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Collart C, Craighead C, Yao M, Rose S, Chien EK, Frankel RM, Coleridge M, Hu B, Edmonds BT, Ranzini AC, Farrell RM. Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care. J Perinat Med 2024; 52:467-477. [PMID: 38669584 PMCID: PMC11143442 DOI: 10.1515/jpm-2023-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Decisional conflict and regret about prenatal genetic screening and diagnostic tests may have important consequences in the current pregnancy and for future reproductive decisions. Identifying mechanisms that reduce conflict associated with the decision to use or decline these options is necessary for optimal patient counseling. METHODS We conducted a cluster-randomized controlled trial of a shared decision-making tool (NEST) at the beginning of prenatal care. Enrolled patients completed follow-up surveys at the time of testing (QTT) and in the second-third trimester (QFF), including the Decision Conflict Scale (DCS). Total DCS scores were analyzed using a multivariate linear mixed-effect model. RESULTS Of the total number of participants (n=502) enrolled, 449 completed the QTT and QFF surveys. The mean age of participants was 31.6±3.8, with most parous at the time of study participation (n=321; 71.7 %). Both the NEST (the intervention) and control groups had lower median total DCS scores at QFF (NEST 13.3 [1.7, 25.0] vs. control 16.7 [1.7, 25.0]; p=0.24) compared to QTT (NEST 20.8 [5.0, 25.0] vs. control 18.3 [3.3, 26.7]; p=0.89). Participants exposed to NEST had lower decisional conflict at QFF compared to control (β -3.889; [CI -7.341, -0.437]; p=0.027). CONCLUSIONS Using a shared decision-making tool at the start of prenatal care decreased decisional conflict regarding prenatal genetic testing. Such interventions have the potential to provide an important form of decision-making support for patients facing the unique type of complex and preference-based choices about the use of prenatal genetic tests.
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Affiliation(s)
- Christina Collart
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Caitlin Craighead
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah Rose
- Department of Biomedical Informatics and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward K. Chien
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Marissa Coleridge
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - Angela C. Ranzini
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH, USA
| | - Ruth M. Farrell
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Bioethics, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
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2
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Bakkeren IM, Henneman L, van Vliet-Lachotzki EH, Martin L, Gitsels-van der Wal JT, Polak MG, Bekker MN, Galjaard RJH. Psychological impact of additional findings detected by genome-wide Non-Invasive Prenatal Testing (NIPT): TRIDENT-2 study. Eur J Hum Genet 2024; 32:302-308. [PMID: 38057584 PMCID: PMC10923886 DOI: 10.1038/s41431-023-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/01/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
In the Netherlands, genome-wide non-invasive prenatal testing (NIPT) is offered to all pregnant women as part of the nationwide TRIDENT-2 study. Findings other than trisomy 21, 18, or 13, which are called "additional findings", are reported only on request of the pregnant woman. This study examined: (1) women's pre-test perceptions and reasons to opt for additional findings and (2) women's experiences with- and the psychological impact of being informed about an additional finding. A questionnaire, consisting of the anxiety measure State-Trait Anxiety Inventory (STAI), distress measure Impact of Event Scale (IES) and questions developed specifically for this study, was retrospectively administered to 402 women who received an additional finding. A total of 227 (56.5%) women completed the questionnaire. Most (60.2%) chose to know additional findings because they wanted as much information as possible about the health of their fetus. Almost all (92%) stated that receiving the additional finding was unexpected, a shock, and/or they were in disbelief, for 85% it caused a lot of worry. Post-test, high anxiety (STAI) levels were reported in 15.5% of women, and 7.5% reported severe distress (IES). Women who gave birth to an affected child (n = 10) experienced most psychological impact (STAI and IES). Eighty-six percent of women with a fetal aberration would opt for additional findings again, compared to 49.2% of women whose result was confined to the placenta. Pre-test counseling should focus on explaining the different results NIPT can generate. Post-test counseling should focus on guiding pregnant women through this uncertain and anxious time.
