genetics, Universiteit Antwerpen Antwerpen Belgium
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16
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Lou S, Petersen OB, Lomborg K, Vogel I. How do geneticists and prospective parents interpret and negotiate an uncertain prenatal genetic result? An analysis of clinical interactions. J Genet Couns 2020; 29:1221-1233. [PMID: 32453502 DOI: 10.1002/jgc4.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
Variants of unknown significance (VUS) and susceptibility loci (SL) are a challenge in prenatal genetic counseling. The aim of this study was to explore how such uncertain genetic results are communicated, negotiated, and made meaningful by genetics healthcare providers and couples in the actual clinical setting where results are delivered. The study was based on an anthropological approach and the material consisted of observations and audio-recordings from 16 purposively sampled genetic counseling sessions where prenatal testing had identified an inherited or de novo VUS or SL result. Field notes and transcripts from audio-recordings were analyzed using thematic analysis. The analysis identified a number of specific interpretations and strategies that clinical geneticists and couples collectively used for dealing with the ambiguity of the result. Thus, the analysis resulted in a total of three themes, each with 3-4 subthemes. The theme 'Setting the scene' describes the three-stage structure of the consultation. The theme 'Dealing with uncertainty' includes 'normalizing strategies' that emphasized the inherent uncertainty in human life in general and 'contextualizing strategies' that placed the result in relation to the surrounding society, where technological developments lead to new and unforeseen challenges. The theme 'Regaining control' includes interpretations that made the knowledge useful by focusing on the value of being prepared for potential, future challenges. Other strategies were to book an extra scan-to reconfirm fetal structural health and to reconnect to the pregnancy. Finally, inquiring about the sex was clearly a way for the couple to signal their investment in the pregnancy. Based on the analysis, we propose that these interpretations served to transform and reduce ambiguity through a process of reconfiguring the biomedical information into knowledge that resonated with the couples' lifeworlds. In this process, both geneticist and couples drew on wider social and moral concerns about uncertainty and responsibility.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Fetal Medicine Unit, Department of Obstetrics & Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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17
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Harding E, Hammond J, Chitty LS, Hill M, Lewis C. Couples experiences of receiving uncertain results following prenatal microarray or exome sequencing: A mixed-methods systematic review. Prenat Diagn 2020; 40:1028-1039. [PMID: 32362033 PMCID: PMC8425413 DOI: 10.1002/pd.5729] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
Abstract
Background Tests in pregnancy such as chromosomal microarray analysis and exome sequencing are increasing diagnostic yield for fetal structural anomalies, but have greater potential to result in uncertain findings. This systematic review investigated the experiences of prospective parents about receiving uncertain results from these tests. Methods A systematic search of three electronic databases was conducted. Data extraction was performed for studies that met the eligibility and quality criteria. Results were synthesised following the principles of thematic analysis. Results Fourteen studies (10 qualitative, 4 quantitative) were included. Findings were grouped into three overarching themes. Sources of uncertainty included the testing procedure, the diagnosis and prognosis, and health professionals' own uncertainty. The clinical impact of the uncertainty included parents struggling to make clinical decisions with the information available, the emotional impact included decisional‐regret, shock, worry and feeling overwhelmed. To manage the uncertainty, parents sought support from healthcare professionals, friends, family, the internet and other parents as well as remaining hopeful. Conclusions Prospective parents experience a myriad of uncertainties in the prenatal setting, which must be handled sensitively. Future research should explore optimal ways of managing uncertainty to minimise harm. Recommendations are made for discussing uncertainty during pre‐ and post‐test counseling.
