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Pietersma CS, Rousian M, Moolenaar L, Steegers EAP, Mulders A. Impact of first-trimester anomaly scan on health-related quality of life and healthcare costs: a scoping review. J Psychosom Obstet Gynaecol 2024; 45:2330414. [PMID: 38511633 DOI: 10.1080/0167482x.2024.2330414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
IMPORTANCE The first-trimester anomaly scan (FTAS) has the potential to detect major congenital anomalies in an early stage of pregnancy. Due to this potential early detection, there is a trend to introduce FTAS in regular care. Data regarding the impact of FTAS on the patient's perspective are limited. OBJECTIVE To provide an overview of the literature assessing the impact of the FTAS on health-related quality of life (HRQoL) and healthcare costs. EVIDENCE ACQUISITION Literature search was performed in Embase, PubMed, Medline Ovid, Cochrane Library database, Web-of-Science, and Google Scholar were searched. All studies that reported the performance of a nuchal translucency measurement with a basic fetal assessment HRQoL or healthcare costs of FTAS were included. Studies solely describing screening of chromosomal anomalies were excluded. Three authors independently screened the studies and extracted the data. Results were combined using descriptive analysis. PROSPERO registration number: CRD42016045190. RESULTS The search yielded 3242 articles and 16 were included. Thirteen articles (7045 pregnancies) examined the relationship between FTAS and HRQoL. Anxiety scores were raised temporarily before FTAS and returned to early pregnancy baseline following the absence of anomalies. Depression scores did not change significantly as a result of FTAS. Three articles studied healthcare costs. These studies, published before 2005, found a combination of FTAS and second-trimester anomaly scan (STAS) resulted in an increased amount of detected anomalies when compared to a STAS-only regimen. However, the combination would also be more costly. CONCLUSIONS Women experience anxiety in anticipation of the FTAS result and following a reassuring FTAS result, anxiety returns to the baseline level. FTAS seems to be a reassuring experience. The included studies on costs showed the addition of FTAS is likely to increase the number of detected anomalies against an increase in healthcare costs per pregnancy.Review registration: PROSPERO CRD42016045190.
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Affiliation(s)
- Carsten S Pietersma
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Lobke Moolenaar
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
| | - Annemarie Mulders
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, CA, The Netherlands
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Antolin M, Tarrasó G, Sánchez MÁ, Plaja A, Martínez-Cruz D, Xunclà M, Castells N, Carreras E, Tizzano EF, García-Arumí E. Performance of Massive Parallel Sequencing-Based Cell-Free DNA Testing in Compromised Pregnancies. J Clin Med 2024; 13:4007. [PMID: 39064047 PMCID: PMC11277969 DOI: 10.3390/jcm13144007] [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: 05/09/2024] [Revised: 06/26/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Non-Invasive prenatal test (NIPT) is used as a universal or contingent test after prior risk assessment. Screening is mainly performed for common trisomies (T21, T13, T18), although other chromosomal anomalies may be detected. Our objective was to study the performance of GWNIPT in the detection of chromosomal abnormalities in pregnancies in which an invasive prenatal study was performed and in early pregnancy losses, in comparison with the reference test. Method: VeriSeqTM NIPT Solution v2, a genome-wide NIPT (GWNIPT), was performed prior to invasive testing in fetal diagnostic study cases (FDS, n = 155) and in early pregnancy losses (EPL, n = 68). Results: In the FDS group, the diagnostic test (QFPCR, array and karyotype) detected anomalies in 32 pregnancies (21%), in twenty of them (61%) also detected by GWNIPT. Eleven of the twelve cases undetected by GWNIPT were balanced translocations (n = 4) or deletions/duplications <7 Mb (n = 7). In the EPL group, GWNIPT detected anomalies in 46% of cases (31/68) but comparison with reference test (QFPCR and karyotype) in products of conception (POC) was only possible in 18 cases. Concordant results between POC and GWNIPT test were obtained in 16 of the 18 cases. In EPL, with GWNIPT testing, common trisomies accounted for 25.8% of cases (8/31), rare trisomies 54.8% (17/31) and microdeletions/duplications 16.1% (5/31). Conclusions: The GWNIPT test may be useful in clinical practice in prenatal and in EPL's genetic diagnosis when the appropriate sample is not available.
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Affiliation(s)
- Maria Antolin
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Guillermo Tarrasó
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - María Ángeles Sánchez
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Alberto Plaja
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Desiree Martínez-Cruz
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Mar Xunclà
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Neus Castells
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Elena Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Eduardo F. Tizzano
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Elena García-Arumí
- Department of Clinical and Molecular Genetics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain (E.G.-A.)
- Research Group on Neuromuscular and Mitochondrial Disorders, Vall d’Hebron Research Institut (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, 08041 Barcelona, Spain
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3
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Tramontano AL, Marano I, Orlandi G, Angelino A, Rivieccio M, Fulgione C, Maruotti GM, Saccone G, De Vita G, Guida M, Sarno L. Maternal Reassurance, Satisfaction, and Anxiety after First-Trimester Screening for Aneuploidies: Comparison between Contingent Screening and Universal Cell-Free DNA Testing. Diagnostics (Basel) 2024; 14:1198. [PMID: 38893724 PMCID: PMC11172334 DOI: 10.3390/diagnostics14111198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND This study aims to evaluate maternal reassurance, satisfaction, and anxiety after two different strategies for the first-trimester screening for aneuploidies. METHODS Patients between 11 + 3 and 13 + 6 weeks of gestation attending the first-trimester screening at Department of Mother and Child, University Hospital Federico II, Naples, Italy have been recruited and randomly allocated to contingent screening or universal cell-free fetal DNA testing (cffDNA). Questionnaires to measure reassurance, satisfaction, and anxiety have been filled twice: (Q1) after randomization and (Q2) after receiving results. Anxiety was measured by an Italian-version short form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI); child-related anxiety was measured by the 11-item Pregnancy-Related Anxiety Questionnaire-Revised Regardless of Parity (PRAQ-R2 scale); fear of bearing a physically or mentally handicapped child was measured considering only four items (item 4, 9, 10, and 11) of the PRAQ-R2 scale. RESULTS 431 patients were recruited: 205 (49%) were randomized in the contingent screening arm, 226 (51%) in the cfDNA arm. Maternal reassurance, satisfaction, and anxiety were not different in the two groups. CONCLUSION A contingent screening for aneuploidies in the first trimester seems able to ensure the same maternal reassurance and satisfaction as a cfDNA analysis in the low-risk population and to not affect maternal anxiety.
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Affiliation(s)
- Anna Luna Tramontano
- Mother and Child Department, University Hospital Federico II, 80131 Naples, Italy; (A.L.T.); (I.M.)
| | - Ilaria Marano
- Mother and Child Department, University Hospital Federico II, 80131 Naples, Italy; (A.L.T.); (I.M.)
| | - Giuliana Orlandi
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (C.F.); (G.S.)
| | - Antonio Angelino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy (G.M.M.)
| | - Maria Rivieccio
- Department of Molecular Medicine and Medical Biotecnology, University of Naples Federico II, 80131 Naples, Italy; (M.R.); (G.D.V.)
| | - Caterina Fulgione
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (C.F.); (G.S.)
| | | | - Gabriele Saccone
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (C.F.); (G.S.)
| | - Gabriella De Vita
- Department of Molecular Medicine and Medical Biotecnology, University of Naples Federico II, 80131 Naples, Italy; (M.R.); (G.D.V.)
| | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (C.F.); (G.S.)
| | - Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (G.O.); (C.F.); (G.S.)
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Sacca L, Zerrouki Y, Burgoa S, Okwaraji G, Li A, Arshad S, Gerges M, Tevelev S, Kelly S, Knecht M, Kitsantas P, Hunter R, Scott L, Reynolds AP, Colon G, Retrouvey M. Exploring measurement tools used to assess knowledge, attitudes, and perceptions of pregnant women toward prenatal screening: A systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241273557. [PMID: 39206551 PMCID: PMC11363050 DOI: 10.1177/17455057241273557] [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: 04/09/2024] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
There is a lack of standardized measurement tools globally to assess knowledge, attitudes, and perceptions of expecting women toward prenatal screening. The purpose of this systematic review was to identify reasons women pursue or decline prenatal screening and compare the strengths and limitations of available measurement tools used to assess pregnant women's perceptions, knowledge, and attitudes toward prenatal screening. This review followed the five-step York methodology by Arksey and O'Malley and incorporated recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist for the extraction, analysis, and presentation of results. The five steps consisted of: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. Four online databases (PubMed, Embase, Web of Science, and Cochrane Library) were selected after the librarian's development of a detailed search strategy. The Rayyan platform was used between June 2023 and August 2023 to epitomize the articles produced from our search. A total of 68 eligible studies were included in the analysis. The top five major reasons for declining prenatal screening uptake included (1) being unsure of the risk of prenatal screening and harm to the baby or miscarriage (n = 15), (2) not considering action such as termination of pregnancy for prenatal screening to be considered as necessary (n = 14), (3) high cost (n = 12), (4) lack of knowledge about testing procedures and being anxious about the test (n = 10), and (5) being worried about probability of false negative or false positive results (n = 6). Only 32 studies utilized scientifically validated instruments. Difficulties in capturing representative, adequately sized samples inclusive of diverse ethnicities and demographics were pervasive. Findings highlight the need for rigorous validation of research measurement methodologies to ensure the accuracy and applicability of resulting data regarding the assessment of prenatal screening perceptions, knowledge, and attitudes across diverse female populations.Registration: N/A.