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Affiliation(s)
- Iris M Bakkeren
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Linda Martin
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marike G Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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3
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Baldus M. "Overestimated technology - underestimated consequences" - reflections on risks, ethical conflicts, and social disparities in the handling of non-invasive prenatal tests (NIPTs). MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:271-282. [PMID: 36932273 PMCID: PMC10023216 DOI: 10.1007/s11019-023-10143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 05/13/2023]
Abstract
New technologies create new complexities. Since non-invasive prenatal tests (NIPTs) were first introduced, keeping pace with complexity constitutes an ongoing task for medical societies, politics, and practice. NIPTs analyse the chromosomes of the fetus from a small blood sample. Initially, NIPTs were targeted at detecting trisomy 21 (Down syndrome): meanwhile there are sequencing techniques capable of analysing the entire genome of the unborn child. These yield findings of unclear relevance for the child's future life, resulting in new responsibility structures and dilemmas for the parents-to-be.The industry's marketing strategies overemphasize the benefits of the tests while disregarding their consequences. This paper chooses the opposite path: starting with the underestimated consequences, it focuses on adverse developments and downsides. Disparities, paradoxes, and risks associated with NIPTs are illustrated, ethical conflicts described. Indications that new technologies developed to solve problems create new ones are examined. In the sense of critical thinking, seemingly robust knowledge is scrutinized for uncertainties and ambiguities. It analyses how the interplay between genetic knowledge and social discourse results in new dimensions of responsibility not only for parents-to-be, but also for decision-makers, authorities, and professional societies, illustrated by a review of different national policies and implementation programmes. As shown by the new NIPT policy in Norway, the consequences can be startling. Finally, a lawsuit in the United States illustrates how an agency can risk forfeiting its legitimation in connection with the inaccuracy of NIPTs.
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Affiliation(s)
- Marion Baldus
- Faculty of Social Work, Hochschule Mannheim / Mannheim University of Applied Sciences, Paul-Wittsack-Str. 10, Mannheim, Germany.
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4
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Johnston M, Warton C, Pertile MD, Taylor-Sands M, Delatycki MB, Hui L, Savulescu J, Mills C. Ethical issues associated with prenatal screening using non-invasive prenatal testing for sex chromosome aneuploidy. Prenat Diagn 2023; 43:226-234. [PMID: 35929376 DOI: 10.1002/pd.6217] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
Prenatal screening for sex chromosome aneuploidies (SCAs) is increasingly available through expanded non-invasive prenatal testing (NIPT). NIPT for SCAs raises complex ethical issues for clinical providers, prospective parents and future children. This paper discusses the ethical issues that arise around NIPT for SCAs and current guidelines and protocols for management. The first section outlines current practice and the limitations of NIPT for SCAs. It then outlines key guidelines before discussing the ethical issues raised by this use of NIPT. We conclude that while screening for SCAs should be made available for people seeking to use NIPT, its implementation requires careful consideration of what, when and how information is provided to users.
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Affiliation(s)
| | | | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lisa Hui
- University of Melbourne, Melbourne, Victoria, Australia
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5
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Lewit-Mendes MF, Robson H, Kelley J, Elliott J, Brown E, Menezes M, Archibald AD. Experiences of receiving an increased chance of sex chromosome aneuploidy result from non-invasive prenatal testing in Australia: "A more complicated scenario than what I had ever realized". J Genet Couns 2023; 32:213-223. [PMID: 36114608 DOI: 10.1002/jgc4.1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
Many non-invasive prenatal testing (NIPT) platforms screen for sex chromosome aneuploidy (SCA) and SCA analysis is generally included in Australia where NIPT is available as a self-funded test. Little is known about the experience of receiving an NIPT result indicating an increased chance of SCA. This study aimed to explore the experiences of people who received this result and their perspectives on the information, care, and support they received from healthcare practitioners (HCPs). Semi-structured interviews were conducted with people who received an NIPT result indicating an increased chance of SCA and continued their pregnancy. Most participants only had contact with a genetic counselor after receiving their result. Transcribed data were analyzed using rigorous thematic analysis to identify important patterns and themes. Participants (18 women, 2 male partners) described embarking on NIPT, primarily based on advice from their HCP and without much consideration. Consequently, participants expressed feeling unprepared for the unanticipated complexity of their NIPT result and were faced with making a time-sensitive decision about a condition they had not previously considered. While more pre-test information was desired, timely access to genetic counseling post-test assisted with adjustment to the result. These findings suggest that routinization of NIPT may be compromising informed decision-making, resulting in unpreparedness for an increased chance result. Given the increasing uptake and expanding scope of NIPT, resources should be dedicated to educating HCPs offering NIPT and ensuring timely access to genetic counseling post-result. With appropriate funding, genetics services may be able to play a central role in offering information and support to both people who undertake NIPT and their HCPs ordering the testing. Implementing a publicly funded screening program in Australia could assist with standardizing prenatal screening care pathways and consequently better access to appropriate resources.