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Affiliation(s)
- Eleanor Harding
- BSc Paediatrics and Child Health, The UCL Great Ormond Street Institute of Child Health, London, UK.,London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jennifer Hammond
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lyn S Chitty
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
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18
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Abstract
OBJECTIVE To examine the choices of women with both high-risk and low-risk pregnancies who are undergoing prenatal chromosomal microarray analysis in a clinical setting regarding three challenging types of findings: variants of uncertain clinical significance, susceptibility loci for neurodevelopmental disorders, and copy number variants associated with risks for adult-onset conditions. We assessed whether women's choices were associated with indications for testing or with one-on-one pretest genetic counseling. METHODS In this cross-sectional study, medical records of women who underwent invasive prenatal chromosomal microarray analysis testing (N=1,070) at Hadassah Medical Center between June 2017 and February 2018 were examined for testing indications, choices regarding chromosomal microarray analysis findings, and type of pretest genetic counseling. Multivariable analyses to assess associations with testing indication and prior genetic counseling were carried out using logistic regression models. RESULTS In total, 56% of women (n=593) chose to be informed of all three types of findings and 20% (n=218) chose not to be informed of any of the findings beyond high-penetrance childhood-onset pathogenic findings. Variants of uncertain clinical significance as a single choice was the least-selected finding (2.5%, n=27). Low-risk pregnancies (ie, those with normal biochemical screening and fetal ultrasound examinations) were associated with increased interest in receiving genetic information about adult-onset conditions (adjusted odds ratio [aOR] 1.7; 95% CI 1.18-2.33) and susceptibility loci (aOR 1.5; 95% CI 1.08-2.10). CONCLUSION Women with both high-risk and low-risk pregnancies were generally more likely to choose to receive additional genetic information, albeit differences in preferences depend on testing indication and type of pretest counseling.
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19
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Lou S, Lomborg K, Lewis C, Riedijk S, Petersen OB, Vogel I. "It's probably nothing, but…" Couples' experiences of pregnancy following an uncertain prenatal genetic result. Acta Obstet Gynecol Scand 2020; 99:791-801. [PMID: 31955407 DOI: 10.1111/aogs.13813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/20/2019] [Accepted: 01/14/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION A common concern regarding the introduction of chromosomal microarray in prenatal testing is the concomitant identification of an uncertain copy number variant (CNV) where significance and clinical implication for the unborn child can be difficult or impossible to predict. Following the identification of an uncertain CNV, prospective parents may decide to continue the pregnancy. The aim of this study was to explore how prospective parents manage uncertainty and experience pregnancy in light of an uncertain CNV result. MATERIAL AND METHODS Qualitative interviews with 16 women and 10 partners who had received a prenatally diagnosed, uncertain CNV. Participants were recruited from the Aarhus University Hospital, Denmark and most were interviewed in their homes 1-14 weeks after birth. Data were analyzed using thematic analysis. RESULTS Following the CNV diagnosis, some couples focused on the severe syndromes ruled out by the result, whereas others were more concerned with the new potential risks, for example, learning disabilities. Most couples did not remember the actual diagnosis, but all described a number of attention points generated by the CNV result. During pregnancy, the couples used various strategies to limit worry and enjoy their pregnancy, such as limiting information seeking, reducing talk of the CNV, and deferring thoughts of potential consequences. Furthermore, ultrasound was considered a valuable resource for reducing worry as it provided reassurance about the development of the baby. Inherited CNVs caused relief on one hand, but also feelings of responsibility for the child's potential challenges. After birth, worry decreased considerably, but all couples paid some extra attention to the child's development, while also being alert to the risk of wrongfully interpreting the child's development in terms of the CNV. Eleven couples expressed satisfaction with knowing about the child's CNV, whereas five couples would rather not have known. CONCLUSIONS The results indicate that health professionals should be mindful of terminology, remember to point out what has been ruled out by the CNV result, and discuss potential coping strategies with the couple. Furthermore, these couples may have a higher need for ultrasound during pregnancy to help reduce worry. More research is needed on the families' long-term coping.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Celine Lewis
- London North Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sam Riedijk
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olav Bjørn Petersen
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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20
