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Tzela P, Antsaklis P, Kanellopoulos D, Antonakopoulos N, Gourounti K. Factors Influencing the Decision-Making Process for Undergoing Invasive Prenatal Testing. Cureus 2024; 16:e58803. [PMID: 38654958 PMCID: PMC11036145 DOI: 10.7759/cureus.58803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Invasive prenatal testing, amniocentesis, and chorionic villus sampling offer insights into fetal genetic integrity and health, but carry inevitable minor risks of miscarriage and infection, thus complicating the decision-making process for parents. Previous research has revealed several factors that influence the decision to undergo invasive prenatal testing, including demographic, clinical, and psychological aspects, and attitudes towards testing. Informed choice, involving understanding options and aligning them with personal values, is crucial, with healthcare providers playing a key role in offering unbiased information. This systematic review aims to gather and synthesize literature data on the above factors to draw conclusions to aid antenatal care providers in supporting couples to make more informed decisions about their prenatal care. A systematic search was performed in PubMed and PsycInfo databases using the appropriate keywords and an in-depth evaluation of the studies retrieved followed. Finally, 17 articles were eligible for our review investigating the decision-making process of invasive prenatal testing. Factors like maternal age, education, and ethnicity are pivotal during the decision-making process. Clinical characteristics also influence decisions and women with pregnancies categorized as high-risk or those who have undergone fertility treatment display a preference for invasive testing. There seems to be a direct correlation between a woman's willingness to consider pregnancy termination, deeply rooted in psychological and moral stances, and the inclination to undergo invasive testing. In the patient decision-making process, the provision and depth of knowledge are of paramount importance. A comprehensive understanding facilitates more informed decisions. Finally, attitudes towards termination of pregnancy, as another factor influencing the decision-making process, reveal a nuanced landscape where personal beliefs, religious considerations, legal restrictions, and perspectives on disability converge. Within this complex context, religion emerges as an important determinant, shaping individuals' views on the morality of abortion. This review sheds light on the most important factors influencing the couples' consent for invasive prenatal testing. Healthcare professionals must identify which factors are critical in every specific case among several sociodemographic, clinical, emotional, and religious factors. Thus, they will be able to provide balanced and comprehensive information to help couples under this stressful procedure. We advocate for a patient-centered multidisciplinary approach while navigating couples through the intricate landscape of decision-making concerning invasive prenatal testing.
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Affiliation(s)
- Panagiota Tzela
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Panagiotis Antsaklis
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Kanellopoulos
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Nikolaos Antonakopoulos
- Department of Obstetrics and Gynecology, School of Health Sciences, University of Patras, Patras, GRC
| | - Kleanthi Gourounti
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
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2
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Dubois ML, Winters PD, Rodrigue MA, Gekas J. Patient attitudes and preferences about expanded noninvasive prenatal testing. Front Genet 2023; 14:976051. [PMID: 37152999 PMCID: PMC10161390 DOI: 10.3389/fgene.2023.976051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: Noninvasive prenatal testing (NIPT) using cell-free DNA (cfDNA) is typically carried out to screen for common fetal chromosomal anomalies, with the option to screen for a wider range of chromosomal changes (expanded NIPT) becoming increasingly available. However, little is known about pregnant patients' attitudes and preferences regarding expanded NIPT. Methods: To address this gap, we surveyed general-risk patients having first-tier cfDNA screening at a private prenatal clinic on their expectations for expanded NIPT. Patients were asked questions regarding their current pregnancy and previous pregnancy history, their opinions on fetal DNA screenings during pregnancy and incidental findings, information and opinions on financial resources for NIPT, as well as socio-cultural questions to determine patient demographics. Results: Of the 200 survey participants, the majority were educated, self-reported as white, had a higher than average income, and reported no aneuploidy risk factors. When asked what information they would like to receive from cfDNA screening, the vast majority of participants wanted all information available that could have an immediate impact on fetal health (88%) or an immediate impact on infant health from birth (82%). Many participants also wanted information that could have a future impact on the child's health or an immediate or future impact on the pregnant woman's own health. Most participants wanted information about the sex of fetus (86%) and common trisomies (71%), with almost half of participants desiring information about rare autosomal aneuploidies and/or all genetic information that may affect the baby. In addition, participants were found to be comfortable screening for conditions that are well-known, influence care during pregnancy, and are treatable. Finally, while most respondents either had insurance coverage for NIPT or were able to afford NIPT out of pocket, the majority of our participants felt that expanded NIPT should be either free for everyone or for those considered high risk. Discussion: Our findings suggest that with appropriate pre-test counseling, pregnant patients may choose NIPT for an expanding list of conditions.
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Affiliation(s)
| | | | - Marc-André Rodrigue
- CHU de Quebec Research and Mother and Child Center, Department of Medical Genetics, University Hospital of Quebec, Laval University, Quebec City, QC, Canada
| | - Jean Gekas
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
- CHU de Quebec Research and Mother and Child Center, Department of Medical Genetics, University Hospital of Quebec, Laval University, Quebec City, QC, Canada
- *Correspondence: Jean Gekas,
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3
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Winters P, Curnow KJ, Benachi A, Gil MM, Santacruz B, Nishiyama M, Hasegawa F, Sago H. Multisite assessment of the impact of a prenatal testing educational App on patient knowledge and preparedness for prenatal testing decision making. J Community Genet 2022; 13:435-444. [PMID: 35680723 PMCID: PMC9314500 DOI: 10.1007/s12687-022-00596-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/25/2022] [Indexed: 10/25/2022] Open
Abstract
In this study, we wanted to assess the impact of the use of a patient educational app on patient knowledge about noninvasive prenatal testing (NIPT) and preparedness for prenatal screening decision-making. A randomized control study was carried out at three international sites between January 2019 and October 2020. Study participants completed a pre-consultation survey and post-consultation survey to assess knowledge, satisfaction, and preparedness for prenatal screening consultation. Providers completed a post-consultation survey. In the control arm, the pre-consultation survey was completed prior to consultation with their prenatal care provider. In the intervention arm, the pre-consultation survey was completed after using the app but prior to consultation with their prenatal care provider. Mean knowledge scores in the 203 participants using the app were significantly higher pre-consultation (p < 0.001) and post-consultation (p < 0.005) than those not using the app. Higher pre-consultation knowledge scores in the intervention group were observed at all sites. Most (86%) app users stated they were "Satisfied" or "Very Satisfied" with it as a tool. Providers rated the intervention group as more prepared than controls (p = 0.027); provider assessment of knowledge was not significantly different (p = 0.073). This study shows that clinical implementation of a patient educational app in a real-world setting was feasible, acceptable to pregnant people, and positively impacted patient knowledge.
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Affiliation(s)
| | | | - Alexandra Benachi
- Obstetrics and Gynecology Department, Hôpital Antoine Béclère, AP-HP, Université Paris Saclay, Clamart, France
| | - Maria Mar Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón and School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Belen Santacruz
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón and School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miyuki Nishiyama
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Fuyuki Hasegawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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4
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Bowden B, de Souza S, Puchades A, Williams K, Morgan S, Anderson S, Tucker D, Hillier S. Title: Implementation of Non-Invasive Prenatal Testing within a national UK antenatal screening programme: Impact on women's choices. Prenat Diagn 2022; 42:549-556. [PMID: 35278232 DOI: 10.1002/pd.6131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the implementation of non-invasive prenatal testing (NIPT) on pregnant women's choices in a national NHS antenatal screening programme for Down's syndrome, Edwards' syndrome and Patau's syndrome. METHOD An observational study of all pregnant women with a singleton pregnancy and higher chance (≤ 1:150) combined or quadruple screening result from 30 April 2018 to 25 September 2020 in Wales, UK. Pregnant women's journey through the pathway was determined including uptake of NIPT, performance of NIPT in a non-research setting and invasive procedures performed. RESULTS Of the 1273 women with a higher chance initial screening, 1073 (84%) chose NIPT contingent test, 174 (14%) no further testing and 26 (2%) invasive procedure. There were 1001 (93%) low chance NIPT results; 11 (1%) failed results and 61 (6%) high chance results. Average annual incidence of 27 invasive procedures undertaken compared to 229 pre-NIPT implementation, a nearly 9-fold reduction. Down's syndrome annual live birth rate remained unchanged across the implementation period. DISCUSSION This study demonstrates that NIPT contingent screening was highly acceptable to women with a resulting reduction in invasive procedures performed. CONCLUSION The high uptake of NIPT in NHS antenatal screening pathway conditions should inform planning for other national screening programmes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bethan Bowden
- Screening Division, Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, CF10 4BZ
| | - Sikha de Souza
- Screening Division, Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, CF10 4BZ
| | - Alice Puchades
- Swansea Bay Local Public Health Team, Public Health Wales, Matrix House, Swansea, SA6 8BX
| | - Kindry Williams
- Screening Division, Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, CF10 4BZ
| | - Sian Morgan
- All Wales Medical Genomics Service, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW
| | - Sarah Anderson
- All Wales Medical Genomics Service, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales, Singleton Hospital, Sketty Lane, Swansea, SA2 8QA
| | - Sharon Hillier
- Screening Division, Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, CF10 4BZ
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5
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Bawazeer S, AlSayed M, Kurdi W, Balobaid A. Knowledge and attitudes regarding non-invasive prenatal testing among women in Saudi Arabia. Prenat Diagn 2021; 41:1343-1350. [PMID: 34159638 DOI: 10.1002/pd.5991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/02/2021] [Accepted: 06/04/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To explore women's knowledge and attitudes regarding NIPT, its implications, the factors affecting their decision to undergo the test and actions taken following a positive result. METHODS In this descriptive study, women who were offered NIPT through the foetal maternal clinic, were asked to complete an anonymous questionnaire about NIPT. The questionnaire consisted of 29 statements and covered four areas: demographics, knowledge, attitudes and decision-making. RESULTS A total of 150 women who were offered NIPT participated in this study. The results showed that generally women had poor knowledge of critical aspects of NIPT. This included the conditions tested for, the implications of the test and its limitations. Over 90% of women were in favour of NIPT and it being offered to all women of advanced maternal age while 66% of the tested women agreed to having confirmatory invasive testing in the case of a positive result. CONCLUSION This study shows that the acceptance rate for NIPT is high despite incomplete understanding of the benefits and limitations of the test. The study findings support the need for education regarding this test through dedicated genetic counselling sessions in order to ensure that an informed decision can be made.