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Affiliation(s)
- Miranda F Lewit-Mendes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Genetics, Monash Health, Melbourne, Victoria, Australia
| | - Hazel Robson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Genetics Department, Number 1 Fertility, Melbourne, Victoria, Australia
| | - Joanne Kelley
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Erica Brown
- Genetics Clinic, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Melody Menezes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Ultrasound for Women, Monash IVF, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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6
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Whitehead J, Hirsch J, Rosoklija I, Weisman AG, Dungan J, Finlayson C, Chen D, Johnson EK. Prenatal Detection and Evaluation of Differences of Sex Development: A Qualitative Interview Study of Parental Perspectives and Unmet Needs. Prenat Diagn 2022; 42:1332-1342. [PMID: 35670269 PMCID: PMC9545652 DOI: 10.1002/pd.6191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022]
Abstract
Objectives Prenatal diagnoses of differences of sex development (DSD) are increasing due to availability of cell‐free DNA screening (cell‐free DNA screening (cfDNA)). This study explores first‐hand experiences of parents whose children had prenatal findings of DSD. Methods Eligible parents were identified through chart review at a pediatric center and interviewed about their prenatal evaluation, decision making, informational sources, and support systems. Interviews were coded using a combined inductive and deductive thematic analysis. Parents also completed quantitative measures of decisional regret. Results Seventeen parents (13 mothers; 4 fathers) of 13 children (with 7 DSD diagnoses) were recruited. Four children had discordance between sex predicted by cfDNA versus prenatal ultrasound, and 2 had non‐binary appearing (atypical) genitalia on prenatal ultrasound. Of these 6, 3 were not offered additional prenatal testing or counseling. Most parents described tension between obtaining support through disclosure of their child's diagnosis and preserving their child's autonomy/privacy, highlighting the need for mental health support. Conclusion This is the first study to gather qualitative data from parents whose children had prenatal findings of DSD. We identified multiple targets for intervention to improve care for patients with DSD across the lifespan, including improvements in clinician education, pre‐ and post‐test counseling, and patient education materials.
What's already known about this topic? What does this study add?
Prenatal detection of potential differences of sex development (DSD) is increasing as the availability of non‐invasive prenatal screening increases. Algorithms have been developed for the diagnostic evaluation, but little is known about the psychosocial implications of that process. This study focuses on the first‐hand experiences of families whose children had prenatal findings of a potential DSD, to identify existing sources of support and information, and areas for future improvement.