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Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Yasmine Zerrouki
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Goodness Okwaraji
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ashlee Li
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Shaima Arshad
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Maria Gerges
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Stacey Tevelev
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sophie Kelly
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michelle Knecht
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Panagiota Kitsantas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Robert Hunter
- Maternal-Fetal Medicine, Memorial HealthCare System, Hollywood, FL, USA
| | - Laurie Scott
- Maternal-Fetal Medicine, Memorial HealthCare System, Hollywood, FL, USA
| | | | - Gabriela Colon
- Maternal-Fetal Medicine, Memorial HealthCare System, Hollywood, FL, USA
| | - Michele Retrouvey
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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5
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Maya I, Sukenik-Halevy R, Basel-Salmon L, Sagi-Dain L. A call for public funding of invasive and non-invasive prenatal testing. J Perinat Med 2023; 51:992-996. [PMID: 37207994 DOI: 10.1515/jpm-2023-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
For decades, prenatal screening and genetic testing strategies were limited, requiring less complex decisions. Recently, however, several new advanced technologies were introduced, including chromosomal microarray analysis (CMA) and non-invasive prenatal screening (NIPS), bringing about the need to choose the most appropriate testing for each pregnancy. A worrisome issue is that opposed to the wide implementation and debates over public funding of NIPS, currently invasive testing is still recommended only in selected pregnancies with increased risk for chromosomal aberrations (according to screening tests or sonographic anomalies). This current decision-making regarding public funding for invasive and screening testing might compromise informed consent and patient's autonomy. In this manuscript, we compare several characteristics of CMA vs. NIPS, namely: the accuracy and the diagnostic scope, the risks for miscarriage and for clinically uncertain findings, the timing for testing, and pretest counselling. We argue that it must be recognized that one size might not fit all, and suggest that both options should be presented to all couples through early genetic counseling, with public funding for the specific selected test.
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Affiliation(s)
- Idit Maya
- Rabin Medical Center, Recanati Genetics Institute, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Sukenik-Halevy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meir Medical Center, Genetics Institute, Kfar Saba, Israel
| | - Lina Basel-Salmon
- Rabin Medical Center, Recanati Genetics Institute, Beilinson Hospital, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Lena Sagi-Dain
- Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Genetics Institute, Technion - Israel Institute of Technology, Haifa, Israel
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6
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Maya I, Salzer Sheelo L, Basel-Salmon L, Sagi-Dain L. A good screening test: benefits and limitations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:783-784. [PMID: 37267098 DOI: 10.1002/uog.26228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/04/2023]
Affiliation(s)
- I Maya
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Salzer Sheelo
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - L Basel-Salmon
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Felsenstein Medical Research Center, Rabin Medical Center, Petah Tikva, Israel
| | - L Sagi-Dain
- Genetics Institute, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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7
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Alipour SM, Rahimzadeh M, Tourzani ZM, Mahmoodi Z, Esmaelzadeh Saeieh S. Predictor role of marital conflict on maternal competency with mediating role of perceived stress and concerns during pregnancy: A structural equation model. Neuropsychopharmacol Rep 2023; 43:95-102. [PMID: 36692423 PMCID: PMC10009430 DOI: 10.1002/npr2.12309] [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: 06/28/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023] Open
Abstract
AIM Pregnancy prepares the mother for the transition to motherhood. Maternal concerns during pregnancy cause reduced time spent with the spouse and lack of social support; additional stresses such as marital conflicts could impact maternal competency. This study aimed to assess the predictive effect of marital conflicts with the mediating role of perceived stress and pregnancy concern on maternal competency. METHODS This was a longitudinal study. It was done on 250 mothers referred to selected health centers in Alborz province. The sampling method was convenient. Marital conflicts, perceived stress, and pregnancy concerns questionnaires were completed in the third trimester of pregnancy, and the maternal competency questionnaire was completed 6 weeks after delivery. Data were analyzed by SPSS software and smart partial least squares. RESULTS The results of structural equations showed that marital conflicts have a negative and significant effect on maternal competency (β = -0.14), marital conflicts have a positive and significant effect on perceived stress (β = 0.42), and marital conflicts have a positive and significant effect on pregnancy concern (β = 0.31). Also, perceived stress negatively and significantly affected maternal competency (β = -0.36). DISCUSSION Results of the study showed the necessities for screening and identifying mothers with conflicts and assessing the perceived stress of mothers will improve the mental health of pregnant mothers and consequently increase maternal competency.
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Affiliation(s)
| | - Mitra Rahimzadeh
- Social Determinants of Health Research Center, School of public health, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh Saeieh
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
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8
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Bowman-Smart H, Gyngell C, Mand C, Amor DJ, Delatycki MB, Savulescu J. Non-Invasive Prenatal Testing for "Non-Medical" Traits: Ensuring Consistency in Ethical Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:3-20. [PMID: 34846986 PMCID: PMC7614328 DOI: 10.1080/15265161.2021.1996659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including "non-medical" traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as "non-medical"; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework.
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Affiliation(s)
- Hilary Bowman-Smart
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Corresponding author: Hilary Bowman-Smart Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville Victoria Australia 3052, , (03) 8341 6200
| | - Christopher Gyngell
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Cara Mand
- Murdoch Children’s Research Institute, Parkville, Australia
| | - David J. Amor
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Martin B. Delatycki
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Julian Savulescu
- Murdoch Children’s Research Institute, Parkville, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
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9
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Mirtabar SM, Pahlavan Z, Aligoltabar S, Barat S, Nasiri-Amiri F, Nikpour M, Behmanesh F, Taheri S, Nasri K, Faramarzi M. Women's worries about prenatal screening tests suspected of fetal anomalies: a qualitative study. BMC Womens Health 2023; 23:66. [PMID: 36782219 PMCID: PMC9926685 DOI: 10.1186/s12905-023-02211-8] [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: 08/13/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Pregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies. METHODS Through the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews. RESULTS The four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety). CONCLUSION Women with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.
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Affiliation(s)
- Seyyedeh Mahboubeh Mirtabar
- grid.411495.c0000 0004 0421 4102Research Clinical Psychology, Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Zeynab Pahlavan
- grid.411495.c0000 0004 0421 4102Rouhani Hospital, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Sajedeh Aligoltabar
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Shahnaz Barat
- grid.411495.c0000 0004 0421 4102Infertility and Health Reproductive Research Center, Health Research Institue, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Fatemeh Nasiri-Amiri
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Maryam Nikpour
- grid.411495.c0000 0004 0421 4102Non-Communicable pediatric Disease Research Center, Health Research Institute, Babol University of Medical Science, Babol, Islamic Republic of Iran
| | - Fereshteh Behmanesh
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Sina Taheri
- grid.411495.c0000 0004 0421 4102Rouhani Hospital, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Khadijeh Nasri
- grid.468130.80000 0001 1218 604XDepartment of Gynecology and Obstetrics, Arak University of Medical Sciences, Arak, Islamic Republic of Iran
| | - Mahbobeh Faramarzi
- Social Determinants of Health Research Center, Health Research Institue, Department of General Courses, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
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10
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Oliveri S, Ongaro G, Cutica I, Menicucci G, Belperio D, Spinella F, Pravettoni G. Decision-making process about prenatal genetic screening: how deeply do moms-to-be want to know from Non-Invasive Prenatal Testing? BMC Pregnancy Childbirth 2023; 23:38. [PMID: 36653738 PMCID: PMC9845820 DOI: 10.1186/s12884-022-05272-z] [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: 09/24/2022] [Accepted: 12/01/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prenatal information may be obtained through invasive diagnostic procedures and non-invasive screening procedures. Several psychological factors are involved in the decision to undergo a non-invasive prenatal testing (NIPT) but little is known about the decision-making strategies involved in choosing a specific level of in-depth NIPT, considering the increased availability and complexity of NIPT options. The main aim of this work is to assess the impact of psychological factors (anxiety about pregnancy, perception of risk in pregnancy, intolerance to uncertainty), and COVID-19 pandemic on the type of NIPT chosen, in terms of the number of conditions that are tested. METHODS A self-administered survey evaluated the decision-making process about NIPT. The final sample comprised 191 women (Mage = 35.53; SD = 4.79) who underwent a NIPT from one private Italian genetic company. Based on the test date, the sample of women was divided between "NIPT before COVID-19" and "NIPT during COVID-19". RESULTS Almost all of the participants reported being aware of the existence of different types of NIPT and more than half reported having been informed by their gynecologist. Results showed no significant association between the period in which women underwent NIPT (before COVID-19 or during COVID-19) and the preferences for more expanded screening panel. Furthermore, regarding psychological variables, results showed a significant difference between perceived risk for the fetus based on the NIPT type groups, revealing that pregnant women who underwent the more expanded panel had a significantly higher level of perceived risk for the fetus than that reported by pregnant women who underwent the basic one. There was no statistically significant difference between the other psychological variables and NIPT type. CONCLUSIONS Our findings indicate the paramount role of gynecologist and other health care providers, such as geneticists and psychologists, is to support decision-making process in NIPT, in order to overcome people's deficits in genetic knowledge, promote awareness about their preferences, and control anxiety related to the unborn child. Decision-support strategies are critical during the onset of prenatal care, according to the advances in prenatal genomics and to parent's needs.