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Affiliation(s)
- Shahad Bawazeer
- Department of Pediatrics, Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moeenaldeen AlSayed
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Wesam Kurdi
- Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynaecology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Ameera Balobaid
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Di Mattei V, Ferrari F, Perego G, Tobia V, Mauro F, Candiani M. Decision-making factors in prenatal testing: A systematic review. Health Psychol Open 2021; 8:2055102920987455. [PMID: 33489303 PMCID: PMC7809316 DOI: 10.1177/2055102920987455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This review examines the factors that affect the decision-making process of parental couples evaluating prenatal screening and diagnostic tests. A systematic search was performed using PubMed and PsycInfo databases. The 46 included studies had to: investigate the decision-making process about prenatal testing; focus on tests detecting trisomy 21, 18, 13, and abnormalities of sex chromosomes; be published in English peer-reviewed journals. The decision-making process seems composed of different levels: an individual level with demographic, clinical, and psychological aspects; a contextual level related to the technical features of the test and the information received; a relational level involving family and society.
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Affiliation(s)
- Valentina Di Mattei
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
| | | | | | | | - Fabio Mauro
- IRCCS San Raffaele Scientific Institute, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University, Italy.,IRCCS San Raffaele Scientific Institute, Italy
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7
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Wehbe K, Brun P, Gornet M, Bory JP, Raimond É, Graesslin O, Barbe C, Duminil L. DEPIST 21: Information and knowledge of pregnant women about screening strategies including non-invasive prenatal testing for Down syndrome. J Gynecol Obstet Hum Reprod 2020; 50:102001. [PMID: 33246134 DOI: 10.1016/j.jogoh.2020.102001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the knowledge of pregnant women and provide information about Down syndrome (DS) screening, including non-invasive prenatal testing (NIPT). MATERIALS AND METHODS A prospective unicenter study of pregnant women recruited during their first trimester foetal ultrasound was carried out. Single pregnancies from 11 to 17 + 6 weeks of amenorrhoea (SA) without a history of DS were included. "Pre" and "post" questionnaire were fulfilled before and after the consultation. Patient characteristics, prior information, information provided during the consultation, and patient satisfaction were also analysed. RESULTS A total of 273 were included in the study, and 147 completed surveys (pre and post) were examined. In pre-consultation, 82 % of women know that integrated screening includes maternal serum markers and nuchal translucency (n = 103). Concerning NIPT for DS, 8% (n = 11) of women declare having been informed before the ultrasound. A minority of patients know modalities of reimbursement (n = 33, 26 %) and invasive sampling is mandatory for diagnosis when NIPT is positive (n = 37, 28 %). Significant improvement in right answers was obtained for three questions: "nuchal translucency is included in the combined screening test for DS" (p = 0,007); "blood serum markers is included in the combined screening for DS" (p = 0,009) and advanced maternal age increases risk for DS" (p = 0,004). Total score in the post questionnaire was significantly higher than the "pre" consultation questionnaire (14,7 ± 2.8 versus 14,1 ± 2.9; p = 0.01). CONCLUSION Patients show a high level of knowledge on screening strategies for DS in pre-consultation. They benefit from the consultation on global knowledge, NIPT, and ultrasound notions.
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Affiliation(s)
- Karl Wehbe
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France.
| | - Pauline Brun
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
| | - Marion Gornet
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
| | - Jean-Paul Bory
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
| | - Émilie Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
| | - Coralie Barbe
- Department of Clinical Research, Robert Debré Hospital, Reims Champagne-Ardenne University, rue du Général Koenig, 51100, Reims France
| | - Laura Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims Champagne-Ardenne University, 45, Cognacq-Jay, 51100, Reims, France
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8
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Wu L, Wu Y, Zou S, Sun C, Chen J, Li X, Lin Z, Guan L, Zeng Q, Zhao S, Liang J, Chen R, Hu Z, Au K, Xie D, Xiao X, Ming WK. Eliciting women's preference for prenatal testing in China: a discrete choice experiment. BMC Pregnancy Childbirth 2020; 20:604. [PMID: 33032548 PMCID: PMC7542883 DOI: 10.1186/s12884-020-03270-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Pregnancy tests can be used for the early diagnosis of fetal problems and can prevent abnormal birth in pregnancies. Yet, testing preferences among Chinese women are poorly investigated. Methods We developed a Discrete Choice Experiment with 5 attributes: test procedure, detection rate, miscarriage rate, time to wait for result, and test cost. By studying the choices that the women make in the hypothetical scenarios and comparing the attributes and levels, we can analyze the women’s preference of prenatal testing in China. Results Ninety-two women completed the study. Respondents considered the test procedure as the most important attribute, followed by detection rate, miscarriage rate, wait time for result, and test cost, respectively. The estimated preference weight for the non-invasive procedure was 0.928 (P < 0.0001). All other attributes being equal, the odds of choosing a non-invasive testing procedure over an invasive one was 2.53 (95% confidence interval, 2.42–2.64; P < 0.001). Participants were willing to pay up to RMB$28,810 (approximately US$4610) for a non-invasive test, RMB$6061(US$970) to reduce the miscarriage rate by 1% and up to RMB$3356 (US$537) to increase the detection rate by 1%. Compared to other DCE (Discrete Choice Experiment) studies regarding Down’s syndrome screening, women in our study place relatively less emphasis on test safety. Conclusions The present study has shown that Chinese women place more emphasis on detection rate than test safety. Chinese women place great preference on noninvasive prenatal testing, which indicate a popular need of incorporating noninvasive prenatal testing into the health insurance coverage in China. This study provided valuable evidence for the decision makers in the Chinese government.
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Affiliation(s)
- Liangzhi Wu
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shiqian Zou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Cong Sun
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Junyu Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueyan Li
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zihang Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lizhi Guan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qing Zeng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Sihan Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingtong Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rui Chen
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhiwen Hu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kingyan Au
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daipeng Xie
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaomin Xiao
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wai-Kit Ming
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China. .,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. .,School of Medicine, Jinan University, Guangzhou, Guangdong, China. .,Harvard Medical School, Harvard University, Boston, MA, USA.
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9
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Thorolfsdottir E, Lunde Å, Stefansdottir V, Hjartardottir H, Rut Haraldsdottir K. Comparing prenatal screening experiences of Icelandic women who received false-positive and true-negative first-trimester combined screening results in Iceland in 2012-2016. J Genet Couns 2020; 29:644-657. [PMID: 32198907 DOI: 10.1002/jgc4.1269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023]
Abstract
First-trimester combined screening (FTS) has been offered to all pregnant women in Iceland since 2003. Individuals with high-risk FTS results are offered an invasive test option with a ≤1% risk of fetal loss. This study gives insight into the prenatal screening and diagnosis experiences and preferences of 101 women who underwent FTS in Iceland in the years 2012-2016, comparing the experience of those who received false-positive FTS results to those who received true-negative results. Retrospective patient-reported anxiety levels at the time of receiving FTS results were significantly higher in those who received false-positive results compared to those who received true-negative results. For a subset of these participants, the anxiety lasted through pregnancy, and for a smaller subset, it lasted even longer. Non-invasive prenatal testing (NIPT) is currently not offered in Iceland, aside from the rare exceptional case. Given the extremely low false-positive rates of NIPT, we believe NIPT is worth considering as Iceland's standard first-tier screening method for trisomy 13, 18, and 21. We believe the findings of this study are beneficial not only for Iceland but also for other countries where FTS is the first-tier prenatal screening method or the only offered test. Additionally, only 21% of participants in our study reported that they had heard of NIPT, which emphasizes the need for comprehensive NIPT pretest information to be available prior to its uptake to ensure informed and autonomous decision-making.