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Affiliation(s)
- J Whitehead
- Division of Endocrinology, Chicago, United States.,Department of Pediatrics, Chicago, United States
| | | | | | | | | | - Courtney Finlayson
- Division of Endocrinology, Chicago, United States.,Department of Pediatrics, Chicago, United States
| | - Diane Chen
- Adolescent & Young Adult Medicine, Chicago, United States.,Department of Psychiatry & Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Chicago, United States.,Psychiatry & Behavioral Sciences, Chicago, United States
| | - Emilie K Johnson
- Urology, Chicago, United States.,Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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7
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van der Meij KR, Sistermans EA, Macville MV, Stevens SJ, Bax CJ, Bekker MN, Bilardo CM, Boon EM, Boter M, Diderich KE, de Die-Smulders CE, Duin LK, Faas BH, Feenstra I, Haak MC, Hoffer MJ, den Hollander NS, Hollink IH, Jehee FS, Knapen MF, Kooper AJ, van Langen IM, Lichtenbelt KD, Linskens IH, van Maarle MC, Oepkes D, Pieters MJ, Schuring-Blom GH, Sikkel E, Sikkema-Raddatz B, Smeets DF, Srebniak MI, Suijkerbuijk RF, Tan-Sindhunata GM, van der Ven AJE, van Zelderen-Bhola SL, Henneman L, Galjaard RJH, Van Opstal D, Weiss MM. TRIDENT-2: National Implementation of Genome-wide Non-invasive Prenatal Testing as a First-Tier Screening Test in the Netherlands. Am J Hum Genet 2019; 105:1091-1101. [PMID: 31708118 DOI: 10.1016/j.ajhg.2019.10.005] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)-96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13-were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.
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Shea TL. Informed Decision Making Regarding Prenatal Aneuploidy Screening. J Obstet Gynecol Neonatal Nurs 2019; 49:41-54. [PMID: 31809696 DOI: 10.1016/j.jogn.2019.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore informed decision making for prenatal aneuploidy screening (PAS) by investigating the relationships among women's understanding of PAS, their health literacy, and their satisfaction with their decisions regarding PAS. DESIGN A descriptive, cross-sectional, correlational study. SETTING Southeastern United States. PARTICIPANTS Ninety-five adult women who were at least 18 weeks pregnant; most were White non-Hispanic (n = 75, 78.9%) and college educated (n = 56, 59.0%). METHODS Potential participants were invited to complete an online survey that was distributed via e-mail to recipients of an electronic pregnancy and parenting newsletter. The survey included questions about women's understanding of PAS, their health literacy, and their satisfaction with their decisions regarding PAS based on three validated instruments. I used descriptive statistics, bivariate correlational analysis, and multiple linear regression to analyze the data. RESULTS Higher level of education (β =.225, p = .038) and higher scores from the Health Literacy Questionnaire's scale Ability to Actively Engage With Health Care Providers (β =.317, p = .004) were significantly associated with increased understanding of PAS. Higher scores on two scales from the Health Literacy Questionnaire, Feeling Understood andSupportedby Health Care Providers (β =.329 , p = .004) and Ability to Find Good Health Information (β = .402, p = .013), were significantly associated with greater satisfaction with decisions regarding prenatal aneuploidy screening. Forty-two percent (n = 40) of participants did not report satisfaction with PAS. CONCLUSION A woman's health literacy and her ability to actively engage with health care providers are critical for informed decision making about PAS. Findings highlight the need for woman-centered strategies to promote open and intentional communication about PAS.