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Affiliation(s)
- Serena Oliveri
- grid.15667.330000 0004 1757 0843Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Ongaro
- grid.15667.330000 0004 1757 0843Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ilaria Cutica
- grid.4708.b0000 0004 1757 2822Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Menicucci
- Eurofins Genoma Group, Molecular Genetics Laboratories, Rome, Italy
| | - Debora Belperio
- Eurofins Genoma Group, Molecular Genetics Laboratories, Rome, Italy
| | | | - Gabriella Pravettoni
- grid.15667.330000 0004 1757 0843Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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11
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Kristalijn SA, White K, Eerbeek D, Kostenko E, Grati FR, Bilardo CM. Patient experience with non-invasive prenatal testing (NIPT) as a primary screen for aneuploidy in the Netherlands. BMC Pregnancy Childbirth 2022; 22:782. [PMID: 36266611 PMCID: PMC9585792 DOI: 10.1186/s12884-022-05110-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Non-invasive prenatal testing (NIPT) as a screening method for trisomy 21 and other chromosomal abnormalities has been adopted widely across the globe. However, while many clinical validation studies have been performed, less is known regarding the patient experience with NIPT. This study explored how individuals experience NIPT in a pre- and post-test setting, where NIPT is broadly available as a primary screening method with the option of reporting beyond common trisomies. Methods Participants were recruited using social media with a strategy designed to select individuals who had the option to have NIPT as part of the TRIDENT-2 study (In the Netherlands, NIPT is only available within the TRIDENT studies executed by the NIPT consortium. This research was done independently from the NIPT consortium.) in the Netherlands. The study used online questionnaires and semi-structured interviews. Both were developed around a patient experience framework consisting of seven themes: information, patient as active participant, responsiveness of services, lived experience, continuity of care and relationships, communication, and support. Results Overall, 4539 questionnaire responses were analyzed and 60% of the respondents had experienced NIPT. Of those, 1.7% received a high-risk result for trisomy or another chromosomal copy number variant (referred to as an “additional finding”). Overall, participants felt they had received sufficient information and had control over their decision regarding whether or not to choose NIPT. The vast majority of respondents who had NIPT were positive about their experience and would use it again. Those with results showing an increased probability for trisomy or additional findings were more likely to report negative feelings such as tension and anxiety, and less likely to feel that they had been sufficiently prepared for the implications of their results. Conclusions The patient experience with first-tier NIPT in the Netherlands was largely positive. Areas for improvement included counseling on the implications of screening and the different possible outcomes of NIPT, including additional findings that may be uncovered by expanding NIPT beyond the common trisomies. The experiences reported in this study may be useful for other countries intending to implement NIPT.
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Affiliation(s)
| | | | - Deanna Eerbeek
- Management Policy Analysis and Entrepreneurship, VU University Amsterdam, Amsterdam, The Netherlands
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12
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Maya I, Salzer Sheelo L, Brabbing-Goldstein D, Matar R, Kahana S, Agmon-Fishman I, Klein C, Gurevitch M, Basel-Salmon L, Sagi-Dain L. Residual risk for clinically significant copy number variants in low-risk pregnancies, following exclusion of noninvasive prenatal screening-detectable findings. Am J Obstet Gynecol 2022; 226:562.e1-562.e8. [PMID: 34762861 DOI: 10.1016/j.ajog.2021.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chromosomal microarray analysis detects a clinically significant amount of copy number variants in approximately 1% of low-risk pregnancies. As the constantly growing use of noninvasive prenatal screening has facilitated the detection of chromosomal aberrations, defining the rate of abnormal chromosomal microarray analysis findings following normal noninvasive prenatal screening is of importance for making informed decisions regarding prenatal testing and screening options. OBJECTIVE To calculate the residual risk for clinically significant copy number variants following theoretically normal noninvasive prenatal screening. STUDY DESIGN The chromosomal microarray results of all pregnancies undergoing amniocentesis between the years 2013 and 2021 in a large hospital-based laboratory were collected. Pregnancies with sonographic anomalies, abnormal maternal serum screening, or multiple fetuses were excluded. Clinically significant (pathogenic and likely pathogenic) copy number variants were divided into the following: 3-noninvasive prenatal screening-detectable (trisomies 13, 18, and 21), 5- noninvasive prenatal screening-detectable (including sex chromosome aberrations), 5-noninvasive prenatal screening and common microdeletion-detectable (including 1p36.3-1p36.2, 4p16.3-4p16.2, 5p15.3-5p15.1, 15q11.2-15q13.1, and 22q11.2 deletions), and genome-wide noninvasive prenatal screening-detectable (including variants >7 Mb). The theoretical residual risk for clinically significant copy number variants was calculated following the exclusion of noninvasive prenatal screening-detectable findings. RESULTS Of the 7235 pregnancies, clinically significant copy number variants were demonstrated in 87 cases (1.2%). The residual risk following theoretically normal noninvasive prenatal screening was 1.07% (1/94) for 3-noninvasive prenatal screening, 0.78% (1/129) for 5- noninvasive prenatal screening, 0.74% (1/136) for 5- noninvasive prenatal screening including common microdeletions, and 0.68% (1/147) for genome-wide noninvasive prenatal screening. In the subgroup of 4048 pregnancies with advanced maternal age, the residual risk for clinically significant copy number variants following theoretically normal noninvasive prenatal screening ranged from 1.36% (1/73) for 3- noninvasive prenatal screening to 0.82% (1/122) for genome-wide noninvasive prenatal screening. In 3187 pregnancies of women <35 years, this residual risk ranged from 0.69% (1/145) for 3- noninvasive prenatal screening to 0.5% (1/199) for genome-wide noninvasive prenatal screening. CONCLUSION The residual risk of clinically significant copy number variants in pregnancies without structural sonographic anomalies is appreciable and depends on the noninvasive prenatal screening extent and maternal age. This knowledge is important for the patients, obstetricians, and genetic counselors to facilitate informed decisions regarding prenatal testing and screening options.
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13
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Women’s perspectives and attitudes towards the utility of angiogenic biomarkers in preeclampsia. Pregnancy Hypertens 2022; 28:109-113. [DOI: 10.1016/j.preghy.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
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14
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Bermejo-Franco A, Sánchez-Sánchez JL, Gaviña-Barroso MI, Atienza-Carbonell B, Balanzá-Martínez V, Clemente-Suárez VJ. Gender Differences in Psychological Stress Factors of Physical Therapy Degree Students in the COVID-19 Pandemic: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020810. [PMID: 35055632 PMCID: PMC8776211 DOI: 10.3390/ijerph19020810] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: The aim of the study was to investigate how the COVID-19 pandemic impacted the mental health and quality of life of male and female physical therapy students at the European University of Madrid. (2) Methods: A cross-sectional online survey was conducted including a range of tests capturing different domains: 36-item Short Form Health Survey, six-item state version of the State–Trait Anxiety Inventory, Acceptance and Action Questionnaire, Three Items Loneliness Scale, four-item version of the Perceived Stress Scale, Beck Depression Inventory revised version, and Sleep Quality Numeric Rating Scale. (3) Results: A total of 151 students completed the study, consisting of 78 females and 73 males. Gender differences were observed on most of the domains evaluated. Female participants showed worse levels of general health perception, quality of life, depression symptoms, anxiety, stress, experiential avoidance and psychological inflexibility, sleep quality and loneliness compared to male physical therapy students. (4) Conclusions: The results of this study support the need of psychological interventions as preventive programs in situations such as COVID-19 pandemic. The aims of this study comprise of improving knowledge, awareness, and self-coping strategies or other psychological domains oriented to mitigate the effects of COVID-19 on mental health and health-related quality of life in university students, especially among female ones.
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Affiliation(s)
- Alberto Bermejo-Franco
- Faculty of Sports Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (A.B.-F.); (M.I.G.-B.); (V.J.C.-S.)
| | - Juan Luis Sánchez-Sánchez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (A.B.-F.); (M.I.G.-B.); (V.J.C.-S.)