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Affiliation(s)
- Eirny Thorolfsdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Åshild Lunde
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vigdis Stefansdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Hulda Hjartardottir
- Prenatal Diagnostic Unit, Women's and Children's Services, Landspitali University Hospital, Reykjavik, Iceland
| | - Kristin Rut Haraldsdottir
- Prenatal Diagnostic Unit, Women's and Children's Services, Landspitali University Hospital, Reykjavik, Iceland
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10
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Governing the futures of non-invasive prenatal testing: An exploration of social acceptability using the Delphi method. Soc Sci Med 2020; 304:112930. [PMID: 32216981 DOI: 10.1016/j.socscimed.2020.112930] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 01/16/2023]
Abstract
Non-invasive prenatal testing (NIPT) using cell-free DNA (cfDNA) offers numerous benefits to pregnant women and their families. It also raises ethical, legal and social concerns regarding, for instance, the possible effects of a routinization of prenatal genetic testing on free and informed decision-making by prospective parents, and the role of the state in governing its use. Technological advances are allowing cfDNA analyses to detect an increasing number of genetic risks and conditions in the fetus, potentially further exacerbating such concerns. From May 2015 to December 2016, we conducted a three-round Policy Delphi study (NR1 = 61, NR2 = 58, NR3 = 47; overall retention rate = 77.0%) to explore the social acceptability (SA) of current and potential future uses of NIPT in Canada according to participants with relevant professional, research or advocacy expertise. Participants came from four groups: healthcare professionals (NR3 = 14), social sciences and humanities researchers (NR3 = 13), patients/disability rights advocates (NR3 = 14), and cultural/religious communities advocates (NR3 = 6). This paper presents SA criteria and contextual contingencies relevant to the assessment of NIPT's SA according to the group. It also reports what uses (conditions or motives) participants thought should be banned, permitted, publicly funded, or promoted as a public health strategy. According to them, conditions resulting in severe pain or early death, as well as trisomies (13, 18, 21) and sex chromosome abnormalities, should be covered by Canadian public health insurance. However, there was wide agreement that direct-to-consumer NIPT should be legally banned, and that testing for fetal sex for non-medical reasons using NIPT should be either proscribed or discouraged. In addition to identifying areas of consensus, our results point to disagreement regarding, for instance, the required level of governance of whole-genome sequencing and testing for late onset conditions with low penetrance. This study also provides a model for exploring the SA of emerging technologies using the Policy Delphi method.
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11
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Crombag NMTH, Page‐Christiaens GCML, Skotko BG, Graaf G. Receiving the news of Down syndrome in the era of prenatal testing. Am J Med Genet A 2019; 182:374-385. [DOI: 10.1002/ajmg.a.61438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/06/2019] [Accepted: 11/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Neeltje MTH Crombag
- Department of Development and RegenerationCluster Woman and Child, Biomedical Sciences Leuven Belgium
| | | | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Genomics, Department of PediatricsMassachusetts General Hospital Boston Massachusetts
- Department of PediatricsHarvard Medical School Boston Massachusetts
| | - Gert Graaf
- Dutch Down Syndrome Foundation Meppel The Netherlands
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Bellai-Dussault K, Meng L, Huang T, Reszel J, Walker M, Lanes A, Okun N, Armour C, Dougan S. A 2-year review of publicly funded cell-free DNA screening in Ontario: utilization and adherence to funding criteria. Prenat Diagn 2019; 40:164-172. [PMID: 31525278 DOI: 10.1002/pd.5563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/09/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ontario offers a publicly funded modified contingent model of prenatal screening for aneuploidy in which cell-free DNA (cfDNA) screening is covered for pregnancies at higher risk of fetal aneuploidy. The objective of this study was to review utilization of provincially funded cfDNA screening and adherence to the criteria laid out in Ontario prenatal screening guidelines. METHODS This was a descriptive cohort study using data collected by Ontario's prescribed maternal and child registry. The study population included all pregnant individuals who received cfDNA screening from January 2016 to December 2017. RESULTS The most common criteria for provincially funded cfDNA screening were advanced maternal age ≥40 years (37.7%), positive multiple marker screen (34.1%), modifying risk factors such as ultrasound soft markers (7.1%), and previous aneuploidy (5.5%). The audit demonstrated that 2.9% of funded cfDNA screens tests did not meet funding criteria, and that 11.4% of self-paid cfDNA screens could have been publicly funded. CONCLUSION Reviewing and auditing the application of criteria for funded cfDNA screening using prescribed registry data allows an opportunity to identify areas where targeted education may improve adherence to standardized screening protocols, and provides a basis for reassessment of the funding model.
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Affiliation(s)
- Kara Bellai-Dussault
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Lynn Meng
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Tianhua Huang
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada.,The Institute of Health Policy, Management and Evaluation & Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Mark Walker
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Andrea Lanes
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Nan Okun
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Armour
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Shelley Dougan
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
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Chau MHK, Cao Y, Kwok YKY, Chan S, Chan YM, Wang H, Yang Z, Wong HK, Leung TY, Choy KW. Characteristics and mode of inheritance of pathogenic copy number variants in prenatal diagnosis. Am J Obstet Gynecol 2019; 221:493.e1-493.e11. [PMID: 31207233 DOI: 10.1016/j.ajog.2019.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Microdeletions and microduplications can occur in any pregnancy independent of maternal age. The spectrum and features of pathogenic copy number variants including the size, genomic distribution, and mode of inheritance are not well studied. These characteristics have important clinical implications regarding expanding noninvasive prenatal screening for microdeletions and microduplications. OBJECTIVES The aim was to investigate the spectrum and characteristics of pathogenic copy number variants in prenatal genetic diagnosis and to provide recommendations for expanding the scope of noninvasive prenatal screening for microdeletions and microduplications. STUDY DESIGN This was a retrospective study of 1510 pregnant women who underwent invasive prenatal diagnostic testing by chromosomal microarray analysis. Prenatal samples were retrieved by amniocentesis or chorionic villus sampling and sent to our prenatal genetic diagnosis laboratory for chromosomal microarray analysis. The risk of carrying a fetus with pathogenic copy number variants is stratified by the patients' primary indication for invasive testing. We searched the literature for published prenatal chromosomal microarray data to generate a large cohort of 23,865 fetuses. The characteristics and spectrum of pathogenic copy number variants including the type of aberrations (gains or losses), genomic loci, sizes, and the mode of inheritance were studied. RESULTS Overall, 375 of 23,865 fetuses (1.6%) carried pathogenic copy number variants for any indication for invasive testing, and 44 of them (11.7%) involve 2 or more pathogenic copy number variants. A total of 428 pathogenic copy number variants were detected in these fetuses, of which 280 were deletions and 148 were duplications. Three hundred sixty (84.1%) were less than 5 Mb in size and 68 (15.9%) were between 5 and 10 Mb. The incidence of carrying a pathogenic copy number variant in the high-risk group is 1 in 36 and the low-risk group is 1 in 125. Parental inheritance study results were available for 311 pathogenic copy number variants, 71 (22.8%) were maternally inherited, 36 (11.6%) were paternally inherited, and 204 (65.6%) occurred de novo. CONCLUSION Collectively, pathogenic copy number variants are common in pregnancies. High-risk pregnancies should be offered invasive testing with chromosomal microarray analysis for the most comprehensive investigation. Detection limits on size, parental inheritance, and genomic distribution should be carefully considered before implementing copy number variant screening in expanded noninvasive prenatal screening.
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Affiliation(s)
- Matthew Hoi Kin Chau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yvonne Ka Yin Kwok
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Samantha Chan
- Warwick Medical School at the University of Warwick, Coventry, United Kingdom
| | - Yiu Man Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Huilin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Department of Central Laboratory, Bao'an Maternity and Child Healthcare Hospital, Jinan University School of Medicine, Key Laboratory of Birth Defects Research, Birth Defects Prevention Research, and Transformation Team, Shenzhen, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Zhenjun Yang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Hoi Kin Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; The Chinese University of Hong Kong-Baylor College of Medicine Joint Center for Medical Genetics, Hong Kong, China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; The Chinese University of Hong Kong-Baylor College of Medicine Joint Center for Medical Genetics, Hong Kong, China.
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How B, Smidt A, Wilson NJ, Barton R, Valentin C. 'We would have missed out so much had we terminated': What fathers of a child with Down syndrome think about current non-invasive prenatal testing for Down syndrome. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:290-309. [PMID: 30021487 DOI: 10.1177/1744629518787606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Non-invasive prenatal testing (NIPT) allows early, accurate diagnosis of Down syndrome that has resulted in increased terminations. This qualitative study involved in-depth interviews of fathers of children with Down syndrome about their views on the availability of NIPT. Thematic network analysis revealed that although fathers appreciated an early diagnosis with NIPT, they saw the test as being a predetermined pathway to termination. Fathers felt that expectation to terminate reflects negative societal attitudes towards those with Down syndrome and disability, fearing that NIPT may become a form of eugenics. Fathers retrospectively contrasted these attitudes with the actual reality of raising their children with Down syndrome, which they described as bringing joy to their lives. Findings suggest that although fathers valued NIPT as an information-giving tool that allowed autonomous parental choices about the pregnancy, they believe that it should be accompanied by balanced information about the reality of raising a child with Down syndrome.
