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Verdonschot JAJ, Paulussen ADC, Lakdawala NK, de Die-Smulders CEM, Ware JS, Ingles J. Reproductive options and genetic testing for patients with an inherited cardiac disease. Nat Rev Cardiol 2024:10.1038/s41569-024-01073-3. [PMID: 39289540 DOI: 10.1038/s41569-024-01073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/19/2024]
Abstract
In the past decade, genetic testing for cardiac disease has become part of routine clinical care. A genetic diagnosis provides the possibility to clarify risk for relatives. For family planning, a genetic diagnosis provides reproductive options, including prenatal diagnosis and preimplantation genetic testing, that can prevent an affected parent from having a child with the genetic predisposition. Owing to the complex genetic architecture of cardiac diseases, characterized by incomplete disease penetrance and the interplay between monogenic and polygenic variants, the risk reduction that can be achieved using reproductive genetic testing varies among individuals. Globally, disparities, including regulatory and financial barriers, in access to reproductive genetic tests exist. Although reproductive options are gaining a prominent position in the management of patients with inherited cardiac diseases, specific policies and guidance are lacking. Guidelines recommend that prenatal diagnosis and preimplantation genetic testing are options that should be discussed with families. Health-care professionals should, therefore, be aware of the possibilities and feel confident to discuss the benefits and challenges. In this Review, we provide an overview of the reproductive options in the context of inherited cardiac diseases, covering the genetic, technical, psychosocial and equity considerations, to prepare health-care professionals for discussions with their patients.
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Affiliation(s)
- Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Maastricht, The Netherlands.
| | - Aimee D C Paulussen
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Neal K Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine E M de Die-Smulders
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - James S Ware
- National Heart and Lung Institute & MRC Laboratory of Medical Sciences, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Jodie Ingles
- Genomics and Inherited Disease Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- UNSW Sydney, Sydney, New South Wales, Australia
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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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Severijns Y, Heijmans MWF, de Die-Smulders CEM, Bijlsma EK, Corsten-Janssen N, Joosten SJR, van Kuijk SMJ, Lichtenbelt KD, Ottenheim CPE, Stuurman KE, Tan-Sindhunata GMB, de Vries H, van Osch LADM. The effects of an online decision aid to support the reproductive decision-making process of genetically at risk couples-A pilot study. J Genet Couns 2023; 32:153-165. [PMID: 36056622 PMCID: PMC10087273 DOI: 10.1002/jgc4.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Couples at risk of transmitting a genetic disease to their offspring may experience doubts about their reproductive options. This study examines the effects of an online decision aid (DA) on the (joint) reproductive decision-making process of couples (not pregnant at time of inclusion) at risk of transmitting a genetic disease to their offspring. The primary outcome is decisional conflict, and secondary outcomes are knowledge, realistic expectations, deliberation, joint informed decision-making, and decisional self-efficacy. These outcomes were measured with a pretest-posttest design: before use (T0), after use (T1), and 2 weeks after use (T2) of the decision aid (DA). Usability of the DA was assessed at T1. Paired sample t-tests were used to compute differences between baseline and subsequent measurements. The comparisons of T0-T1 and T0-T2 indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict scores. Furthermore, use of the DA led to increased knowledge, improved realistic expectations, and increased levels of deliberation, with higher increase in participants with low baseline scores. Decision self-efficacy only improved for participants with lower baseline scores. Participants indicated that the information in the DA was comprehensible and clearly organized. These first results indicate that this online DA is an appropriate tool to support couples at risk of transmitting a genetic disease and a desire to have (a) child(ren) in their reproductive decision-making process.
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Affiliation(s)
- Yil Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maartje W F Heijmans
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nicole Corsten-Janssen
- University of Groningen, University Medical Center Groningen Groningen, Department of Genetics, Groningen, The Netherlands
| | - Sara J R Joosten
- Department of Clinical Genetics, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Klaske D Lichtenbelt
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Kyra E Stuurman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Hein de Vries
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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van Dijke I, van El CG, Lakeman P, Goddijn M, Rigter T, Cornel MC, Henneman L. Dynamics of reproductive genetic technologies: Perspectives of professional stakeholders. PLoS One 2022; 17:e0269719. [PMID: 35727796 PMCID: PMC9212161 DOI: 10.1371/journal.pone.0269719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
Reproductive and genetic medicine are evolving rapidly, and new technologies are already impacting current practices. This includes technologies that can identify a couples' risk of having a child with a genetic disorder. Responsible implementation of new technologies requires evaluation of safety and ethics. Valuable insights for shaping governance processes are provided by various stakeholders involved, including healthcare professionals. Their willingness to adopt these technologies and guide the necessary systemic changes is required for the successful implementation of these technologies. In this study, twenty-one semi-structured interviews were conducted with professionals from different disciplines in the field of reproductive and genetic healthcare in the Netherlands. Three emerging technologies were discussed: expanded carrier screening (ECS), non-invasive prenatal diagnosis (NIPD) and germline genome editing (GGE). By probing stakeholders' views, we explored how culture, structure and practice in healthcare is being shaped by innovations and changing dynamics in genetic and reproductive medicine. The general consensus was that the implementation of reproductive genetic technologies nationwide is a slow process in Dutch healthcare. A "typical Dutch approach" emerged that is characterized by restrictive legislation, broad support for people living with disabilities, values of an egalitarian society and limited commercialisation. Different scenarios for embedding ECS in future practice were envisioned, while implementation of NIPD in clinical practice was considered obvious. Views on GGE varied among stakeholders. Previous implementation examples in the Netherlands suggest introduction of new technology involves an organized collective learning process, with pilot studies and stepwise implementation. In addition, introducing and scaling up new technologies is complex due to perceived barriers from the legislative framework and the complex relationship between the government and stakeholders in this area. This paper describes how the international trends and advances of technologies are expected to manifest itself in a national setting.
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Affiliation(s)
- Ivy van Dijke
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine and Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Carla G. van El
- Department of Human Genetics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Phillis Lakeman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariëtte Goddijn
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine and Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Tessel Rigter
- Department of Human Genetics and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martina C. Cornel
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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