- Correspondence:
| | - María Isabel Gaviña-Barroso
- Faculty of Sports Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (A.B.-F.); (M.I.G.-B.); (V.J.C.-S.)
| | | | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, 46010 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28007 Madrid, Spain
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (A.B.-F.); (M.I.G.-B.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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15
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Sagi-Dain L, Singer A, Petersen OB, Lou S, Vogel I. Trends in Non-invasive Prenatal Screening and Invasive Testing in Denmark (2000-2019) and Israel (2011-2019). Front Med (Lausanne) 2021; 8:768997. [PMID: 34869484 PMCID: PMC8635699 DOI: 10.3389/fmed.2021.768997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Following the wide distribution of non-invasive prenatal genetic screening (NIPS), numerous studies have reported a decline in total invasive tests in the recent years, up to 50–70% in some countries. However, in Denmark and Israel we have not experienced these declines. The objective of our study was to evaluate the trends in NIPS and chromosomal microarray analysis (CMA) use in Denmark and Israel. Methods: This retrospective study was performed by data acquisition from the Danish Cytogenetics Central Registry throughout the years 2000–2019, and Israeli Public Health Services, Ministry of Health computerized database (from 2011). Results: Of the 1,243,956 live births registered in Denmark over the years 2000–2019, a relatively steady level of invasive testing around 6% was noted since 2004, as opposed to 13.0% in Israel based on 1,594,962 live births between 2011 and 2019. The average uptake of NIPS was 1.1 ± 0.5% in Denmark vs. 4.3% in Israel (2013–2019). Relatively steady rates of invasive testing were noted in both countries, compared to a slight decline in NIPS in the recent years. Discussion: The recent decrease in the rates of invasive testing in the NIPS era was not observed in Denmark or in Israel. These results imply that Danish and Israeli women and/or health providers might favor the high resolution and yield of CMA testing over the non-invasiveness of NIPS. We explore and discuss this phenomenon, based on five central factors.
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Affiliation(s)
- Lena Sagi-Dain
- Prenatal Genetics, Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Amihood Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Olav B Petersen
- Department of Obstetrics, Center for Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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16
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Schobers G, Koeck R, Pellaers D, Stevens SJC, Macville MVE, Paulussen ADC, Coonen E, van den Wijngaard A, de Die-Smulders C, de Wert G, Brunner HG, Zamani Esteki M. Liquid biopsy: state of reproductive medicine and beyond. Hum Reprod 2021; 36:2824-2839. [PMID: 34562078 PMCID: PMC8523207 DOI: 10.1093/humrep/deab206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 08/06/2021] [Indexed: 01/23/2023] Open
Abstract
Liquid biopsy is the process of sampling and analyzing body fluids, which enables non-invasive monitoring of complex biological systems in vivo. Liquid biopsy has myriad applications in health and disease as a wide variety of components, ranging from circulating cells to cell-free nucleic acid molecules, can be analyzed. Here, we review different components of liquid biopsy, survey state-of-the-art, non-invasive methods for detecting those components, demonstrate their clinical applications and discuss ethical considerations. Furthermore, we emphasize the importance of artificial intelligence in analyzing liquid biopsy data with the aim of developing ethically-responsible non-invasive technologies that can enhance individualized healthcare. While previous reviews have mainly focused on cancer, this review primarily highlights applications of liquid biopsy in reproductive medicine.
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Affiliation(s)
- Gaby Schobers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rebekka Koeck
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Dominique Pellaers
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Servi J C Stevens
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Aimée D C Paulussen
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Edith Coonen
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Center for Reproductive Medicine, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Christine de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Guido de Wert
- Faculty of Health, Medicine and Life Sciences, Department of Health, Ethics and Society, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Masoud Zamani Esteki
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Genetics and Cell Biology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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17
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Plantinga M, Zwienenberg L, van Dijk E, Breet H, Diphoorn J, El Mecky J, Bouman K, Verheij J, Birnie E, Ranchor AV, Corsten-Janssen N, van Langen IM. Parental experiences of rapid exome sequencing in cases with major ultrasound anomalies during pregnancy. Prenat Diagn 2021; 42:762-774. [PMID: 34643287 PMCID: PMC9298392 DOI: 10.1002/pd.6056] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adding rapid exome sequencing (rES) to conventional genetic tests improves the diagnostic yield of pregnancies showing ultrasound abnormalities but also carries a higher chance of unsolicited findings. We evaluated how rES, including pre- and post-test counseling, was experienced by parents investigating its impact on decision-making and experienced levels of anxiety. METHODS A mixed-methods approach was adopted. Participating couples (n = 46) were asked to fill in two surveys (pre-test and post-test counseling) and 11 couples were approached for an additional interview. RESULTS All couples accepted the rES test-offer with the most important reason for testing emphasizing their hope of finding an underlying diagnosis that would aid decision-making. The actual impact on decision-making was low, however, since most parents decided to terminate the pregnancy based on the major and multiple fetal ultrasound anomalies and did not wait for their rES results. Anxiety was elevated for most participants and decreased over time. CONCLUSION Major congenital anomalies detected on ultrasound seem to have more impact on prenatal parental decision-making and anxiety then the offer and results of rES. However, the impact of rES on reproductive decision-making and experienced anxiety requires further investigation, especially in pregnancies where less (severe) fetal anomalies are detected on ultrasound.
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Affiliation(s)
- Mirjam Plantinga
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lauren Zwienenberg
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva van Dijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanna Breet
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janouk Diphoorn
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Julia El Mecky
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Katelijne Bouman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joke Verheij
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole Corsten-Janssen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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18
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Cornell P, Armstrong T, Fyfe R, Mallise CA, Dudding-Byth T, Campbell LE. Experiences of non-invasive prenatal screening: A survey study. Aust N Z J Obstet Gynaecol 2021; 62:241-249. [PMID: 34570369 DOI: 10.1111/ajo.13436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Australia, using non-invasive prenatal testing (NIPT) to screen for fetal abnormalities is becoming more commonplace. However, there is a lack of standardised procedures surrounding pre-test counselling. This holds the potential for variability in pregnant people's experiences when undergoing NIPT, which subsequently may impact their ability to make informed decisions surrounding NIPT results. AIM This study sought to characterise the experiences of Australian women undergoing NIPT, including perceptions of informed choice, counselling experiences and decision to undergo NIPT. MATERIALS AND METHODS Australian women who had been recently pregnant (n = 94) completed an online survey which assessed: their knowledge of and attitude toward NIPT; satisfaction with counselling; satisfaction with their decision; and decisional conflict to undergo NIPT. The survey also allowed participants to provide qualitative information about their counselling experience and reasons for undergoing NIPT. RESULTS Overall, participants had good knowledge of and positive attitudes toward NIPT, experienced low decisional conflict and were overall satisfied with their counselling experience and decision to undergo NIPT. However, some participants expressed dissatisfaction with the lack of information provided, and biased language, by counselling providers. The desire to be informed was the most frequent reason for undergoing NIPT. CONCLUSION The provision of accurate and objective information in pre-test counselling is important to reduce decisional conflict and improve satisfaction with the decision to undergo NIPT. It is recommended counselling providers present pregnant people with neutral, objective, and accurate information at the time of pre-test counselling.
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Affiliation(s)
- Paige Cornell
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Taylah Armstrong
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Rina Fyfe
- Maternal Fetal Medicine Unit, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Carly A Mallise
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Tracy Dudding-Byth
- Hunter Genetics, Callaghan, NSW, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Linda E Campbell
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
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19
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The yield of chromosomal microarray in pregnancies with congenital cardiac defects and normal noninvasive prenatal screening. Am J Obstet Gynecol 2021; 225:333.e1-333.e14. [PMID: 34052193 DOI: 10.1016/j.ajog.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Evidence comparing the yield of chromosomal microarray analysis to noninvasive prenatal screening in pregnancies with congenital heart anomalies is currently limited. OBJECTIVE This study aimed to examine the residual risk of clinically significant chromosomal microarray analysis results in fetuses with congenital heart defects by its various subtypes following a normal noninvasive prenatal screening. STUDY DESIGN Using a population-based, countrywide computerized database, we retrieved the reports of all pregnancies undergoing chromosomal microarray analysis because of congenital heart defects through the years 2013-2019. We examined the risk of clinically significant (pathogenic and likely pathogenic) chromosomal microarray analysis results and compared it with the results of a local cohort of low-risk pregnancies. Of 5541 fetuses, 78 (1.4%) showed abnormal results. The residual risk of abnormal chromosomal microarray analysis results was calculated using several options-trisomies 21, 18, and 13; sex chromosome aneuploidies; 22q11.2 deletion, and deletions and duplications of at least 10 MB in size (genome-wide noninvasive prenatal screening)-following the exclusion of theoretically detectable noninvasive prenatal screening anomalies. RESULTS Of the 1728 fetuses with congenital heart defects, 93 (5.4%) showed clinically significant chromosomal microarray analysis results (relative risk, 2.7; 95% confidence interval, 2.3-3.1). The result of pregnancies with fetuses with congenital heart defects was compared with the results of the control population. Unique variants were found in 15 pregnancies (16.1%). The detection rate of noninvasive prenatal screening in isolated congenital heart defects varied from 1.0% (aimed at 3 common trisomies) to 2.2% (aimed at 5 common aneuploidies and 22q11.2 deletion) using noninvasive prenatal screening. In nonisolated congenital heart defects, the noninvasive prenatal screening detection rates ranged from 7.8% (aimed at common autosomal trisomies) to 9.2% using genome-wide noninvasive prenatal screening. The residual risk of clinically significant chromosomal microarray analysis results following normal noninvasive prenatal screening ranged from 2.0% to 2.8% in isolated congenital heart defects and 4.5% to 5.9% in nonisolated cases and was significantly higher than those of the control cohort in all noninvasive prenatal screening options. In addition, the residual risk following noninvasive prenatal screening aimed at chromosomes 13, 18, 21, X, and Y was significantly higher than those of the control cohort for most specific congenital heart defect subtypes, except for ventricular septal defects and aberrant right subclavian artery. CONCLUSION The residual risk of clinically significant chromosomal microarray analysis results in pregnancies with fetuses with congenital heart defects following normal noninvasive prenatal screening was higher than those in pregnancies with normal ultrasound in most isolated and nonisolated congenital heart defect subtypes. This information should be taken into account by obstetricians and genetic counselors when considering the option of diagnostic testing.