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15
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Qiu J. Buying reassurance: uptake of non-invasive prenatal testing among pregnant women of advanced maternal age in China. HEALTH, RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1639636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jifang Qiu
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, Jiangsu, China
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16
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Valentin C, Smidt A, Barton R, Wilson NJ, How B. Mothers of a child with Down syndrome: A qualitative analysis of the perspectives on non-invasive prenatal testing. Midwifery 2019; 76:118-124. [PMID: 31202107 DOI: 10.1016/j.midw.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/27/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The introduction of non-invasive prenatal testing (NIPT) for Down syndrome (DS) has sparked social and ethical debates. To date, in-depth exploration of the voices of Australian mothers of a child with DS about NIPT has been lacking. The purpose of this study was to investigate the perspectives of Australian mothers of a child with DS towards the increasing availability of NIPT. DESIGN AND SETTING Fifteen mothers of children with DS aged 8 months-39 years participated in-depth interviews, conducted online via the software Zoom™. An inductive thematic analysis of interview data explored mothers' perceptions of NIPT. FINDINGS Mothers perspectives were nuanced and personal to each woman's circumstance. All mothers highlighted the inevitable association between testing and termination, the importance of autonomy and respecting [m]others' choices to test and to terminate, and that appropriate supports must be provided to ensure informed decision-making. These perspectives existed within an overarching theme of NIPT reflecting and reinforcing societal attitudes towards disability. CONCLUSION Mothers of a child with DS viewed informed decision-making as crucial both prior to undertaking NIPT and following a positive test result. This study adds a unique Australian perspective to the necessary ongoing social and ethical debate.
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Affiliation(s)
- Chelsea Valentin
- Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Andy Smidt
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Cumberland C42, PO Box 170, Sydney, New South Wales 1825, Australia.
| | - Rebecca Barton
- Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Nathan J Wilson
- School of Nursing and Midwifery Western Sydney University Sydney, Australia.
| | - Bethea How
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Cumberland C42, PO Box 170, Sydney, New South Wales 1825, Australia.
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Seror V, L’Haridon O, Bussières L, Malan V, Fries N, Vekemans M, Salomon LJ, Ville Y. Women's Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome. JAMA Netw Open 2019; 2:e191062. [PMID: 30924894 PMCID: PMC6450316 DOI: 10.1001/jamanetworkopen.2019.1062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Noninvasive prenatal testing (NIPT) using cell-free DNA in maternal blood is increasingly common compared with invasive testing (IT) in routine antenatal detection of Down syndrome (DS). OBJECTIVE To assess attitudes and decision making in pregnant women facing a risk of fetal DS greater than 1 in 250 as established by combined first trimester screening at 11 to 14 weeks of gestation. DESIGN, SETTING, AND PARTICIPANTS Survey study in which data were collected from pregnant women at high risk of fetal DS participating in a randomized clinical trial. Data were collected from April 8, 2014, to April 7, 2016, in 57 prenatal diagnosis centers in France. Data were analyzed in 2018. INTERVENTIONS Data on attitudes were collected prior to offering randomization between NIPT and IT, whereas data on decision making and test results were collected as part of the clinical trial. MAIN OUTCOME AND MEASURES The primary outcome related to attitudes. A hierarchical cluster analysis was conducted to identify clusters with contrasting attitudes. Logistic regression analyses were used to identify factors associated with attitudes. RESULTS All 2436 consecutive women to whom the study was proposed (mean [SD] age, 36.3 [5.0] years) answered the questionnaire: 515 (21.1%) expressed preference toward IT with complete karyotyping, whereas 1843 (75.7%) favored NIPT with almost certain but limited information. Hierarchical cluster analysis yielded 4 different clusters that mainly differed in attitudes toward risk taking and extent of information seeking. Factors likely associated with attitudes driven by risk aversion were mostly age and religious beliefs (adjusted odds ratio [aOR], 1.03; 95% CI, 1.00-1.05; P = .03 and aOR, 1.62; 95% CI, 1.29-2.04; P < .001, respectively), whereas higher nuchal translucency measurements by ultrasonography were associated with attitudes driven by ambiguity aversion (aOR, 1.67; 95% CI, 1.27-2.20; P < .001). For attitudes involving both risk and ambiguity aversion at different extents, lower education was associated with highly valuing all possibilities of getting information on pregnancy, whereas higher education was associated with highly valuing information on fetal DS as a primary concern (aOR, 0.54; 95% CI, 0.44-0.67; P < .001 and aOR, 1.44; 95% CI, 1.20-1.74; P < .001, respectively). In all, decision making was in line with attitudes. CONCLUSIONS AND RELEVANCE Aversion to risk of fetal loss related to IT and aversion to ambiguity generated by incomplete information from NIPT played a major role in shaping attitudes and decision making. Informed decision making should require pregnant women at high risk of DS to receive extensive information on targeted abnormalities by both tests.
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Affiliation(s)
- Valerie Seror
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | | | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Nicolas Fries
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Laurent J. Salomon
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Groupe de Recherche en Obstétrique et Gynécologie, Paris, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
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18
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Metcalfe SA. Genetic counselling, patient education, and informed decision-making in the genomic era. Semin Fetal Neonatal Med 2018; 23:142-149. [PMID: 29233487 DOI: 10.1016/j.siny.2017.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Genomic technologies are now being applied to reproductive genetic screening. Circulating cell-free DNA testing in pregnancy for fetal chromosomal abnormalities is becoming more widely used as a screening test, and expanded carrier screening for autosomal and X-linked recessive conditions for more than a hundred conditions is available to couples for testing before and during pregnancy. These are most typically available as a commercial test. The purpose of reproductive genetic screening is to facilitate autonomous reproductive choices. Previous studies would suggest that many women do not make informed decisions about prenatal genetic screening, and the introduction of genomic technologies has generally added to the ethical debate. Appropriate pre-test genetic counselling is recommended, and healthcare providers should include information that is balanced, accurate and up-to-date, comprising written and/or e-learning tools, as well as providing psychosocial support so that couples consider the pros and cons of being tested and can make informed decisions.
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Affiliation(s)
- Sylvia A Metcalfe
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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19
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Griffin B, Edwards S, Chitty LS, Lewis C. Clinical, social and ethical issues associated with non-invasive prenatal testing for aneuploidy. J Psychosom Obstet Gynaecol 2018. [PMID: 28635528 DOI: 10.1080/0167482x.2017.1286643] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Non-invasive prenatal testing (NIPT), based on analysis of cell-free foetal DNA, is rapidly becoming a preferred method to screen for chromosomal aneuploidy with the technology now available in over 90 countries. This review provides an up-to-date discussion of the key clinical, social and ethical implications associated with this revolutionary technology. Stakeholders are positive about a test that is highly accurate, safe, can be perfomed early in pregnancy, identifies affected pregnancies that might otherwise have been missed and reduces the need for invasive testing. Nevertheless, professional societies currently recommend it as an advanced screening test due to the low false positive rate (FPR). Despite the practical and psychological benefits, a number of concerns have been raised which warrant attention. These include the potential for routinisation of testing and subsequent impact on informed decision-making, an "easy" blood test inadvertently contributing to women feeling pressured to take the test, fears NIPT will lead to less tolerance and support for those living with Down syndrome and the heightened expectation of having "perfect babies". These issues can be addressed to some extent through clinician education, patient information and establishing national and international consensus in the development of comprehensive and regularly updated guidelines. As the number of conditions we are able to test for non-invasively expands it will be increasingly important to ensure pre-test counselling can be delivered effectively supported by knowledgeable healthcare professionals.
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Affiliation(s)
- Blanche Griffin
- a North East Thames Regional Genetics Service , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Samantha Edwards
- a North East Thames Regional Genetics Service , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Lyn S Chitty
- a North East Thames Regional Genetics Service , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK.,b Genetics and Genomic Medicine , UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Celine Lewis
- a North East Thames Regional Genetics Service , Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK.,b Genetics and Genomic Medicine , UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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20
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Miltoft CB, Rode L, Tabor A. Positive view and increased likely uptake of follow-up testing with analysis of cell-free fetal DNA as alternative to invasive testing among Danish pregnant women. Acta Obstet Gynecol Scand 2018; 97:577-586. [DOI: 10.1111/aogs.13297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Caroline B. Miltoft
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Line Rode
- Department of Clinical Biochemistry; Copenhagen University Hospital, Herlev and Gentofte Hospital; Copenhagen Denmark
| | - Ann Tabor
- Center of Fetal Medicine; Department of Obstetrics; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
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21
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Borry P, Favaretto M, Batthyany A, Boey E, Van Tongerloo S, Dooms M, Huys I. Noninvasive prenatal testing: a survey of young (future) parents in Flanders. Per Med 2018; 15:35-43. [DOI: 10.2217/pme-2017-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To explore the opinions of young (future) parents toward noninvasive prenatal testing. Materials & methods: A questionnaire was administrated. Results: A total of 1006 surveys were completed by visitors of 40 secondhand clothing fairs spread equally over Flanders (Belgium). The respondents expressed an overall positive opinion toward the use and implementation of a noninvasive prenatal test (NIPT). Most respondents claimed that they would test their unborn child for genetic disorders, even if this was to result in a termination of the pregnancy. Conclusion: The participants agreed nearly unanimously that NIPT must be offered to pregnant women with an increased risk of having a child with a genetic disorder, but they were also positive about extending NIPT screening to all pregnant women.