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Kang CM. Effects of psychological intervention and relevant influence factors on pregnant women undergoing interventional prenatal diagnosis. J Chin Med Assoc 2020; 83:202-205. [PMID: 31714444 DOI: 10.1097/jcma.0000000000000220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aims to explore the effects of psychological intervention on eliminating anxiety and fear in pregnant women caused by interventional prenatal diagnosis, and the success rate of surgery. METHODS A total of 100 pregnant women who scheduled for interventional prenatal diagnosis were included in this study, and were randomly divided into two groups: control group and intervention group. Women in the control group were given routine nursing care, and women in the intervention group were given psychological intervention in different stages of the operation. Psychological status were assessed by the symptom checklist-90 (SCL-90), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and visual analogue scale (VAS). Furthermore, the success rate of surgery and the incidence of postoperative complications were tracked. RESULTS Compared with the control group, the SCL-90 test scores of pregnant women in the intervention group were significantly lower in the following five factors: somatization, interpersonal sensitivity, depression, anxiety, and fear (p < 0.05). Furthermore, postoperative SAS, SDS, and VAS scores in the intervention group were significantly lower than in the control group; and the differences were statistically significant (p < 0.01). CONCLUSION Before pregnant women undergo interventional prenatal diagnosis, nurses should understand their psychological status and give psychological guidance in time, calm their anxiety, tension and fear, and help them build confidence to weather the pregnancy stages before and after the operation. This would improve the success rate of puncture and reduce the incidence of complications.
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Affiliation(s)
- Chun-Mei Kang
- The Third Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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21
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Muys J, Blaumeiser B, Janssens K, Loobuyck P, Jacquemyn Y. Chromosomal microarray analysis in prenatal diagnosis: ethical considerations of the Belgian approach. JOURNAL OF MEDICAL ETHICS 2020; 46:104-109. [PMID: 31527144 DOI: 10.1136/medethics-2018-105186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/25/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
Detection of genetic aberrations in prenatal samples, obtained through amniocentesis or chorion villus biopsy, is increasingly performed using chromosomal microarray (CMA), a technique that can uncover both aneuploidies and copy number variants throughout the genome. Despite the obvious benefits of CMA, the decision on implementing the technology is complicated by ethical issues concerning variant interpretation and reporting. In Belgium, uniform guidelines were composed and a shared database for prenatal CMA findings was established. This Belgian approach sparks discussion: it is evidence-based, prevents inconsistencies and avoids parental anxiety, but can be considered paternalistic. Here, we reflect on the cultural and moral bases of the Belgian reporting system of prenatally detected variants.
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Affiliation(s)
- Joke Muys
- Department of Obstetrics and Gynaecology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- Center for Medical Genetics, Universiteit Antwerpen, Edegem, Belgium
| | - Bettina Blaumeiser
- Center for Medical Genetics, Universiteit Antwerpen, Edegem, Belgium
- Department of Medical Genetics, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Katrien Janssens
- Center for Medical Genetics, Universiteit Antwerpen, Edegem, Belgium
| | | | - Yves Jacquemyn
- Department of Obstetrics and Gynaecology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- Global Health Institute, Universiteit Antwerpen, Edegem, Belgium
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22
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Hashiloni-Dolev Y, Nov-Klaiman T, Raz A. Pandora's pregnancy: NIPT, CMA, and genome sequencing-A new era for prenatal genetic testing. Prenat Diagn 2019; 39:859-865. [PMID: 31161621 DOI: 10.1002/pd.5495] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/06/2019] [Accepted: 05/30/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We delineate in this article a shift from the "traditional" technologies of karyotyping in PND to the current phase of advanced genetic technologies including noninvasive prenatal testing (NIPT), chromosomal microarray analysis (CMA), and whole-exome sequencing (WES) with their higher detection rate and related abundance of uncertain data. METHODS Conceptual analysis based on seminal works that shaped the socioethical discourse surrounding the experiences of parents as well as professionals with prenatal diagnosis in the last 30 years. RESULTS We consider the implications of this new era of PND for patients and health professionals by drawing on previous studies documenting how probability and uncertainty affect informed consent/choice, health risks communication, customer satisfaction and decision making, and parent-child bonding. CONCLUSIONS We argue that these changes move us beyond the idioms and realities of the tentative pregnancy and moral pioneering, to uncertainty, probability-based counseling, and moral/translational gambling. We conclude by discussing what is needed to maintain hope in the era of Pandora's pregnancy.