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20
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Bawazeer S, AlSayed M, Kurdi W, Balobaid A. Knowledge and attitudes regarding non-invasive prenatal testing among women in Saudi Arabia. Prenat Diagn 2021; 41:1343-1350. [PMID: 34159638 DOI: 10.1002/pd.5991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/02/2021] [Accepted: 06/04/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To explore women's knowledge and attitudes regarding NIPT, its implications, the factors affecting their decision to undergo the test and actions taken following a positive result. METHODS In this descriptive study, women who were offered NIPT through the foetal maternal clinic, were asked to complete an anonymous questionnaire about NIPT. The questionnaire consisted of 29 statements and covered four areas: demographics, knowledge, attitudes and decision-making. RESULTS A total of 150 women who were offered NIPT participated in this study. The results showed that generally women had poor knowledge of critical aspects of NIPT. This included the conditions tested for, the implications of the test and its limitations. Over 90% of women were in favour of NIPT and it being offered to all women of advanced maternal age while 66% of the tested women agreed to having confirmatory invasive testing in the case of a positive result. CONCLUSION This study shows that the acceptance rate for NIPT is high despite incomplete understanding of the benefits and limitations of the test. The study findings support the need for education regarding this test through dedicated genetic counselling sessions in order to ensure that an informed decision can be made.
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Affiliation(s)
- Shahad Bawazeer
- Department of Pediatrics, Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moeenaldeen AlSayed
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Wesam Kurdi
- Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynaecology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Ameera Balobaid
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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21
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Health Literacy in Pregnant Women: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073847. [PMID: 33917631 PMCID: PMC8038834 DOI: 10.3390/ijerph18073847] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Health literacy plays a crucial role during pregnancy, as the mother’s health behavior influences both her own health and that of her child. To the authors’ best knowledge, no comprehensive overview on evidence of the health literacy of pregnant women and its impact on health outcomes during pregnancy exists. Therefore, this review aims to assess health literacy levels in pregnant women, whether health literacy is associated with outcomes during pregnancy and whether effective interventions exist to improve the health literacy of pregnant women. A systematic literature search was conducted in PubMed and EBSCO, resulting in 14 studies. The results show mixed levels of health literacy in pregnant women. Limited health literacy is associated with unhealthy behaviors during pregnancy. Mixed health literacy levels can be attributed to the recruitment site, the number of participants and the measurement tool used. Quality assessment reveals that the quality of the included studies is moderate to good. The review revealed that randomized controlled trials and interventions to improve health literacy in pregnant women are rare or do not exist. This is crucial in the light of the mixed health literacy levels found among pregnant women. Healthcare providers play a key role in this context, as pregnant women with limited health literacy rely on them as sources of health information.
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22
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Vuorenlehto L, Hinnelä K, Äyräs O, Ulander VM, Louhiala P, Kaijomaa M. Women's experiences of counselling in cases of a screen-positive prenatal screening result. PLoS One 2021; 16:e0247164. [PMID: 33690660 PMCID: PMC7946296 DOI: 10.1371/journal.pone.0247164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To study women's apprehensions, understanding and experiences of counselling concerning a screen-positive result in screening for fetal chromosomal defects. METHODS A questionnaire study including different steps of the prenatal screening process was carried out in Helsinki University Hospital. Women's experiences concerning counselling immediately after a screen-positive result and during further examinations in the Fetal Medicine Unit (FMU) were analyzed. RESULTS 143 women filled in the questionnaire. Less than half of the women considered the primary counselling after a screen-positive result to be explicit (43.9%) and sufficient (43.1%). In the FMU, 88.3% and 89.8% of women were satisfied with the explicitness and sufficiency of counselling. Most women (75%) experienced worry before further examinations but less than half (45%) had considered their personal values concerning diagnostic tests. Half (50.5%) of women expected the worry to continue even if diagnostic tests turn out normal. Most (81%) women were aware that diagnostic tests are voluntary and were confident (85.3%) with their decision to participate. CONCLUSIONS After a screen-positive result, women have unanswered questions, experience anxiety and confusion. The possibility of an abnormal screening result is not seriously considered beforehand. To enable an informed consent for prenatal screening, improvements in prescreening counselling during the first visits of antenatal care need to be made.
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Affiliation(s)
- Leena Vuorenlehto
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Kaisa Hinnelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Veli-Matti Ulander
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pekka Louhiala
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Marja Kaijomaa
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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23
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Farrell RM, Pierce M, Collart C, Craighead C, Coleridge M, Chien EK, Perni U, Frankel R, Ranzini A, Edmonds BT, Rose SS. The impact of the emergence of COVID-19 on women's prenatal genetic testing decisions. Prenat Diagn 2021; 41:1009-1017. [PMID: 33569794 PMCID: PMC8014673 DOI: 10.1002/pd.5902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/28/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022]
Abstract
Objective We conducted a study to examine the impact of COVID on patients' access and utilization of prenatal genetic screens and diagnostic tests at the onset of the COVID‐19 pandemic in the United States. Methods We conducted telephone interviews with 40 patients to examine how the pandemic affected prenatal genetic screening and diagnostic testing decisions during the initial months of the pandemic in the United States. An interview guide queried experiences with the ability to access information about prenatal genetic testing options and to utilize the tests when desired. Audio recordings were transcribed and coded using NVivo 12. Analysis was conducted using Grounded Theory. Results The pandemic did not alter most participants' decisions to undergo prenatal genetic testing. Yet, it did impact how participants viewed the risks and benefits of testing and timing of testing. There was heightened anxiety among those who underwent testing, stemming from the risk of viral exposure and the fear of being alone if pregnancy loss or fetal abnormality was identified at the time of an ultrasound‐based procedure. Conclusion The pandemic may impact patients' access and utilization of prenatal genetic tests. More research is needed to determine how best to meet pregnant patients' decision‐making needs during this time.
What is already known about this topic?
Prenatal genetic screens and diagnostic tests are a core component to the delivery of high‐quality, evidence‐based prenatal care. It is critical that pregnant patients have the information and resources to make an informed decision about a growing array of prenatal genetic screening and diagnostic testing options. In the decision‐making process, pregnant patients commonly weigh the risks and benefits of gaining genetic information about the fetus with the risks and benefits of the available screens and diagnostic tests.
What does this study add?
The pandemic has led to significant changes in healthcare delivery and insurance benefits for prenatal genetic testing, raising key questions about how pregnant patient are weighing the risks and benefits of the available prenatal genetic screening and diagnostic testing options against the risks of COVID exposure by presenting to a healthcare facility for testing. COVID‐19 appears to impact how women view the utility of prenatal genetic testing, including how they weigh the risk and benefits of prenatal genetic screening and diagnostic testing in addition to when in the pregnancy they may elect to undergo testing. The COVID‐19 pandemic has resulted in increased levels of concern and anxiety that may be encountered by pregnant women in the testing process, raising awareness of the need for additional resources to support patients' decision‐making during the pandemic.
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Affiliation(s)
- Ruth M. Farrell
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
- Center for BioethicsCleveland ClinicClevelandOhioUSA
| | - Madelyn Pierce
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | | | | | - Marissa Coleridge
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
- Genomic Medicine InstituteCleveland ClinicClevelandOhioUSA
| | - Edward K. Chien
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | - Uma Perni
- OB/GYN and Women's Health InstituteCleveland ClinicClevelandOhioUSA
| | | | - Angela Ranzini
- Department of OB/GYNMetroHealth Medical CenterClevelandOhioUSA
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The Knowledge, Attitude, Practices, and Satisfaction of Non-Invasive Prenatal Testing among Chinese Pregnant Women under Different Payment Schemes: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197187. [PMID: 33008137 PMCID: PMC7579635 DOI: 10.3390/ijerph17197187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy screening has been widely applied across China, and costs can affect Chinese pregnant women’s choices. This study aims to assess the knowledge, attitude, practices (KAP) and satisfaction regarding NIPT among pregnant women in China, and to further explore the relationship between payment schemes and women’s acceptability of and satisfaction with NIPT. A questionnaire survey was performed in Shenzhen and Zhengzhou, China, which separately applied “insurance coverage” and “out-of-pocket” payment scheme for NIPT. The major differences between the two cities were compared using chi-square test, Wilcoxon rank sum test, and propensity score matched analysis. Logistic regression models were applied to explore predictors for women’s acceptability and satisfaction. Compared with Zhengzhou participants, a higher proportion of Shenzhen women had heard of NIPT (87.30% vs. 64.03%), were willing to receive NIPT (91.80% vs. 80.43%) and had taken NIPT (83.12% vs. 54.54%), while their satisfaction level was lower. Having NIPT-related knowledge was associated with higher acceptability, and receiving genetic counseling helped to improve satisfaction. Besides, women with higher annual household incomes were more likely to take and be satisfied with NIPT. In conclusion, more attention should be paid to health education, subsidies for NIPT, and genetic counseling.