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Affiliation(s)
- Pascal Borry
- Centre for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Flanders, Belgium
| | - Maddalena Favaretto
- Centre for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Flanders, Belgium
| | - Ann Batthyany
- Department of Clinical Pharmacology & Pharmacotherapy, KU Leuven, Flanders, Belgium
| | - Eline Boey
- Department of Clinical Pharmacology & Pharmacotherapy, KU Leuven, Flanders, Belgium
| | - Sophie Van Tongerloo
- Department of Clinical Pharmacology & Pharmacotherapy, KU Leuven, Flanders, Belgium
| | - Marc Dooms
- Department of Clinical Pharmacology & Pharmacotherapy, KU Leuven, Flanders, Belgium
| | - Isabelle Huys
- Department of Clinical Pharmacology & Pharmacotherapy, KU Leuven, Flanders, Belgium
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Hill M, Barrett A, Choolani M, Lewis C, Fisher J, Chitty LS. Has noninvasive prenatal testing impacted termination of pregnancy and live birth rates of infants with Down syndrome? Prenat Diagn 2017; 37:1281-1290. [PMID: 29111614 PMCID: PMC5767768 DOI: 10.1002/pd.5182] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Implementation of noninvasive prenatal testing (NIPT) as a highly accurate aneuploidy screening test has raised questions around whether the high uptake may result in more terminations of pregnancies and fewer births of children with Down syndrome (DS). AIM The aim of the study was to investigate the impact of NIPT on termination and live birth rates for DS. METHODS Literature reporting pregnancy outcomes following NIPT was reviewed. Termination rates were calculated for women with a high-risk NIPT result for DS. Two audits of pregnancy outcomes where NIPT indicated DS were conducted in the United Kingdom and Singapore. RESULTS Fourteen studies from the United States, Asia, Europe, and the United Kingdom were included in the review. Live births of children with DS were reported in 8 studies. Termination rates following NIPT were unchanged or decreased when compared to termination rates prior to the introduction of NIPT. Audits found 15 of 43 women in the United Kingdom and 2 of 6 in Singapore continued pregnancies following a high-risk NIPT result. CONCLUSIONS Termination rates following the detection of DS by NIPT are unchanged or decreased compared to historical termination rates. Impact on live birth rates may be minimal in settings where termination rates fall. Population-based studies are required to determine the true impact.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Angela Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Celine Lewis
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | | | - Lyn S. Chitty
- Genetics and Genomic MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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23
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Lewis C, Hill M, Chitty LS. Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained? Prenat Diagn 2017; 37:1130-1137. [PMID: 28892219 PMCID: PMC5969260 DOI: 10.1002/pd.5154] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 12/14/2022]
Abstract
Objectives To assess rates of informed choice among women offered non‐invasive prenatal testing (NIPT) for aneuploidy as part of routine clinical care. Methods A cross‐sectional survey was conducted across 6 antenatal clinics in England. Women with a high risk (≥1/150) Down syndrome screening result were offered NIPT, invasive testing, or no further testing. Pretest counselling was delivered as part of routine care by the local maternity team. Women were given a questionnaire containing a measure of informed choice immediately after pretest counselling. Results In total, 220 of 247 women completed the questionnaire. Seventy‐six percent were judged to have made an informed choice, a significant decline from our previous study (89.0% vs 75.6%; χ2(2) = 20.2, P < .001). Of those making an uninformed choice, 46% had insufficient knowledge, 19% had not deliberated, and 13% had made a value‐inconsistent decision. Multivariate analysis showed women who were highly educated (OR, 4.33; 95% CI, 1.08‐17.36) or had had screening in a previous pregnancy (OR, 0.24; 95% CI, 0.90‐0.65) were significantly more likely to make an informed choice. Conclusions The findings highlight the challenges of ensuring informed choice in routine prenatal care where NIPT is not discussed at multiple points, less time is available for counselling, and written consent is not required. What's already known about this topic?
Non‐invasive prenatal testing for aneuploidy is a highly accurate screening test, but concerns exist around potential routinisation. Previous evidence indicated high levels of informed choice are possible, but this was a tightly controlled research setting.
What does this study add?
Non‐invasive prenatal testing can be offered within routine prenatal care in a way that facilitates high levels of informed choice. However, the decline in rates of informed choice compared with those in the research setting highlight the challenges of offering non‐invasive prenatal testing in routine prenatal care.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health and Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health and Great Ormond Street Institute of Child Health, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health and Great Ormond Street Institute of Child Health, London, UK
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Nshimyumukiza L, Beaumont JA, Duplantie J, Langlois S, Little J, Audibert F, McCabe C, Gekas J, Giguère Y, Gagné C, Reinharz D, Rousseau F. Cell-Free DNA-Based Non-invasive Prenatal Screening for Common Aneuploidies in a Canadian Province: A Cost-Effectiveness Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:48-60. [PMID: 28784564 DOI: 10.1016/j.jogc.2017.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Yearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness of NIPT strategies compared with conventional strategies. METHODS This study used a decision analytic model to estimate the cost-effectiveness of 13 prenatal screening strategies for fetal aneuploidies: six frequently used strategies, universal NIPT, and six strategies incorporating NIPT as a second-tier test. The study considered a virtual cohort of pregnant women of similar size and age as women in Quebec. Model data were obtained from published sources and government databases. The study predicted the number of chromosomal anomalies detected (trisomies 21, 13, and 18), invasive procedures and euploid fetal losses, direct costs, and incremental cost-effectiveness ratios. RESULTS Of the 13 strategies compared, eight identified fewer cases at a higher cost than at least one of the remaining five strategies. Integrated serum screening with conditional NIPT had the lowest cost, and the cost per case detected was $63 139, with a 90% reduction of invasive procedures. The number of cases identified was improved with four other screening strategies, but with increasing of incremental costs per case (from $61 623 to $1 553 615). Results remained robust, except when NIPT costs and risk cut-offs varied. CONCLUSION NIPT as a second-tier test for high-risk women is likely to be cost-effective as compared with screening algorithms not involving NIPT.
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Affiliation(s)
- Léon Nshimyumukiza
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC.
| | - Jean-Alexandre Beaumont
- Department of Software Engineering, Faculty of Sciences and Engineering, Université Laval, Québec City, QC
| | - Julie Duplantie
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, BC
| | - Julian Little
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - François Audibert
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Université de Montréal, Montréal, QC
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta Hospital, Edmonton, AB
| | - Jean Gekas
- Research Centre, Centre hospitalier universitaire de Québec, Québec City, QC
| | - Yves Giguère
- Research Centre, Centre hospitalier universitaire de Québec, Québec City, QC; Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec City, QC
| | - Christian Gagné
- Department of Computer Engineering, Faculty of Sciences and Engineering, Université Laval, Québec City, QC
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC
| | - François Rousseau
- Research Centre, Centre hospitalier universitaire de Québec, Québec City, QC; Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Québec City, QC
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Smith H, Bulbul A, Jones CJ. Can Online Discussion Sites Generate Quality Data for Research Purposes? Front Public Health 2017; 5:156. [PMID: 28730148 PMCID: PMC5499632 DOI: 10.3389/fpubh.2017.00156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Affiliation(s)
- Helen Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alpaslan Bulbul
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Hill M, Oteng-Ntim E, Forya F, Petrou M, Morris S, Chitty LS. Preferences for prenatal diagnosis of sickle-cell disorder: A discrete choice experiment comparing potential service users and health-care providers. Health Expect 2017; 20:1289-1295. [PMID: 28504327 PMCID: PMC5689222 DOI: 10.1111/hex.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/29/2023] Open
Abstract
Background Non‐invasive prenatal diagnosis (NIPD) for sickle‐cell disorder (SCD) is moving closer to implementation and studies considering stakeholder preferences are required to underpin strategies for offering NIPD in clinical practice. Objective Determine service user and provider preferences for key attributes of prenatal diagnostic tests for SCD and examine views on NIPD. Method A questionnaire that includes a discrete choice experiment was used to determine the preferences of service users and providers for prenatal tests that varied across three attributes: accuracy, time of test and risk of miscarriage. Results Adults who were carriers of SCD or affected with the condition (N=67) were recruited from haemoglobinopathy clinics at two maternity units. Health professionals, predominately midwives, who offer antenatal care (N=62) were recruited from one maternity unit. No miscarriage risk was a key driver of decision making for both service users and providers. Service providers placed greater emphasis on accuracy than service users. Current uptake of invasive tests was 63%, whilst predicted uptake of NIPD was 93.8%. Many service users (55.4%) and providers (52.5%) think pressure to have prenatal testing will increase when NIPD for SCD becomes available. Conclusions There are clear differences between service users and health professionals’ preferences for prenatal tests for sickle‐cell disorder. The safety of NIPD is welcomed by parents and uptake is likely to be high. To promote informed choice, pretest counselling should be balanced and not exclusively focused on test safety. Counselling strategies that are sensitive to feelings of pressure to test will be essential.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Directorate of Women's Health, Guy's and St Thomas' Foundation Trust, London, UK.,King's College London, London, UK
| | - Frida Forya
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Women's Health, University College London, London, UK
| | - Mary Petrou
- Institute of Women's Health, University College London, London, UK.,Haemoglobinopathy Genetics Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
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Oxenford K, Daley R, Lewis C, Hill M, Chitty LS. Development and evaluation of training resources to prepare health professionals for counselling pregnant women about non-invasive prenatal testing for Down syndrome: a mixed methods study. BMC Pregnancy Childbirth 2017; 17:132. [PMID: 28449648 PMCID: PMC5408404 DOI: 10.1186/s12884-017-1315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/24/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The availability of non-invasive prenatal testing (NIPT) for aneuploidies is expanding rapidly throughout the world. Training health professionals to offer NIPT in a way that supports informed choice is essential for implementation. The aim of this study was to develop and evaluate a training package for health professionals to support the introduction of NIPT into clinical practice. METHODS Training on NIPT was offered to health professionals, primarily midwives, involved in Down syndrome screening and testing in eight hospitals located in England and Scotland as part of a research study evaluating the implementation of NIPT in the UK National Health Service. Training was evaluated using a mixed methods approach that included quantitative questionnaires at three time points and post-training qualitative interviews. The questionnaires measured confidence, self-perceived knowledge and actual knowledge about NIPT for Down syndrome. Interviews explored opinions about the training and experiences of offering NIPT. RESULTS The training provided to the health professionals was found to positively impact on their confidence in discussing NIPT with women in their clinic, and both their perceived and actual knowledge and understanding of NIPT was improved. Knowledge remained weak in four areas; cell-free fetal DNA levels increase with gestation; turnaround time for NIPT results; cell-free fetal DNA is placental in origin; and NIPT false positive rate. CONCLUSIONS Training materials, including a lesson plan, PowerPoint presentation and written factsheet on NIPT, have been developed and evaluated for use in educating midwives and supporting the introduction of NIPT. Implementation of training should include a greater focus on the areas where knowledge remained low. Some groups of midwives will need additional training or support to optimise their confidence in discussing NIPT with women.