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Affiliation(s)
- Yael Hashiloni-Dolev
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Tamar Nov-Klaiman
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Aviad Raz
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beersheba, Israel
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23
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Muys J, Blaumeiser B, Jacquemyn Y, Bandelier C, Brison N, Bulk S, Chiarappa P, Courtens W, De Leener A, De Rademaeker M, Désir J, Destrée A, Devriendt K, Dheedene A, Fieuw A, Fransen E, Gatot JS, Holmgren P, Jamar M, Janssens S, Keymolen K, Lederer D, Menten B, Meuwissen M, Parmentier B, Pichon B, Rombout S, Sznajer Y, Van Den Bogaert A, Van Den Bogaert K, Vanakker O, Vermeesch J, Janssens K. The Belgian MicroArray Prenatal (BEMAPRE) database: A systematic nationwide repository of fetal genomic aberrations. Prenat Diagn 2018; 38:1120-1128. [PMID: 30334587 DOI: 10.1002/pd.5373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE With the replacement of karyotyping by chromosomal microarray (CMA) in invasive prenatal diagnosis, new challenges have arisen. By building a national database, we standardize the classification and reporting of prenatally detected copy number variants (CNVs) across Belgian genetic centers. This database, which will link genetic and ultrasound findings with postnatal development, forms a unique resource to investigate the pathogenicity of variants of uncertain significance and to refine the phenotypic spectrum of pathogenic and susceptibility CNVs. METHODS The Belgian MicroArray Prenatal (BEMAPRE) consortium is a collaboration of all genetic centers in Belgium. We collected data from all invasive prenatal procedures performed between May 2013 and July 2016. RESULTS In this three-year period, 13 266 prenatal CMAs were performed. By national agreement, a limited number of susceptibility CNVs and no variants of uncertain significance were reported. Added values for using CMA versus conventional karyotyping were 1.8% in the general invasive population and 2.7% in cases with an ultrasound anomaly. Of the reported CNVs, 31.5% would have remained undetected with non-invasive prenatal test as the first-tier test. CONCLUSION The establishment of a national database for prenatal CNV data allows for a uniform reporting policy and the investigation of the prenatal and postnatal genotype-phenotype correlation.
