Implications of the Human Genome Project for obstetrics and gynecology

Genetic influences on preterm birth

This article summarizes the scientific evidence supporting a genetic predisposition to preterm birth (PTB) and current molecular methods used to study the genetic links. Selected candidate genes currently under consideration for study are also discussed. Understanding the etiology and pathophysiology of PTB remains at the forefront of research efforts to solve this critical problem. Awareness of the contributing factors is imperative to the development of prevention and early intervention strategies that can reduce the incidence of PTB and the consequence of long-term neonatal complications. The possibility of a genetic predisposition to preterm delivery is a relatively new area of study to emerge over the past few years, although for a long time it has been suspected that PTB results from gene-environment interactions. More advanced genetic research methods are now being applied to study this hypothesis. A sample of candidate genes under study and their speculated role in PTB are presented in this article. There will be more research that links genetic influences and environmental factors to PTB in future, and researchers are hopeful that genetic knowledge can be applied to better understand the entire spectrum of prematurity.

Personal characteristics of older primary care patients who provide a buccal swab for apolipoprotein E testing and banking of genetic material: the spectrum study

OBJECTIVE

To determine the personal characteristics and reasons associated with providing a buccal swab for apolipoprotein E (APOE) genetic testing in a primary care study.

METHODS

The study sample consisted of 342 adults aged 65 years and older recruited from primary care settings.

RESULTS

In all, 88% of patients agreed to provide a DNA sample for APOE genotyping and 78% of persons providing a sample agreed to banking of the DNA. Persons aged 80 years and older and African-Americans were less likely to participate in APOE genotyping. Concern about confidentiality was the most common reason for not wanting to provide a DNA sample or to have DNA banked.

CONCLUSION

We found stronger relationships between sociodemographic variables of age and ethnicity with participation in genetic testing than we did between level of educational attainment, gender, function, cognition, and affect.

Recent advances in prenatal screening and diagnosis of genetic disorders

In any pregnancy, there is an approximate 3% to 5% chance that a fetal complication will occur. The most familiar prenatal diagnostics cannot be performed until the fetus is well into gestation, and most involve invasive procedures along with their inherent risks. In light of these facts, many noninvasive prenatal screening and diagnostic tests have been developed, the newest using recombinant deoxyribonucleic acid (DNA) technology in the examination of fetal cells. Through these procedures, genetic coding errors and chromosomal disruptions may be detected. This article discusses the currently available prenatal and screening diagnostic tests for genetic disorders with a focus on the latest technology.

The genetic revolution: new ethical issues for obstetrics and gynaecology

The genomic revolution inherently changes the paradigms that have informed the interactions between patient and physician. These changes obligate physicians both to continually learn about the advances occurring in genetic testing and to review their interactions in light of the changing ethical issues these advances uncover. Particular areas for concern are the use of genetic testing for predisposition genes. The issues differ between uses for adults, for children and for pre-implantation genetics. Furthermore, there are issues of justice raised by limited access to these technologies, research confidentiality, potential discrimination and the meaning of individuality in an era of potential genetic cloning. These changes require obstetrician/gynaecologists to advocate for the best interests of both their patients and those who may not be able to voice their interests, for example children-to-be and research subjects in developing countries.