Innovations in prenatal genetic testing beyond the fetal karyotype

Relationship-Based Care for Newborns With Down Syndrome and Endocardial Cushion Defect

Down syndrome with endocardial cushion defect is a challenging diagnosis for parents as well as members of the health care team. Utilizing a framework of relationship-based care, nurses are in a position to positively affect parents' experience by providing education, advocacy, and support from initial diagnosis through discharge. The plan of care is multidisciplinary and focuses on critical developmental needs, such as bonding and feeding. Because Down syndrome is associated with multiple anomalies, anticipatory guidance is needed to assist parents with establishing a health maintenance plan for their child after discharge.

The Fascinating and Complex Role of the Placenta in Pregnancy and Fetal Well-being

Existing evidence implicates the placenta as the origin of some common pregnancy complications. Moreover, some maternal conditions, such as inadequate nutrition, diabetes, and obesity, are known to adversely affect placental function, with subsequent negative impact on the fetus and newborn. The placenta may also contribute to fetal programming with health consequences into adulthood, such as cardiovascular, metabolic, and mental health disorders. There is evidence that altered placental development, specifically impaired trophoblast invasion and spiral artery remodeling in the first trimester, is the origin of preeclampsia. Prenatal care providers who understand the relationships between placental health and maternal-newborn health can better inform and guide women to optimize health early in pregnancy and prior to conception. This article reviews the current understanding of placental function; placental contributions to normal fetal brain development and timing of birth; and impact of maternal nutrition, obesity, and diabetes on the placenta.

Pre- and post-test genetic counseling for chromosomal and Mendelian disorders

Genetic carrier screening, prenatal screening for aneuploidy, and prenatal diagnostic testing have expanded dramatically over the past 2 decades. Driven in part by powerful market forces, new complex testing modalities have become available after limited clinical research. The responsibility for offering these tests lies primarily on the obstetrical care provider and has become more burdensome as the number of testing options expands. Genetic testing in pregnancy is optional, and decisions about undergoing tests, as well as follow-up testing, should be informed and based on individual patients' values and needs. Careful pre- and post-test counseling is central to supporting informed decision-making. This article explores three areas of technical expansion in genetic testing: expanded carrier screening, non-invasive prenatal screening for fetal aneuploidies using cell-free DNA, and diagnostic testing using fetal chromosomal microarray testing, and provides insights aimed at enabling the obstetrical practitioner to better support patients considering these tests.

Public Perceptions of Recessive Carrier Testing in the Preconception and Prenatal Periods

OBJECTIVE

To explore public perceptions of preconception and prenatal recessive carrier testing.

DESIGN

Qualitative, descriptive.

SETTING

Chat rooms located in four websites targeted to those who are pregnant or planning a pregnancy.

PARTICIPANTS

Anonymous comments (N = 1925) in online chat rooms.

METHODS

The Centers for Disease Control and Prevention's (CDC) Analytic validity, Clinical validity, Clinical utility, Ethical, legal, social implications Model Process (ACCE) for evaluating a genetic test guided this deductive-inductive content analysis.

RESULTS

Participant perceptions of the clinical utility of recessive carrier screening with universal carrier panels are multidimensional. Data analysis revealed four a priori deductive themes present in the data. Secondary inductive analysis produced 20 themes, which exceeded the scope of the CDC's ACCE Model Process for assessing the clinical utility of a genetic test.

CONCLUSION

Participant perceptions of carrier testing are important to consider in the clinical utility of carrier testing. Participant perceptions of clinical utility vary from those of the CDC's ACCE Model Process and should be considered in evaluation of the clinical utility of recessive carrier testing in the preconception and prenatal populations.