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Affiliation(s)
- Joke Muys
- Department of Obstetrics and Gynaecology, University Hospital Antwerp, Edegem, Belgium.,Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium
| | - Bettina Blaumeiser
- Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium.,Department of Medical Genetics, University Hospital Antwerp, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynaecology, University Hospital Antwerp, Edegem, Belgium
| | - Claude Bandelier
- Center for Medical Genetics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nathalie Brison
- Center for Medical Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Saskia Bulk
- Center for Medical Genetics, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Patrizia Chiarappa
- Center for Medical Genetics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Winnie Courtens
- Center for Medical Genetics, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Anne De Leener
- Center for Medical Genetics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marjan De Rademaeker
- Department of Medical Genetics, University Hospital Antwerp, Edegem, Belgium.,Center for Medical Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Julie Désir
- Center for Medical Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Destrée
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Koenraad Devriendt
- Center for Medical Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Annelies Fieuw
- Center for Medical Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erik Fransen
- Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium
| | - Jean-Stéphane Gatot
- Center for Medical Genetics, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Philip Holmgren
- Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium
| | - Mauricette Jamar
- Center for Medical Genetics, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Sandra Janssens
- Center for Medical Genetics, Universiteit Gent, Ghent, Belgium
| | - Kathelijn Keymolen
- Center for Medical Genetics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Damien Lederer
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Björn Menten
- Center for Medical Genetics, Universiteit Gent, Ghent, Belgium
| | - Marije Meuwissen
- Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium
| | - Benoit Parmentier
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Bruno Pichon
- Center for Medical Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Sonia Rombout
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Yves Sznajer
- Center for Medical Genetics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | | | | | - Joris Vermeesch
- Center for Medical Genetics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Katrien Janssens
- Center for Medical Genetics, Universiteit Antwerpen, Antwerp, Belgium
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24
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Li H, Zhang X, Cao Y, Hu S, Peng F, Zhou J, Li J. Association between EN1 rs4144782 and susceptibility of knee osteoarthritis: A case-control study. Oncotarget 2018; 8:36650-36657. [PMID: 28430581 PMCID: PMC5482684 DOI: 10.18632/oncotarget.16842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/10/2017] [Indexed: 11/25/2022] Open
Abstract
Osteoarthritis (OA) is a complex disease that affects the whole joint, resulting from the combined influence of biomechanical factors and genetic factors. The heritable component for primary OA accounts for about 60% of variation in population liability to the disease. So far, genome-wide association studies (GWAS) and candidate gene studies have established many OA-related loci. However, these findings account for only a rather small fraction of the genetic component. To further reveal the genetic architecture of OA, we conducted this case-control study to explore the association of locus EN1 rs4144782 and knee OA susceptibility in a Chinese population. EN1 rs4144782 was significantly associated with increased risk of knee OA (OR=1.26; 95% CI: 1.05-1.50, P value=0.012). In dominant model, compared with carriers of GG genotype, those with AG or AA genotype have an 1.44-fold increased risk of OA (OR: 1.44; 95% CI: 1.10-1.88; P value=0.008). Subgroup analyses didn't change the results materially. This should be the first association study of EN1 locus on risk of OA, and our finding suggested that the EN1 rs4144782 might contribute to the susceptibility of knee OA.
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Affiliation(s)
- Haohuan Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiaolong Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yiping Cao
- Key Laboratory of Optoelectronic Chemical Materials and Devices, Ministry of Education, Jianghan University, Wuhan, 430056, China
| | - Song Hu
- Department of Physiology, Jianghan University, Wuhan Medical College, Wuhan, 430056, China
| | - Fei Peng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jianlin Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jianping Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
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25
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Richardson A, Ormond KE. Ethical considerations in prenatal testing: Genomic testing and medical uncertainty. Semin Fetal Neonatal Med 2018; 23:1-6. [PMID: 29033309 DOI: 10.1016/j.siny.2017.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Prenatal diagnostic testing has recently progressed from karyotype to routinely available chromosomal microarray, and the potential for fetal whole exome sequencing, both through invasive diagnostic testing and, in some cases, non-invasive prenatal testing. These tests bring beneficence through providing a higher diagnostic yield, often with lower risks of miscarriage than previously available testing, but also raise the question of harms related to an increase in uncertain and unknown results. Some parents-to-be report a desire to learn as much information as possible prenatally, and there may be beneficence in providing them with this information. However, the potential uncertainty these tests may create may raise anxiety and may complicate pregnancy decision-making for both patients and providers. This article reviews current prenatal technologies and the growing research on the clinical and ethical aspects of uncertainty as it relates to expanding prenatal testing options.
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Affiliation(s)
- Anastasia Richardson
- Lucile Packard Children's Hospital Stanford, Fetal and Pregnancy Health Program, Palo Alto, CA, USA
| | - Kelly E Ormond
- Stanford University School of Medicine, Department of Genetics and Stanford Center for Biomedical Ethics, Stanford, CA, USA.