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Affiliation(s)
- Kerry Oxenford
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Daley
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Celine Lewis
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Lyn S Chitty
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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28
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Maxwell S, O'Leary P, Dickinson JE, Suthers GK. Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non-invasive prenatal testing. Aust N Z J Obstet Gynaecol 2017; 57:432-439. [PMID: 28369759 DOI: 10.1111/ajo.12612] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/31/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21. AIM To describe the diagnostic and economic performance of prenatal screening models for trisomy 21 that use non-invasive prenatal testing as a contingent screen across a range of combined first trimester screening risk cut-offs from a public health system perspective. METHODS Using a hypothetical cohort of 300 000 pregnancies, we modelled the outcomes of 25 contingent non-invasive prenatal testing screening models and compared these to conventional screening, offering women with a high-risk (1 > 300) combined first trimester screening result an invasive test. The 25 models used a range of risk cut-offs. High-risk women were offered invasive testing. Intermediate-risk women were offered non-invasive prenatal testing. We report the cost of each model, detection rate, costs per diagnosis, invasive tests per diagnosis and the number of fetal losses per diagnosis. RESULTS The cost per prenatal diagnosis of trisomy 21 using the conventional model was $51 876 compared to the contingent models which varied from $49 309-66 686. The number of diagnoses and cost per diagnosis increased as the intermediate-risk threshold was lowered. Results were sensitive to trisomy 21 incidence, uptake of testing and cost of non-invasive prenatal testing. CONCLUSION Contingent non-invasive prenatal testing models using more sensitive combined first trimester screening risk cut-offs than conventional screening improved the detection rate of trisomy 21, reduced procedure-related fetal loss and could potentially be provided at a lower cost per diagnosis than conventional screening.
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Affiliation(s)
- Susannah Maxwell
- Health Policy and Management, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Leary
- Health Policy and Management, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Department of Maternal Fetal Medicine, School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.,Ultrasound Department, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Graeme K Suthers
- Department of Genetics, Sonic Healthcare, Macquarie Park, New South Wales, Australia.,School of Paediatrics & Reproductive Health, University of Adelaide SA 5006, Australia
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Chen A, Tenhunen H, Torkki P, Heinonen S, Lillrank P, Stefanovic V. Considering medical risk information and communicating values: A mixed-method study of women's choice in prenatal testing. PLoS One 2017; 12:e0173669. [PMID: 28355226 PMCID: PMC5371284 DOI: 10.1371/journal.pone.0173669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/26/2017] [Indexed: 01/25/2023] Open
Abstract
Introduction Nowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women’s choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies. Methodology This is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women’s choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women’s choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis. Results Statistical data indicated that gestational age and counseling day were strong factors influencing women’s choice. Interview data revealed that women’s values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs. Discussion Values are the determinants of women’s choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.
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Affiliation(s)
- An Chen
- Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland
- * E-mail:
| | - Henni Tenhunen
- Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland
| | - Paulus Torkki
- Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland
| | - Seppo Heinonen
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paul Lillrank
- Aalto University, Institute of Healthcare Engineering, Management and Architecture (HEMA), Espoo, Finland
| | - Vedran Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Moses RM, Brown JH, Wright DC, Diplock H, Melov SJ, McGee TM. Who is and isn't having babies with Down syndrome in western Sydney: a ten year hospital cohort study. Aust N Z J Obstet Gynaecol 2017; 57:146-151. [DOI: 10.1111/ajo.12617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/22/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Rebecca M. Moses
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - James H.W. Brown
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Dale C. Wright
- Department of Cytogenetics, Sydney Genome Diagnostics; The Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Hayley Diplock
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
| | - Sarah J. Melov
- Department of Obstetrics and Gynaecology, Westmead Institute for Maternal and Fetal Medicine; Westmead Hospital; Sydney New South Wales Australia
| | - Therese Mary McGee
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
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31
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A Framework for Describing the Influence of Service Organisation and Delivery on Participation in Fetal Anomaly Screening in England. J Pregnancy 2017; 2017:4975091. [PMID: 28421145 PMCID: PMC5380857 DOI: 10.1155/2017/4975091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022] Open
Abstract
Objective. The aim of this research was to explore the influence of service organisation and delivery on providers and users' interactions and decision-making in the context of Down's syndrome screening. Methods. A qualitative descriptive study involving online interviews conducted with a purposive sample of 34 community midwives, 35 pregnant women, and 15 partners from two maternity services in different health districts in England. Data were analysed using a combination of grounded theory principles and content analysis and a framework was developed. Results. The main emerging concepts were organisational constraints, power, routinisation, and tensions. Providers were concerned about being time-limited that encouraged routine, minimal information-giving and lacked skills to check users' understanding. Users reported their participation was influenced by providers' attitudes, the ambience of the environment, asymmetric power relations, and the offer and perception of screening as a routine test. Discordance between the national programme's policy of nondirective informed choice and providers' actions of recommending and arranging screening appointments was unexpected. Additionally, providers and users differing perceptions of emotional effects of information, beliefs, and expectations created tensions within them, between them, and in the antenatal environment. Conclusions. A move towards a social model of care may be beneficial to empower service users and create less tension for providers and users.
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Murdoch B, Ravitsky V, Ogbogu U, Ali-Khan S, Bertier G, Birko S, Bubela T, De Beer J, Dupras C, Ellis M, Granados Moreno P, Joly Y, Kamenova K, Master Z, Marcon A, Paulden M, Rousseau F, Caulfield T. Non-invasive Prenatal Testing and the Unveiling of an Impaired Translation Process. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:10-17. [DOI: 10.1016/j.jogc.2016.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
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Chen A, Tenhunen H, Torkki P, Heinonen S, Lillrank P, Stefanovic V. Women's choices for invasive or non-invasive testing: influence of gestational age and service delivery. Prenat Diagn 2016; 36:1217-1224. [DOI: 10.1002/pd.4960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 01/09/2023]
Affiliation(s)
- An Chen
- Aalto University; Institute of Healthcare Engineering, Management and Architecture (HEMA); Finland
| | - Henni Tenhunen
- Aalto University; Institute of Healthcare Engineering, Management and Architecture (HEMA); Finland
| | - Paulus Torkki
- Aalto University; Institute of Healthcare Engineering, Management and Architecture (HEMA); Finland
| | - Seppo Heinonen
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology; Helsinki University Hospital and University of Helsinki; Finland
| | - Paul Lillrank
- Aalto University; Institute of Healthcare Engineering, Management and Architecture (HEMA); Finland
| | - Vedran Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology; Helsinki University Hospital and University of Helsinki; Finland
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Oepkes D, Page-Christiaens GCL, Bax CJ, Bekker MN, Bilardo CM, Boon EMJ, Schuring-Blom GH, Coumans ABC, Faas BH, Galjaard RJH, Go AT, Henneman L, Macville MVE, Pajkrt E, Suijkerbuijk RF, Huijsdens-van Amsterdam K, Van Opstal D, Verweij EJJ, Weiss MM, Sistermans EA. Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part I-clinical impact. Prenat Diagn 2016; 36:1083-1090. [PMID: 27750376 PMCID: PMC5214231 DOI: 10.1002/pd.4945] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the clinical impact of nationwide implementation of genome‐wide non‐invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study). Method Women with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn‐around time and pregnancy outcome. Results Between 1 April and 1 September 2014, 1413/23 232 (6%) women received a high‐risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy‐nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn‐around time was 14 days. Follow‐up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%. Conclusion Introduction of NIPT in the Dutch National healthcare‐funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?Non‐invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 is mainly offered in a commercial setting. Offering NIPT to pregnant women at increased risk for fetal trisomy leads to a reduction in invasive testing.