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Jansen CH, de Vries JM, Engels M, van de Kamp K, Snijders RJ, Martin L, Henneman L, Pajkrt E. Effect of education and attitude on health professionals' knowledge on prenatal screening. Eur J Midwifery 2020; 4:38. [PMID: 33537639 PMCID: PMC7839104 DOI: 10.18332/ejm/126626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/20/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Ongoing developments in prenatal anomaly screening necessitate continuous updating of counsellors’ knowledge. We explored the effect of a refresher counselling course on participants’ knowledge of prenatal screening. METHODS We investigated the association between knowledge and counsellors’ working experience. Also, the association between knowledge and counsellors’ attitude towards prenatal screening was determined. All counsellors in the North-West region of the Netherlands were invited to attend a refresher counselling course and fill in both a pre-course and a post-course questionnaire. The participants consisted of midwifes, sonographers and gynaecologists. A 55-item questionnaire assessed pre-course (T0) and post-course (T1) knowledge. At T0, counsellors’ attitude towards the prenatal screening program was assessed and its association with knowledge analysed. RESULTS Of 387 counsellors, 68 (18%) attended the course and completed both questionnaires. Knowledge increased significantly from 77.7% to 84.6% (p<0.01). Scores were lowest regarding congenital heart diseases. Participants with ultrasound experience scored higher on T0, but improvement was seen in participants with and without ultrasound experience. Participants with a positive attitude towards a free-of-charge first trimester combined test had higher knowledge scores than participants with a negative attitude (62% vs 46%; p=0.002). CONCLUSIONS A refresher course improved counsellors’ knowledge on prenatal screening. Ultrasound experience and a positive attitude towards free screening may be associated with higher knowledge levels. Participating in a mandatory refresher counselling course is useful for the continuous improvement of healthcare practitioners’ knowledge. More research on the effect of knowledge and attitude on the quality of prenatal screening is necessary.
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Affiliation(s)
- Charlotte H Jansen
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Jana M de Vries
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Melanie Engels
- EchoXpert, Prenatal Ultrasound and Training Center, Amsterdam,the Netherlands
| | - Karline van de Kamp
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Rosalinde J Snijders
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Linda Martin
- Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
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Migliorini S, Saccone G, Silvestro F, Massaro G, Arduino B, D'Alessandro P, Petti MT, Paino JAC, Guida M, Locci M, Zullo F. First-trimester screening based on cell-free DNA vs combined screening: A randomized clinical trial on women's experience. Prenat Diagn 2020; 40:1482-1488. [PMID: 32683755 DOI: 10.1002/pd.5800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare women's experience of first-trimester combined screening (FTCS), with women's experience of an approach that uses the combination of a detailed early anatomy scan and cell-free DNA (cfDNA) analysis. METHODS This was single-center, open label, parallel group, randomized clinical trial. Pregnant women were randomized at the time of their first prenatal visit to either a policy of first-trimester risk assessment based on FTCS, or to a policy of first-trimester risk assessment based on ultrasound findings and cfDNA. FTCS included ultrasound evaluation with crown-rump length, nuchal translucency (NT) measurement, and a detailed ultrasound scan, along with biochemistry (PAPP-A and free beta hCG). In this group, invasive diagnostic testing was offered to patients with risk >1 in 100, or NT >3.5 mm, or any fetal abnormalities on ultrasound. Women randomized in the intervention group received an approach of first-trimester risk assessment based on ultrasound findings and cfDNA. cfDNA analysis included a simultaneous microarray-based assay of non-polymorphic (chromosomes 13, 18, 21, X and Y) and polymorphic loci to estimate chromosome proportion and fetal fraction. In the intervention group, invasive diagnostic testing was offered to patients with abnormal cfDNA screening results, or NT >3.5 mm, or any fetal abnormalities on ultrasound. Participants received pre-test and post-test questionnaires regarding to measure reassurance, satisfaction, and anxiety. The primary outcome was the post-test reassurance, defined as mean score of reassurance post-test questionnaire. The effect of the assigned screening test on the mean of each outcome was quantified as mean difference (MD) with 95% confidence interval (CI). RESULTS Forty women with singleton gestations were enrolled in the trial. Mean score for reassurance was significantly higher in the cfDNA group compared to the FTCS group in the pre-test questionnaire (MD 0.80 points, 95% CI 0.27 to 1.33) and in the post-test questionnaire (MD 16.50 points, 95% CI 2.18 to 30.82). Women randomized to the cfDNA group had higher satisfaction and lower mean anxiety score as assessed in the STAI pre-test questionnaire. CONCLUSIONS First-trimester risk assessment for fetal aneuploidy with a combination of a detailed ultrasound examination and cfDNA is associated with better maternal reassurance and better maternal satisfaction compared to the standard first-trimester combined screening with nuchal translucency, and biochemistry. TRIAL REGISTRATION Clinicaltrials.gov NCT04077060.
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Affiliation(s)
- Sonia Migliorini
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fiora Silvestro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giulia Massaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Bruno Arduino
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pietro D'Alessandro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Petti
- Department of Molecular Medicine and Medical Biotechnologies, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Jessica Anna Cinzia Paino
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Wong LP, Hung CC, Alias H, Lee TSH. Anxiety symptoms and preventive measures during the COVID-19 outbreak in Taiwan. BMC Psychiatry 2020; 20:376. [PMID: 32677926 PMCID: PMC7364127 DOI: 10.1186/s12888-020-02786-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It is hypothesized that anxiety and behavioral responses are intense at the beginning of an epidemic. The objective of this study was to investigate anxiety symptoms and use of preventive measures against COVID-19. The study also compared the association between preventive measures and anxiety symptoms during the week immediately preceding the study and those symptoms and measures at the beginning of the outbreak. METHODS A cross-sectional population survey using an online questionnaire commenced on 14 February 2020. The study participants were residents of Taiwan ages 20 to 70 years. The 6-item state version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety symptoms. The questions about preventive measures asked participants about their personal protection, cough etiquette, contact precautions, voluntary quarantine, and prompt reporting. Multivariable logistic regression was used to determine the factors influencing an increase in the preventive measures scores. RESULTS Of a total of 3555 completed responses, a total of 52.1% (95% confidence interval [CI] 50.4-53.7) of the respondents reported moderate to severe levels of anxiety symptoms in the past week, whereas 48.8% (95%CI 47.2-50.5) reported moderate to severe anxiety symptoms at the beginning of the outbreak. With a higher score indicating greater anxiety, the median scores for anxiety symptoms in the past week and at the beginning of the outbreak were 46.7 (IQR [interquartile range] 36.7-53.3) and 43.3 (IQR 36.7-53.3), respectively. The median scores for the preventive measures taken in the past week and at the beginning of the outbreak were 26.0 (IQR 21.0-30.0) and 24.0 (IQR 19.0-28.0), respectively, out of a maximum score of 36. In the multivariable analysis, an increased anxiety symptom score from the beginning of the outbreak to the past week (adjusted OR = 7.38, 95%CI 6.28-8.66) was a strongly significant determinant of an increased preventive measures score in the past week compared with the score at the beginning of the outbreak. CONCLUSIONS Anxiety and preventive measures scores were high and increased with the epidemic rate. Higher anxiety was associated with an increased use of preventive measures against COVID-19.
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Affiliation(s)
- Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia.
| | - Chia-Chun Hung
- grid.260770.40000 0001 0425 5914Institute of Brain Science, National Yang Ming University, Taipei, Taiwan ,grid.454740.6Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Haridah Alias
- grid.10347.310000 0001 2308 5949Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya 50603, Kuala Lumpur, Malaysia
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
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Yotsumoto J, Sekizawa A, Inoue S, Suzumori N, Samura O, Yamada T, Miura K, Masuzaki H, Sawai H, Murotsuki J, Hamanoue H, Kamei Y, Endo T, Fukushima A, Katagiri Y, Takeshita N, Ogawa M, Nishizawa H, Okamoto Y, Tairaku S, Kaji T, Maeda K, Matsubara K, Ogawa M, Osada H, Ohba T, Kawano Y, Sasaki A, Sago H. Qualitative investigation of the factors that generate ambivalent feelings in women who give birth after receiving negative results from non-invasive prenatal testing. BMC Pregnancy Childbirth 2020; 20:112. [PMID: 32066398 PMCID: PMC7027219 DOI: 10.1186/s12884-020-2763-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background Women who receive negative results from non-invasive prenatal genetic testing (NIPT) may find that they later have mixed or ambivalent feelings, for example, feelings of accepting NIPT and regretting undergoing the test. This study aimed to investigate the factors generating ambivalent feelings among women who gave birth after having received negative results from NIPT. Methods A questionnaire was sent to women who received a negative NIPT result, and a contents analysis was conducted focusing on ambivalent expressions for those 1562 women who responded the questionnaire. The qualitative data gathered from the questionnaire were analyzed using the N-Vivo software package. Results Environmental factors, genetic counseling-related factors, and increased anticipatory anxiety, affected the feeling of ambivalence among pregnant women. Furthermore, pregnant women desired more information regarding the detailed prognosis for individuals with Down syndrome and living with them and/or termination, assuming the possibility that they were positive. Conclusions Three major interrelated factors affected the feeling of ambivalence in women. Highlighting and discussing such factors during genetic counseling may resolve some of these ambivalences, thereby enhancing the quality of decisions made by pregnant women.