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26
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de Wit MC, Boekhorst F, Mancini GM, Smit LS, Groenenberg IAL, Dudink J, de Vries FAT, Go ATJI, Galjaard RJH. Advanced genomic testing may aid in counseling of isolated agenesis of the corpus callosum on prenatal ultrasound. Prenat Diagn 2017; 37:1191-1197. [PMID: 28921563 DOI: 10.1002/pd.5158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Isolated agenesis of the corpus callosum on fetal ultrasound has a varied prognosis. Microarray and exome sequencing (ES) might aid in prenatal counseling. METHOD This study includes 25 fetuses with apparently isolated complete corpus callosum (cACC) on ultrasound. All cases were offered single nucleotide polymorphism array. Complementary ES was offered postnatally in selected cases. Clinical physical and neurodevelopmental follow-up was collected. RESULTS Eighteen cases opted for single nucleotide polymorphism array testing, which detected a causal anomaly in 2/18 (11.1%; 95% CI 2.0%-31%). Among ongoing pregnancies without a causal anomaly on microarray, 30% (95% CI 8.5%-60%) showed intellectual disability. Postnatal magnetic resonance imaging and physical examination often (64%; 95% CI 38%-85%, and 64%; 95% CI 38%-85%, respectively) revealed additional physical anomalies in cases without a causal anomaly on microarray. Two cases appeared truly isolated after birth. Postnatal sequencing in 4 of 16 cases without a causal anomaly on microarray but with intellectual disability and/or additional postnatal physical anomalies revealed 2 single-gene disorders. Therefore, the estimated diagnostic yield of ES in chromosomally normal cACC fetuses is between 2/4 (50%; 95% CI 11%-89%) and 2/16 (13.3%; 95% CI 2.4%-36%). CONCLUSION In accordance with current guidelines, we conclude that microarray should be offered in case of isolated cACC on ultrasound. ES is likely to be informative for prenatal counseling and should be offered if microarray is normal.
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Affiliation(s)
- M C de Wit
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - F Boekhorst
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - G M Mancini
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - L S Smit
- Department of Neurology, Division of Pediatric Neurology, Erasmus Medical Centre, University Medical Centre, Rotterdam, the Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, the Netherlands
| | - I A L Groenenberg
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, the Netherlands
| | - F A T de Vries
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - R J H Galjaard
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
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27
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de Wit MC, Bunnik EM, Go ATJI, de Beaufort ID, Hofstra RMW, Steegers EAP, Galjaard RJH. Amniocentesis is still the best option for advanced genomic testing in case of fetal malformations. Prenat Diagn 2017; 37:1360-1363. [PMID: 29149523 DOI: 10.1002/pd.5187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/09/2022]
Affiliation(s)
- M C de Wit
- Department of Obstetrics and Gynecology, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, Rotterdam, The Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - I D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, Rotterdam, The Netherlands
| | - R M W Hofstra
- Department of Clinical Genetics, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R J H Galjaard
- Department of Clinical Genetics, Erasmus Medical Centre and Sophia Children's Hospital, Rotterdam, The Netherlands
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28
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Choosing between Higher and Lower Resolution Microarrays: do Pregnant Women Have Sufficient Knowledge to Make Informed Choices Consistent with their Attitude? J Genet Couns 2017; 27:85-94. [PMID: 28674770 PMCID: PMC5794816 DOI: 10.1007/s10897-017-0124-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
Developments in prenatal testing allow the detection of more findings. SNP arrays in prenatal diagnosis (PND) can be analyzed at 0.5 Mb resolution detecting more clinically relevant anomalies, or at 5 Mb resolution. We investigated whether women had sufficient knowledge to make informed choices regarding the scope of their prenatal test that were consistent with their attitude. Pregnant women could choose between testing at 5 or at 0.5 Mb array. Consenting women (N = 69) received pre-test genetic counseling by phone and filled out the Measure of Informed Choice questionnaire designed for this study. Choices based on sufficient knowledge and consistent with attitude were considered informed. Sixty-two percent of the women made an adequately informed choice, based on sufficient knowledge and attitude-consistent with their choice of microarray resolution. Women who made an informed choice, opted for 0.5 Mb array resolution more often. There were no differences between women making adequately informed or less informed choices regarding level of experienced anxiety or doubts. Over time on T0 and T1, anxiety and doubts significantly decreased. While previous studies demonstrated that knowledge is an important component in informed decision-making, this study underlines that a consistent attitude might be equally important for decision-making. We advocate more focus on attitude-consistency and deliberation as compared to only a strong focus on knowledge.