What does this study adds?NIPT implemented as a contingent test under the umbrella of a national health authority‐supported fetal trisomy screening program facilitates optimal counseling with close to 100% follow‐up, results in 86% uptake and confirms a major reduction of invasive tests.
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Affiliation(s)
- Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Caroline J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catia M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elles M J Boon
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Brigitte H Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Attie T Go
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron F Suijkerbuijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik A Sistermans
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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Lewis C, Hill M, Chitty LS. A qualitative study looking at informed choice in the context of non-invasive prenatal testing for aneuploidy. Prenat Diagn 2016; 36:875-81. [PMID: 27477537 PMCID: PMC5053255 DOI: 10.1002/pd.4879] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022]
Abstract
Objective To explore women's attitudes towards non‐invasive prenatal testing (NIPT) and determine factors influencing their decisions around uptake of NIPT. Method We conducted qualitative interviews to assess knowledge, attitude and deliberation amongst women offered NIPT in a public health service. In total, 45 women took part in telephone interviews (79% participation rate). Results Most women could recount the key aspects of NIPT discussed during pre‐test counselling but had variable knowledge about Down syndrome. Analysis of women's attitudes towards undergoing NIPT revealed three dominant factors they considered when reflecting on the test: (1) how NIPT compared with alternative testing options, (2) reflections on coping and (3) moral or religious values. Exploring the deliberative process revealed the different paths women take when making decisions. For some, it was an extension of the decision to have Down syndrome screening; some considered it early on following the booking‐in appointment; others made step‐wise decisions about NIPT when it became relevant to them. Conclusion Our findings support the importance of personalised counselling, whereby women and their partners have the opportunity to reflect on the implications of the test results in the context of their own lives and values. Our data highlight the influence of personal circumstances on decision‐making. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's Already Known About This Topic?Non‐invasive prenatal testing (NIPT) for aneuploidies has entered clinical practice, although concerns exist around the potential for routinisation and erosion of informed choice. Research into informed decision‐making for NIPT is now beginning to emerge, although these are predominantly quantitative studies.
What Does This Study Add?Participants frequently used a combination of clinical information, personal experiences and moral values to guide action. For many participants, decision‐making was a multistep deliberative process which occurred as and when new information became available.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Georgsson S, Sahlin E, Iwarsson M, Nordenskjöld M, Gustavsson P, Iwarsson E. Knowledge and Attitudes Regarding Non-Invasive Prenatal Testing (NIPT) and Preferences for Risk Information among High School Students in Sweden. J Genet Couns 2016; 26:447-454. [PMID: 27480089 PMCID: PMC5415585 DOI: 10.1007/s10897-016-9997-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/12/2016] [Indexed: 01/24/2023]
Abstract
Non-invasive prenatal testing (NIPT) was recently introduced for prenatal testing of genetic disorders. Cell-free fetal DNA is present in maternal blood during pregnancy and enables detection of fetal chromosome aberrations in a maternal blood sample. The public perspective to this new, simple method has not been illuminated. The views of young people (i.e. future parents) are important to develop suitable counseling strategies regarding prenatal testing. The aim was to explore Swedish high school students’ attitudes, knowledge and preferences regarding NIPT. A questionnaire was completed by 305 students recruited from one high school in Stockholm, November and December 2014. Most students (80 %) considered prenatal testing as good. The majority (65 %) was positive or very positive towards NIPT and 62 % stated that they potentially would like to undergo the test if they or their partner was pregnant. The vast majority (94 %) requested further information about NIPT. Most students (61 %) preferred verbal information, whereas 20 % preferred information via the Internet. The majority of the high school students was positive towards prenatal testing and most was positive towards NIPT. Further, information was requested by the vast majority before making a decision about NIPT. Most of the students preferred verbal information and to a lesser extent information via the Internet. The attitudes, knowledge and preferences for risk information concerning NIPT in young adults are important, in order to increase knowledge on how to educate and inform future parents.
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Affiliation(s)
- Susanne Georgsson
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden. .,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, SE-171 77, Sweden.
| | - Ellika Sahlin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Moa Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
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Chitty LS, Wright D, Hill M, Verhoef TI, Daley R, Lewis C, Mason S, McKay F, Jenkins L, Howarth A, Cameron L, McEwan A, Fisher J, Kroese M, Morris S. Uptake, outcomes, and costs of implementing non-invasive prenatal testing for Down's syndrome into NHS maternity care: prospective cohort study in eight diverse maternity units. BMJ 2016; 354:i3426. [PMID: 27378786 PMCID: PMC4933930 DOI: 10.1136/bmj.i3426] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the benefits and costs of implementing non-invasive prenatal testing (NIPT) for Down's syndrome into the NHS maternity care pathway. DESIGN Prospective cohort study. SETTING Eight maternity units across the United Kingdom between 1 November 2013 and 28 February 2015. PARTICIPANTS All pregnant women with a current Down's syndrome risk on screening of at least 1/1000. MAIN OUTCOME MEASURES Outcomes were uptake of NIPT, number of cases of Down's syndrome detected, invasive tests performed, and miscarriages avoided. Pregnancy outcomes and costs associated with implementation of NIPT, compared with current screening, were determined using study data on NIPT uptake and invasive testing in combination with national datasets. RESULTS NIPT was prospectively offered to 3175 pregnant women. In 934 women with a Down's syndrome risk greater than 1/150, 695 (74.4%) chose NIPT, 166 (17.8%) chose invasive testing, and 73 (7.8%) declined further testing. Of 2241 women with risks between 1/151 and 1/1000, 1799 (80.3%) chose NIPT. Of 71 pregnancies with a confirmed diagnosis of Down's syndrome, 13/42 (31%) with the diagnosis after NIPT and 2/29 (7%) after direct invasive testing continued, resulting in 12 live births. In an annual screening population of 698 500, offering NIPT as a contingent test to women with a Down's syndrome screening risk of at least 1/150 would increase detection by 195 (95% uncertainty interval -34 to 480) cases with 3368 (2279 to 4027) fewer invasive tests and 17 (7 to 30) fewer procedure related miscarriages, for a non-significant difference in total costs (£-46 000, £-1 802 000 to £2 661 000). The marginal cost of NIPT testing strategies versus current screening is very sensitive to NIPT costs; at a screening threshold of 1/150, NIPT would be cheaper than current screening if it cost less than £256. Lowering the risk threshold increases the number of Down's syndrome cases detected and overall costs, while maintaining the reduction in invasive tests and procedure related miscarriages. CONCLUSIONS Implementation of NIPT as a contingent test within a public sector Down's syndrome screening programme can improve quality of care, choices for women, and overall performance within the current budget. As some women use NIPT for information only, the Down's syndrome live birth rate may not change significantly. Future research should consider NIPT uptake and informed decision making outside of a research setting.