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Affiliation(s)
- Junko Yotsumoto
- Department of Genetic Counseling, Graduate School of Health and Welfare Sciences, International University of Health and Welfare, 4-1-26 Minato-ku, Tokyo, 107-8402, Japan.
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Satomi Inoue
- Medical Genetics Center, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nobuhiro Suzumori
- Division of Clinical and Molecular Genetics, Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Yamada
- Clinical Genetics Unit, Kyoto University Hospital, Kyoto, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Masuzaki
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideaki Sawai
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jun Murotsuki
- Department of Maternal and Fetal Medicine, Tohoku University Graduate School of Medicine, Miyagi-Children's Hospital, Sendai, Japan
| | - Haruka Hamanoue
- Department of Clinical Genetics, Yokohama City University Hospital, Yokohama, Japan
| | - Yoshimasa Kamei
- Department of Obstetrics and Gynecology, Saitama Medical University Hospital, Saitama, Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akimune Fukushima
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Yukiko Katagiri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Masaki Ogawa
- Perinatal Medical Center, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology, Fujita Health University, Aichi, Japan
| | - Yoko Okamoto
- Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Shinya Tairaku
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, The University of Tokushima Faculty of Medicine, Tokushima, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Keiichi Matsubara
- Department of Obstetrics and Gynecology, Ehime University School of Medicine, Ehime, Japan
| | - Masanobu Ogawa
- Department of Obstetrics and Gynecology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hisao Osada
- Department of Maternal-fetal Medicine, Chiba University Hospital, Chiba, Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Kumamoto University, Kumamoto, Japan
| | - Yukie Kawano
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Aiko Sasaki
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Bardi F, Bosschieter P, Verheij J, Go A, Haak M, Bekker M, Sikkel E, Coumans A, Pajkrt E, Bilardo C. Is there still a role for nuchal translucency measurement in the changing paradigm of first trimester screening? Prenat Diagn 2019; 40:197-205. [PMID: 31697852 PMCID: PMC7027496 DOI: 10.1002/pd.5590] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/05/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
Objectives To give an overview of the genetic and structural abnormalities occurring in fetuses with nuchal translucency (NT) measurement exceeding the 95th percentile at first‐trimester screening and to investigate which of these abnormalities would be missed if cell‐free fetal DNA (cfDNA) were used as a first‐tier screening test for chromosomal abnormalities. Methods This is a national study including 1901 pregnancies with NT≥95th percentile referred to seven university hospitals in the Netherlands between 1 January 2010 and 1 January 2016. All cases with unknown pregnancy outcome were excluded. Results of detailed ultrasound examinations, karyotyping, genotyping, pregnancy and neonatal outcomes, investigation by a clinical geneticist and post‐mortem investigations were collected. Results In total, 821 (43%) pregnancies had at least one abnormality. The rate of abnormalities was 21% for fetuses with NT between 95th and 99th percentile and 62% for fetuses with NT≥99th percentile. Prevalence of single‐gene disorders, submicroscopic, chromosomal and structural abnormalities was 2%, 2%, 30% and 9%, respectively. Conclusion Although cfDNA is superior to the combined test, especially for the detection of trisomy 21, 34% of the congenital abnormalities occurring in fetuses with increased NT may remain undetected in the first trimester of pregnancy, unless cfDNA is used in combination with fetal sonographic assessment, including NT measurement. What's already known about this topic?
Nuchal translucency is associated with a wide range of chromosomal and structural abnormalities.
What does this study add?
If cell‐free DNA were used as the only first trimester screening test, 34% of fetal congenital abnormalities would be missed in the first trimester of pregnancy. In high‐risk pregnancies with increased nuchal translucency (NT≥95th percentile), 23% of abnormalities are found in fetuses with NT between 95th and 99th percentile.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pien Bosschieter
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joke Verheij
- Department of Clinical Genetics. University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Attie Go
- Department of Obstetrics and Gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique Haak
- Department of Obstetrics and Gynaecology, University Medical Center Leiden, Leiden, the Netherlands
| | - Mireille Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Audrey Coumans
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Caterina Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
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30
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Labonté V, Alsaid D, Lang B, Meerpohl JJ. Psychological and social consequences of non-invasive prenatal testing (NIPT): a scoping review. BMC Pregnancy Childbirth 2019; 19:385. [PMID: 31660889 PMCID: PMC6819451 DOI: 10.1186/s12884-019-2518-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
Background Genomics-based noninvasive prenatal tests (NIPT) allow screening for chromosomal anomalies such as Down syndrome (trisomy 21). The technique uses cell-free fetal DNA (cffDNA) that circulates in the maternal blood and is detectable from 5 weeks of gestation onwards. Parents who choose to undergo this relatively new test (introduced in 2011) might be aware of its positive features (i.e. clinical safety and ease of use); however, they might be less aware of the required decisions and accompanying internal conflicts following a potential positive test result. To show the evidence on psychological and social consequences of the use of NIPT, we conducted a scoping review. Methods We systematically searched four electronic databases (MEDLINE (Ovid), Cochrane Library (Wiley), CINAHL (EBSCO) and PsychINFO (EBSCO)) for studies that investigated the psychological or social consequences of the use of NIPT by pregnant women or expecting parents. The search was limited to studies published between 2011 and August 8, 2018. We identified 2488 studies and, after removal of duplicates, screened 2007 titles and abstracts, and then assessed 99 articles in full text (both screenings were done independently in duplicate). We included 7 studies in our analysis. Results Five studies assessed anxiety, psychological distress and/or decisional regret among women with validated psychological tests like the Spielberger State Trait-Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R), the Kessler Psychological Distress Scale (K6) or the Decisional Regret Scale (DRS). Two studies assessed women’s experiences with and feelings after NIPT in interviews or focus groups. The included studies were heterogeneous in location, study setting, inclusion criteria, outcome assessment, and other characteristics. Conclusions Only few studies on psychological consequences of NIPT have been identified. The studies assessed only short-term psychological consequences of NIPT at baseline and/or after receiving the results or after giving birth. Studies show that short term anxiety decreased when women received negative NIPT results and that decisional regret was generally low. We could not identify studies on long term consequences of NIPT, as well as studies on women’s partners’ short and long term outcomes, nor on social consequences of NIPT.
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Affiliation(s)
- Valérie Labonté
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110, Freiburg, Germany.