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29
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Cornelissen MJ, Apon I, van der Meulen JJNM, Groenenberg IAL, Kraan-van der Est MN, Mathijssen IMJ, Bonsel GJ, Cohen-Overbeek TE. Prenatal ultrasound parameters in single-suture craniosynostosis. J Matern Fetal Neonatal Med 2017; 31:2050-2057. [PMID: 28553772 DOI: 10.1080/14767058.2017.1335706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Although single-suture craniosynostosis is diagnosed sporadically during pregnancy, timely referral is critical for its treatment. Additionally, craniosynostosis leads to increased maternofetal trauma during birth. In the Netherlands, 95% of pregnant women receive a standard ultrasound at around 20 weeks of gestation, potentially an ideal setting for detecting craniosynostosis prenatally. To enhance the prenatal detection of the metopic and the sagittal suture synostosis, we wished to identify new screening parameters. MATERIALS AND METHODS We retrospectively analyzed data of the 20-week anomaly scan in trigonocephaly patients (n = 41), scaphocephaly patients (n = 41), and matched controls (n = 82). We measured six different cranial dimensions, including head circumference, biparietal diameter, and occipito-frontal diameter, defining the cephalic index as the ratio between biparietal and occipito-frontal diameter. RESULTS Prenatal biometric measurements did not differ significantly between trigonocephaly patients and controls. Although significantly lower in scaphocephaly patients (0.76 versus 0.79; p = .000), the cephalic index by itself is not appropriate for screening at 20 weeks of gestation. Longitudinal analysis suggests that a deflection in BPD curve is found in scaphocephaly patients, starting at 20 weeks of gestation. CONCLUSIONS Prenatal biometric measurements do not differ significantly between trigonocephaly patients and controls. The CI is lower in scaphocephaly patients. A deflection in BPD curve should be followed by 3 D imaging of the cranial sutures.
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Affiliation(s)
- Martijn J Cornelissen
- a Department of Plastic and Reconstructive Surgery and Handsurgery , Erasmus MC , Rotterdam , The Netherlands
| | - Inge Apon
- a Department of Plastic and Reconstructive Surgery and Handsurgery , Erasmus MC , Rotterdam , The Netherlands
| | | | - Irene A L Groenenberg
- b Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine , Erasmus MC , Rotterdam , The Netherlands
| | | | - Irene M J Mathijssen
- a Department of Plastic and Reconstructive Surgery and Handsurgery , Erasmus MC , Rotterdam , The Netherlands
| | - Gouke J Bonsel
- b Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine , Erasmus MC , Rotterdam , The Netherlands
| | - Titia E Cohen-Overbeek
- b Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine , Erasmus MC , Rotterdam , The Netherlands
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30
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Srebniak MI, Knapen MF, Polak M, Joosten M, Diderich KE, Govaerts LC, Boter M, Kromosoeto JN, van Hassel DAC, Huijbregts G, van IJcken WF, Heydanus R, Dijkman A, Toolenaar T, de Vries FA, Knijnenburg J, Go AT, Galjaard RJH, Van Opstal D. The influence of SNP-based chromosomal microarray and NIPT on the diagnostic yield in 10,000 fetuses with and without fetal ultrasound anomalies. Hum Mutat 2017; 38:880-888. [DOI: 10.1002/humu.23232] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/24/2017] [Accepted: 04/09/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Maarten F.C.M. Knapen
- Department of Obstetrics and Gynecology; Erasmus Medical Centre; Rotterdam The Netherlands
- Foundation Prenatal Screening Southwest region of the Netherlands; Rotterdam The Netherlands
| | - Marike Polak
- Institute of Psychology; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Karin E.M. Diderich
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Marjan Boter
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Joan N.R. Kromosoeto
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Gido Huijbregts
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Roger Heydanus