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9
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de Wergifosse S, Bevilacqua E, Mezela I, El Haddad S, Gounongbe C, de Marchin J, Maggi V, Conotte S, Badr DA, Fils JF, Guizani M, Jani JC. Cell-free DNA analysis in maternal blood: comparing genome-wide versus targeted approach as a first-line screening test. J Matern Fetal Neonatal Med 2019; 34:3552-3561. [PMID: 31722585 DOI: 10.1080/14767058.2019.1686478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the failure rate and performance of cell-free DNA (cfDNA) testing as a first-line screening method for major trisomies, performed by two laboratories using different analytical methods: a targeted chromosome-selective method (Harmony® prenatal Test) versus a home-brew genome-wide (GW) massively parallel sequencing method (HB-cfDNA test), and to evaluate the clinical value of incidental findings for the latter method.Methods: CfDNA testing was performed in 3137 pregnancies with the Harmony® prenatal Test and in 3373 pregnancies with the HB-cfDNA test. Propensity score analysis was used to match women between both groups for maternal age, weight, gestational age at testing, in vitro fertilization, rate of twin pregnancies and that of aneuploidies. Detection rates for trisomy 21 were compared between the 2 laboratories. For the HB-cfDNA test, cases with rare incidental findings were reported, including their clinical follow-up.Results: The Harmony® prenatal Test failed at the first attempt in 90 (2.9%) of 3114 women and the HB-cfDNA test in 413 (12.2%) of 3373 women. Postmatched comparisons of the women's characteristics indicate a significantly lower failure rate in the Harmony® group (2.8%) than in the HB cfDNA group (12.4%; p < .001). Of the 90 women in whom the Harmony® prenatal Test failed, 61 had a repeat test, which still failed in 10, and of the 413 women in whom the HB-cfDNA test failed, 379 had a repeat test, which still failed in 110. The total failure rate after one or two attempts was therefore 1.3% (39/3114) for Harmony® and 4.3% (144/3373) for the HB cfDNA test. After the first or second Harmony® prenatal Test, a high-risk result was noted in 17 of the 17 cases with trisomy 21, in 5 of the seven cases with trisomy 18, and a no-call in two cases, and in the one case with trisomy 13. The respective numbers for the HB-cfDNA test are 17 of the 18 cases with trisomy 21, and a no-call in one case, 2 of the two cases with trisomy 18, and in 2 of the three cases with trisomy 13, and a no-call in one. Of the 3373 women with the HB-cfDNA test, a rare incidental finding was noted in 28 (0.8%) of the cases, of which only 2 were confirmed on amniocytes (one with microduplication 1q21.1q21.2 and one with a deletion Xp21.1), and in another case a deletion rather than a duplication of the long arm of chromosome 8 was found. In all 28 cases, there was normal clinical follow-up.Conclusions: Comparison of cfDNA testing between these two laboratories showed a four-fold lower failure rate with the Harmony® prenatal Test, with a similar detection rate for trisomy 21. We showed no clinical relevance of disclosing additional findings beyond common trisomies with the GW HB-cfDNA test.
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Affiliation(s)
- Sidonie de Wergifosse
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Iris Mezela
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah El Haddad
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Gounongbe
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Valeria Maggi
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphanie Conotte
- Department of Blood Transfusion, University Hospital Brugmann, Brussels, Belgium
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Meriem Guizani
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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10
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Parham L, Michie M, Allyse M. Expanding Use of cfDNA Screening in Pregnancy: Current and Emerging Ethical, Legal, and Social Issues. CURRENT GENETIC MEDICINE REPORTS 2017; 5:44-53. [PMID: 38089918 PMCID: PMC10715629 DOI: 10.1007/s40142-017-0113-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose of Review In 2011, screening platforms became available in the US that detect and analyze fragments of cell-free placental DNA (cfDNA) in maternal blood serum. Marketed as noninvasive prenatal tests (NIPT), cfDNA screening is more accurate than previously available serum screening tests for certain aneuploidies. The combination of a noninvasive procedure, high specificity and sensitivity, and lower false positive rates for some aneuploidies (most notably Down's syndrome) has led to broad clinician and patient adoption. New ethical, legal, and social issues arise from the increased use and expanded implementation of cfDNA in pregnancy. Recent Findings Recently, several professional associations have amended their guidelines on cfDNA, removing language recommending its use in only "high-risk" pregnancies in favor of making cfDNA screening an available option for women with "low-risk" pregnancies as well. At the same time, commercial cfDNA screening laboratories continue to expand the range of available test panels. As a result, the future of prenatal screening will likely include a broader range of genetic tests in a wider range of patients. Summary This article addresses the ethical, legal, and social issues related to the shift in guidance and expanded use of cfDNA in pregnant women, including concerns regarding routinized testing, an unmet and increasing demand for genetic counseling services, social and economic disparities in access, impact on groups living with disabling conditions, and provider liability.
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Affiliation(s)
- Lindsay Parham
- School of Law, Department of Jurisprudence and Social Policy, University of California, Berkeley, Berkeley, CA, USA
| | - Marsha Michie
- School of Nursing, Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Megan Allyse
- Biomedical Ethics, Mayo Clinic, Rochester, MN, USA
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