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Francoeur AA, Kang SHL, Senaratne TN, Saitta S, Murali A, Peters K, Hansman E, Chen A, Parvataneni R, Patil R, Rible R, Sridhar A, Stoddard A, Zapata M, Krakow D, Pluym ID. The Role of Preprocedure Genetic Counseling in Pregnancies Interrupted for Fetal Abnormalities. Am J Perinatol 2024; 41:383-394. [PMID: 38154468 DOI: 10.1055/s-0043-1777706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Congenital birth defects affect 3 to 5% of pregnancies. Genetic counseling can help patients navigate the testing process and understand results. The study objective was to identify predictors and utility of genetic counseling at the time of pregnancy termination. Additionally, we aimed to see what proportion of patients would benefit from additional testing based on the results of the genetic testing. STUDY DESIGN This was a retrospective cohort review of all terminations performed for fetal anomalies by an academic center from July 2016 to May 2020. Indications were stratified by abnormal serum screening or types of abnormal ultrasound findings. Data were abstracted regarding uptake of genetic counseling and testing results. Abnormal results that warranted additional testing regarding recurrence risks were noted. Multivariable logistic regression was performed to identify predictors of receipt of genetic counseling and testing. RESULTS Of 387 patients, 57% (n = 220) received preprocedure genetic counseling and 43% (n = 167) did not. Among patients who received diagnostic testing, 62% (n = 194) had genetic counseling compared with 38% (n = 121) without counseling (adjusted odds ratio 2.46, 95% confidence interval [1.41-4.29], p < 0.001). Among the entire cohort, 38% (n = 148) had suspected aneuploidy based on serum screening. Of these, 89% (n = 132/148) had definitive testing, 92% (n = 122/132) confirming the aneuploidy. Among the other 68% (n = 239) with structural anomalies, 76% (n = 183) had diagnostic testing with 29% (n = 53) yielding an abnormal result. Among those fetuses with structural anomalies, 36% (n = 19/53) of genetic diagnoses warranted additional parental testing because of risk of recurrence compared with only 2% (n = 2/122) of patients with abnormal serum screening results alone. CONCLUSION Genetic counseling was associated with increased uptake of diagnostic testing, which yielded useful information and prompted additional testing. This is important for determining etiology and recurrence risk and should be offered to patients presenting for termination for fetal indications, as well as providing diagnostic closure for patients. KEY POINTS · Genetic counseling increases the uptake of diagnostic testing in patients with fetal anomalies.. · Patients with ultrasound anomalies received less diagnostic testing despite actionable results 36% of the time.. · Genetic testing is invaluable for recurrence risk counseling even if patients chose to terminate..
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Affiliation(s)
- Alex A Francoeur
- Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
| | - Sung-Hae L Kang
- Department of Pathology and Laboratory medicine, University of California, Los Angeles, California
| | - T Niroshi Senaratne
- Department of Pathology and Laboratory medicine, University of California, Los Angeles, California
| | - Sulagna Saitta
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
- Department of Human Genetics, University of California, Los Angeles, California
| | - Aparna Murali
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Katharine Peters
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Emily Hansman
- David Geffen School of Medicine, Los Angeles, California
| | - Angela Chen
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Ram Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Rajita Patil
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Radhika Rible
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Aparna Sridhar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Amy Stoddard
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Mya Zapata
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Deborah Krakow
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
- Department of Orthopedic Surgery, University of California, Los Angeles, California
- Department of Human Genetics, University of California, Los Angeles, California
| | - Ilina D Pluym
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
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Schuler BA, Mosera M, Hatch LD, Grochowsky A, Wheeler F. Collaborative efforts to improve genetic testing in the neonatal intensive care unit. J Perinatol 2023; 43:1500-1505. [PMID: 37914812 DOI: 10.1038/s41372-023-01817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To reduce unnecessary simultaneous karyotype analysis and chromosomal microarray (CMA) testing in the neonatal intensive care unit (NICU). STUDY DESIGN This quality improvement study investigated the effect of collaborative efforts between the NICU, cytogenetics, and clinical genetics on numbers of genetic tests, rates of abnormal tests, and number of genetics consults comparing baseline and 5-month intervention periods. RESULTS Simultaneous karyotype analyses and CMAs decreased due to a decrease in karyotype testing (11.3% [68/600] vs. 0.98% [6/614], p < 0.01). Karyotype analyses were more likely to be abnormal (13.8% [12/87] vs. 64.0% [16/25], p < 0.01). Frequency of genetics consultation did not change (7.0% [42/600] vs. 9.4% [58/614], p = 0.12). CONCLUSION Collaborative efforts between the NICU, cytogenetics, and clinical genetics decreased redundant genetic testing, which demonstrated potential cost savings to our institution. Ongoing collaborative efforts could facilitate genetic testing practices in the NICU that readily evolve in tandem with genetic testing recommendations.
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Affiliation(s)
- Bryce A Schuler
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mackenzie Mosera
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela Grochowsky
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ferrin Wheeler
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
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Evaluation of chromosomal abnormalities and copy number variations in fetuses with ultrasonic soft markers. BMC Med Genomics 2021; 14:19. [PMID: 33435955 PMCID: PMC7802188 DOI: 10.1186/s12920-021-00870-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Some ultrasonic soft markers can be found during ultrasound examination. However, the etiology of the fetuses with ultrasonic soft markers is still unknown. This study aimed to evaluate the genetic etiology and clinical value of chromosomal abnormalities and copy number variations (CNVs) in fetuses with ultrasonic soft markers. Methods Among 1131 fetuses, 729 had single ultrasonic soft marker, 322 had two ultrasonic soft markers, and 80 had three or more ultrasonic soft markers. All fetuses underwent conventional karyotyping, followed by single nucleotide polymorphism (SNP) array analysis. Results Among 1131 fetuses with ultrasonic soft markers, 46 had chromosomal abnormalities. In addition to the 46 fetuses with chromosomal abnormalities consistent with the results of the karyotyping analysis, the SNP array identified additional 6.1% (69/1131) abnormal CNVs. The rate of abnormal CNVs in fetuses with ultrasonic soft marker, two ultrasonic soft markers, three or more ultrasonic soft markers were 6.2%, 6.2%, and 5.0%, respectively. No significant difference was found in the rate of abnormal CNVs among the groups. Conclusions Genetic abnormalities affect obstetrical outcomes. The SNP array can fully complement conventional karyotyping in fetuses with ultrasonic soft markers, improve detection rate of chromosomal abnormalities, and affect pregnancy outcomes.
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