| | - Dima Alsaid
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110, Freiburg, Germany
| | - Britta Lang
- Clinical Trial Unit, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Elsässer Str. 2, 79110, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 153, 79110, Freiburg, Germany
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Vanstone M, Cernat A, Majid U, Trivedi F, De Freitas C. Perspectives of Pregnant People and Clinicians on Noninvasive Prenatal Testing: A Systematic Review and Qualitative Meta-synthesis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2019; 19:1-38. [PMID: 30838086 PMCID: PMC6398533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background Pregnant people have a risk of carrying a fetus affected by a chromosomal anomaly. Prenatal screening is offered to pregnant people to assess their risk. In recent years, noninvasive prenatal testing (NIPT) has been introduced clinically, which uses the presence of circulating cell-free fetal DNA in the maternal blood to quantify the risk of a chromosomal anomaly. At present, NIPT is publicly funded for pregnancies at high risk of a chromosomal anomaly, and available to pregnant people at average risk if they choose to pay out of pocket. Methods We performed a systematic review of primary, empirical qualitative research that describes the experiences and perspectives of pregnant people, their families, clinicians, and others with lived experience relevant to NIPT. We were interested in the beliefs, experiences, preferences, and perspectives of these groups. We analyzed the evidence available in 36 qualitative and mixed-methods studies using the integrative technique of qualitative meta-synthesis. Results Most people (pregnant people, clinicians, and others with relevant lived experience) said that NIPT offered important information to pregnant people and their partners. Most people were very enthusiastic about widening access to NIPT because it can provide information about chromosomal anomalies quite early in pregnancy, with relatively high accuracy, and without risk of procedure-related pregnancy loss. However, many groups cautioned that widening access to NIPT may result in routinization of this test, causing potential harm to pregnant people, their families, the health care system, people living with disabilities, and society as a whole. Widened logistical, financial, emotional, and informational access may be perceived as a benefit, but it can also confer harm on various groups. Many of these challenges echo historical critiques of other forms of prenatal testing, with some issues mitigated or exacerbated by the particular features of NIPT. Conclusions Noninvasive prenatal testing offers significant benefit for pregnant people but may also be associated with potential harms related to informed decision-making, inequitable use, social pressure to test, and reduced support for people with disabilities.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- Centre for Health Economic and Policy Analysis, McMaster University, Hamilton, Ontario
| | - Alexandra Cernat
- Honours Life Science BSc Program, McMaster University, Hamilton, Ontario
| | - Umair Majid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario
| | - Forum Trivedi
- Honours Life Science BSc Program, McMaster University, Hamilton, Ontario
| | - Chanté De Freitas
- Health Science Education Program, McMaster University, Hamilton, Ontario
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Noninvasive Prenatal Testing for Trisomies 21, 18, and 13, Sex Chromosome Aneuploidies, and Microdeletions: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2019; 19:1-166. [PMID: 30847010 PMCID: PMC6395059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pregnant people have a risk of carrying a fetus affected by a chromosomal anomaly. Prenatal screening is offered to pregnant people to assess their risk. Noninvasive prenatal testing (NIPT) has been introduced clinically, which uses the presence of circulating cell-free fetal DNA in the maternal blood to quantify the risk of a chromosomal anomaly. At the time of writing, NIPT is publicly funded in Ontario for pregnancies at high risk of a chromosomal anomaly. METHODS We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, budget impact, and patient preferences related to NIPT. We performed a systematic literature search for studies on NIPT for trisomies 21, 18, and 13, sex chromosome aneuploidies, and microdeletions in the average-risk or general population. We evaluated the cost-effectiveness of traditional prenatal screening, NIPT as a second-tier test (performed after traditional prenatal screening), and NIPT as a first-tier test (performed instead of traditional prenatal screening). We also conducted a budget impact analysis to estimate the additional costs of funding first-tier NIPT. We interviewed people who had lived experience with NIPT and people living with the conditions NIPT screens for, or their families. RESULTS The pooled clinical sensitivity of NIPT in the average-risk or general population was 99.5% (95% confidence interval [CI] 81.8%-99.9%) for trisomy 21, 93.1% (95% CI 75.9%-98.3%) for trisomy 18, and 92.7% (95% CI 81.6%-99.9%) for trisomy 13. The clinical specificity for any trisomy was 99.9% (95% CI 99.8%-99.9%). Compared with traditional prenatal screening, NIPT was more accurate in detecting trisomies 21, 18, and 13, and decreased the need for diagnostic testing. We found limited evidence on NIPT for sex chromosome aneuploidies or microdeletions in the average-risk or general population. Positive NIPT results should be confirmed by diagnostic testing.Compared with traditional prenatal screening, second-tier NIPT detected more affected fetuses, substantially reduced the number of diagnostic tests performed, and slightly reduced the total cost of prenatal screening. Compared with second-tier NIPT, first-tier NIPT detected more affected cases, but also led to more diagnostic tests and additional budget of $35 million per year for average-risk pregnant people in Ontario.People who had undergone NIPT were largely supportive of the test and the benefits of earlier, more accurate results. However, many discussed the need for improved pre- and post-test counselling and raised concerns about the quality of the information they received from health care providers about the conditions NIPT can screen for. CONCLUSIONS NIPT is an effective and safe prenatal screening method for trisomies 21, 18, and 13 in the average-risk or general population. Compared with traditional prenatal screening, second-tier NIPT improved the overall performance of prenatal screening and slightly decreased costs. Compared with second-tier NIPT, first-tier NIPT detected more chromosomal anomalies, but resulted in a considerable increase in the total budget. Interviewees were generally positive about NIPT, but they raised concerns about the lack of good informed-choice conversations with primary care providers and the quality of the information they received from health care providers about chromosomal anomalies.
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Bowman-Smart H, Savulescu J, Mand C, Gyngell C, Pertile MD, Lewis S, Delatycki MB. 'Small cost to pay for peace of mind': Women's experiences with non-invasive prenatal testing. Aust N Z J Obstet Gynaecol 2019; 59:649-655. [PMID: 30724335 PMCID: PMC6850570 DOI: 10.1111/ajo.12945] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/09/2018] [Indexed: 01/17/2023]
Abstract
Background Non‐invasive prenatal testing (NIPT) has been available in Australia on a user‐pays basis since 2012. Since its introduction, it has grown in popularity as a screening method for fetal aneuploidy and may become publicly funded. Aims To assess the motivations and experiences of women who have undergone NIPT in a user‐pays system in Australia. Materials and methods One thousand women who had undergone NIPT through the Victorian Clinical Genetics Services in Melbourne, Australia were contacted and asked to complete a mixed‐methods survey. The number of eligible responses received was 235. Quantitative data analysis was performed in STATA IC 15.1, and qualitative data were examined using content analysis. Results Women reported generally positive experiences with NIPT and 95% of respondents indicated they would undergo NIPT in a future pregnancy. Most respondents received a low‐risk result, with 2.2% receiving a high‐risk result. Respondents viewed NIPT favourably compared to invasive testing and cited reassurance as a key reason they sought it. However, a small minority of women reported negative experiences with the testing process. Women were also supportive of NIPT becoming publicly funded, with 93% of respondents indicating support. Pre‐ and post‐test counselling were identified as possible areas for improvement to ensure informed consent. Conclusion In support of the existing literature, these results indicate that Australian women generally report positive experiences with NIPT. As NIPT becomes more common, with possible integration into public healthcare, further qualitative research would be valuable to examine the motivations and experiences of women undergoing NIPT.
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Affiliation(s)
- Hilary Bowman-Smart
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Cara Mand
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark D Pertile
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
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Birko S, Ravitsky V, Dupras C, Le Clerc-Blain J, Lemoine ME, Affdal AO, Haidar H, Laberge AM. The value of non-invasive prenatal testing: preferences of Canadian pregnant women, their partners, and health professionals regarding NIPT use and access. BMC Pregnancy Childbirth 2019; 19:22. [PMID: 30630440 PMCID: PMC6327577 DOI: 10.1186/s12884-018-2153-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
Background Canadian policies regarding the implementation and public coverage of non-invasive prenatal testing (NIPT) are heterogeneous and shifting, with NIPT being publicly covered for high-risk pregnancies in some provinces, but not others. Such a diverse and evolving policy landscape provides fertile ground for examining the preferences of pregnant women, their partners, and health professionals regarding the implementation and coverage of NIPT by the public healthcare system, as well as the factors influencing their preferences, which is what the present study does. Methods In this paper, we report the results of three-large scale Canadian surveys, in which 882 pregnant women, 395 partners of pregnant women, and 184 healthcare professionals participated. Results The paper focuses on preferences regarding how and when NIPT should be used, as well as the factors influencing these preferences, and how coverage for NIPT should be provided. These are correlated with respondents’ levels of knowledge about Down syndrome and testing technologies and with their stated intended use of NIPT results. Conclusion Salient is the marked difference between the preferences of prospective parents and those of healthcare professionals, which has potential implications for Canadian policy regarding NIPT implementation and insurance coverage. Electronic supplementary material The online version of this article (10.1186/s12884-018-2153-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stanislav Birko
- University of Montreal School of Public Health, Montreal, Canada.
| | - Vardit Ravitsky
- University of Montreal School of Public Health, Montreal, Canada
| | - Charles Dupras
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | | | | | - Aliya O Affdal
- University of Montreal School of Public Health, Montreal, Canada
| | - Hazar Haidar
- University of Montreal Ethics Research Centre, Montreal, Canada
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Beyond the Brochure: Innovations in Clinical Counseling Practices for Prenatal Genetic Testing Options. J Perinat Neonatal Nurs 2019; 33:12-25. [PMID: 30676459 DOI: 10.1097/jpn.0000000000000374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Remarkable advancements related to preconception and prenatal genetic screening have emerged in recent years. While technology and testing options are more numerous and complex; fundamental genetic counseling issues remain the same. It is essential that with any prenatal genetic testing, women have an opportunity to make informed and autonomous decisions that are consistent with their personal needs and values. Opportunities to discuss testing options, including potential benefits and limitations, are often limited in obstetric visits due to time constraints or lack of sufficient provider education. As genetic testing is not considered a routine component of antepartum care, review of information regarding testing options is imperative so women can decide which, if any, testing to pursue. Developing new strategies to address the growing complexity of prenatal testing while ensuring provider education is accurate is crucial in imparting evidence-based care. This article will arm providers with the knowledge needed to educate women about currently available prenatal genetic screening and diagnostic tests along with guidance on the essential elements and importance of genetic counseling.
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Miltoft CB, Rode L, Tabor A. Positive view and increased likely uptake of follow-up testing with analysis of cell-free fetal DNA as alternative to invasive testing among Danish pregnant women. Acta Obstet Gynecol Scand 2018; 97:577-586. [DOI: 10.1111/aogs.13297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Caroline B. Miltoft
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Line Rode
- Department of Clinical Biochemistry; Copenhagen University Hospital, Herlev and Gentofte Hospital; Copenhagen Denmark
| | - Ann Tabor
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
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