- Department of Obstetrics and Gynecology; Amphia Hospital; Breda The Netherlands
| | - Anneke Dijkman
- Department of Obstetrics and Gynecology; Reinier de Graaf Gasthuis; Delft The Netherlands
| | - Toon Toolenaar
- Department of Gynecology; Albert Schweitzer Hospital Dordrecht; Dordrecht The Netherlands
| | - Femke A.T. de Vries
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Jeroen Knijnenburg
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Attie T.J.I. Go
- Department of Obstetrics and Gynecology; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Diane Van Opstal
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
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31
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Oneda B, Rauch A. Microarrays in prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2017; 42:53-63. [PMID: 28215395 DOI: 10.1016/j.bpobgyn.2017.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/13/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
In prenatal diagnosis, chromosomal microarray (CMA) has not yet fully replaced conventional karyotyping but has rapidly become the recommended test in pregnancies with ultrasound abnormalities. In this review, we provide an overview of the published data concerning this technology and the controversies concerning its use in the prenatal setting. There is abundant evidence indicating the added detection of pathogenic abnormalities with CMA in comparison to the traditional karyotyping, especially in fetuses with multiple or isolated ultrasound abnormalities such as congenital heart disease, increased nuchal translucency, or oral cleft. On the other hand, there is also a risk to detect variants of unknown significance, late-onset disorders, and variants in susceptibility loci. However, it has been shown that pregnant couples tend to prefer a maximum of information about the health of their unborn child. Taken together, CMA has considerable diagnostic and prognostic values during pregnancy and should therefore be the test of choice.
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Affiliation(s)
- Beatrice Oneda
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland.
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
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32
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Govaerts L, Srebniak M, Diderich K, Joosten M, Riedijk S, Knapen M, Go A, Papatsonis D, de Graaf K, Toolenaar T, van der Steen S, Huijbregts G, Knijnenburg J, de Vries F, Van Opstal D, Galjaard RJ. Prenatal diagnosis of susceptibility loci for neurodevelopmental disorders - genetic counseling and pregnancy outcome in 57 cases. Prenat Diagn 2016; 37:73-80. [DOI: 10.1002/pd.4979] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/15/2016] [Accepted: 11/26/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Lutgarde Govaerts
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Malgorzata Srebniak
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Karin Diderich
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Sam Riedijk
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Maarten Knapen
- Department of Obstetrics and Gynecology; Erasmus Medical Center; Rotterdam The Netherlands
- Foundation Prenatal Screening Southwest region of the Netherlands; Rotterdam The Netherlands
| | - Attie Go
- Department of Obstetrics and Gynecology; Erasmus Medical Center; Rotterdam The Netherlands
| | - Dimitri Papatsonis
- Department of Obstetrics and Gynecology; Amphia Hospital; Breda The Netherlands
| | - Katja de Graaf
- Department of Obstetrics and Gynecology; Reinier de Graaf Gasthuis; Delft The Netherlands
| | - Toon Toolenaar
- Department of Gynecology; Albert Schweitzer Hospital Dordrecht; Dordrecht The Netherlands
| | - Sanne van der Steen
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Gido Huijbregts
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Jeroen Knijnenburg
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Femke de Vries
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
| | - Robert-Jan Galjaard
- Department of Clinical Genetics; Erasmus Medical Center; Rotterdam The Netherlands
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