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Affiliation(s)
- Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health, London WC1N 3BH, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Wright
- Department of Statistics, Plymouth University, Plymouth, UK
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health, London WC1N 3BH, UK
| | - Talitha I Verhoef
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca Daley
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Celine Lewis
- Genetics and Genomic Medicine, UCL Institute of Child Health, London WC1N 3BH, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Mason
- North-East Thames Regional Genetics Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fiona McKay
- North-East Thames Regional Genetics Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Jenkins
- North-East Thames Regional Genetics Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Abigail Howarth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Alec McEwan
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals, Nottingham, UK
| | - Jane Fisher
- Antenatal Results and Choices (ARC), London, UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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Gammon BL, Kraft SA, Michie M, Allyse M. "I think we've got too many tests!": Prenatal providers' reflections on ethical and clinical challenges in the practice integration of cell-free DNA screening. ACTA ACUST UNITED AC 2016; 2:334-342. [PMID: 28180146 DOI: 10.1016/j.jemep.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The recent introduction of cell-free DNA-based non-invasive prenatal screening (cfDNA screening) into clinical practice was expected to revolutionize prenatal testing. cfDNA screening for fetal aneuploidy has demonstrated higher test sensitivity and specificity for some conditions than conventional serum screening and can be conducted early in the pregnancy. However, it is not clear whether and how clinical practices are assimilating this new type of testing into their informed consent and counselling processes. Since the introduction of cfDNA screening into practice in 2011, the uptake and scope have increased dramatically. Prenatal care providers are under pressure to stay up to date with rapidly changing cfDNA screening panels, manage increasing patient demands, and keep up with changing test costs, all while attempting to use the technology responsibly and ethically. While clinical literature on cfDNA screening has shown benefits for specific patient populations, it has also identified significant misunderstandings among providers and patients alike about the power of the technology. The unique features of cfDNA screening, in comparison to established prenatal testing technologies, have implications for informed decision-making and genetic counselling that must be addressed to ensure ethical practice. OBJECTIVES This study explored the experiences of prenatal care providers at the forefront of non-invasive genetic screening in the United States to understand how this testing changes the practice of prenatal medicine. We aimed to learn how the experience of providing and offering this testing differs from established prenatal testing methodologies. These differences may necessitate changes to patient education and consent procedures to maintain ethical practice. METHODS We used the online American Congress of Obstetricians and Gynecologists Physician Directory to identify a systematic sample of five prenatal care providers in each U.S. state and the District of Columbia. Beginning with the lowest zip code in each state, we took every fifth name from the directory, excluding providers who were retired, did not currently practice in the state in which they were listed, or were not involved in a prenatal specialty. After repeating this step twice and sending a total of 461 invitations, 37 providers expressed interest in participating, and we completed telephone interviews with 21 providers (4.6%). We developed a semi-structured interview guide including questions about providers' use of and attitudes toward cfDNA screening. A single interviewer conducted and audio-recorded all interviews by telephone, and the interviews lasted approximately 30 minutes each. We collaboratively developed a codebook through an iterative process of transcript review and code application, and a primary coder coded all transcripts. RESULTS Prenatal care providers have varying perspectives on the advantages of cfDNA screening and express a range of concerns regarding the implementation of cfDNA screening in practice. While providers agreed on several advantages of cfDNA, including increased accuracy, earlier return of results, and decreased risk of complications, many expressed concern that there is not enough time to adequately counsel and educate patients on their prenatal screening and testing options. Providers also agreed that demand for cfDNA screening has increased and expressed a desire for more information from professional societies, labs, and publications. Providers disagreed about the healthcare implications and future of cfDNA screening. Some providers anticipated that cfDNA screening would decrease healthcare costs when implemented widely and expressed optimism for expanded cfDNA screening panels. Others were concerned that cfDNA screening would increase costs over time and questioned whether the expansion to include microdeletions could be done ethically. CONCLUSIONS The perspectives and experiences of the providers in this study allow insight into the clinical benefit, burden on prenatal practice, and potential future of cfDNA screening in clinical practice. Given the likelihood that the scope and uptake of cfDNA screening will continue to increase, it is essential to consider how these changes will affect frontline prenatal care providers and, in turn, patients. Providers' requests for additional guidance and data as well as their concerns with the lack of time available to explain screening and testing options indicate significant potential issues with patient care. It is important to ensure that the clinical integration of cfDNA screening is managed responsibly and ethically before it expands further, exacerbating pre-existing issues. As prenatal screening evolves, so should informed consent and the resources available to women making decisions. The field must take steps to maximize the advantages of cfDNA screening and responsibly manage its ethical issues.
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Affiliation(s)
- B L Gammon
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - S A Kraft
- Stanford University Center for Biomedical Ethics, 1215 Welch Road, Modular A, Stanford, CA 94305, USA
| | - M Michie
- UCSF School of Nursing, 3333 Calif. Street, Laurel Heights, San Francisco, CA 94118, USA
| | - M Allyse
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Sahlin E, Nordenskjöld M, Gustavsson P, Wincent J, Georgsson S, Iwarsson E. Positive Attitudes towards Non-Invasive Prenatal Testing (NIPT) in a Swedish Cohort of 1,003 Pregnant Women. PLoS One 2016; 11:e0156088. [PMID: 27195496 PMCID: PMC4872994 DOI: 10.1371/journal.pone.0156088] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 01/20/2023] Open
Abstract
Objective The clinical utilization of non-invasive prenatal testing (NIPT) for identification of fetal aneuploidies is expanding worldwide. The aim of this study was to gain an increased understanding of pregnant women’s awareness, attitudes, preferences for risk information and decision-making concerning prenatal examinations with emphasis on NIPT, before its introduction into Swedish healthcare. Method Pregnant women were recruited to fill in a questionnaire, including multiple-choice questions and Likert scales, at nine maternity clinics located in different areas of Stockholm, Sweden. Results In total, 1,003 women participated in the study (86% consent rate). The vast majority (90.7%) considered examinations aiming to detect fetal abnormalities to be good. Regarding NIPT, 59.8% stated that they had heard about the method previously, yet 74.0% would like to use the test if available. The main factor affecting the women’s decision to undergo prenatal chromosomal screening was worry about the baby’s health (82.5%), followed by the urge to have as much information as possible about the fetus (54.5%). Most women (79.9%) preferred to receive NIPT information orally. Conclusion The overwhelming majority of a cohort of 1,003 pregnant women considered prenatal examinations good. Moreover, the majority had a positive attitude towards NIPT and would like to use the test if available.
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Affiliation(s)
- Ellika Sahlin
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
- * E-mail:
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Josephine Wincent
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Susanne Georgsson
- Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
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40
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Crombag NMTH, van Schendel RV, Schielen PCJI, Bensing JM, Henneman L. Present to future: what the reasons for declining first-trimester combined testing tell us about accepting or declining cell-free DNA testing. Prenat Diagn 2016; 36:587-90. [PMID: 27061402 DOI: 10.1002/pd.4824] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/29/2016] [Accepted: 04/06/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel V van Schendel
- Department of Clinical Genetics, section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Thornton L, Batterham PJ, Fassnacht DB, Kay-Lambkin F, Calear AL, Hunt S. Recruiting for health, medical or psychosocial research using Facebook: Systematic review. Internet Interv 2016; 4:72-81. [PMID: 30135792 PMCID: PMC6096238 DOI: 10.1016/j.invent.2016.02.001] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 11/24/2022] Open
Abstract
Recruiting participants is a challenge for many health, medical and psychosocial research projects. One tool more frequently being used to improve recruitment is the social networking website Facebook. A systematic review was conducted to identify studies that have used Facebook to recruit participants of all ages, to any psychosocial, health or medical research. 110 unique studies that used Facebook as a recruitment source were included in the review. The majority of studies used a cross-sectional design (80%) and addressed a physical health or disease issue (57%). Half (49%) of the included studies reported specific details of the Facebook recruitment process. Researchers paid between $1.36 and $110 per completing participants (Mean = $17.48, SD = $23.06). Among studies that examined the representativeness of their sample, the majority concluded (86%) their Facebook-recruited samples were similarly representative of samples recruited via traditional methods. These results indicate that Facebook is an effective and cost-efficient recruitment method. Researchers should consider their target group, advertisement wording, offering incentives and no-cost methods of recruitment when considering Facebook as a recruitment source. It is hoped this review will assist researchers to make decisions regarding the use of Facebook as a recruitment tool in future research.
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Affiliation(s)
- Louise Thornton
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Philip J. Batterham
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia
| | - Daniel B. Fassnacht
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Frances Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
- Corresponding author at: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Alison L. Calear
- National Institute for Mental Health Research, The Australian National University, Canberra, Australia
| | - Sally Hunt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
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Lewis C, Hill M, Chitty LS. Women's Experiences and Preferences for Service Delivery of Non-Invasive Prenatal Testing for Aneuploidy in a Public Health Setting: A Mixed Methods Study. PLoS One 2016; 11:e0153147. [PMID: 27045195 PMCID: PMC4821600 DOI: 10.1371/journal.pone.0153147] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy is currently only available in the UK through the private sector outside of the research arena. As part of an implementation study in the UK National Health Service we conducted a mixed methods study to assess women’s experience of being offered NIPT using validated measures of decisional conflict, decisional regret and anxiety. Clinical service preferences were also explored. Women with a Down syndrome screening risk >1:1000 were invited to take part in the study and offered NIPT, NIPT and invasive testing (for women with a risk above 1:150) or no further testing. A cross-sectional survey and semi-structured interviews were conducted at two time points; at the time of testing and one month following receipt of results (or equivalent for NIPT decliners). In total, 845 questionnaires and 81 interviews were analysed. The main motivation to accept NIPT was for reassurance (30.8%). Decisional conflict occurred in a minimal number of cases (3.8%), however, none of the participants experienced decisional regret. Around a third (29.9%) of women had elevated anxiety at the time of testing, including intermediate risk women who traditionally would not be offered further testing (54.4% high risk; 20.1% medium risk), a finding supported through the qualitative interviews where prolonged or additional anxiety was found to occur in some medium risk cases. Women were overwhelmingly positive about the opportunity to have a test that was procedurally safe, accurate, reduced the need for invasive testing and identified cases of Down syndrome that might otherwise have been missed. Reassurance was identified as the main motivator for accepting NIPT, particularly amongst medium risk women, with high risk women inclined to accept NIPT to inform decisions around invasive testing. The current turnaround time for test result was identified as a key limitation. All the women interviewed thought NIPT should be adopted as part of NHS clinical practice, with the majority favouring NIPT offered as a first-line test. Our study highlights the potential that NIPT has to positively impact women’s experience of prenatal testing for aneuploidy.
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Affiliation(s)
- Celine Lewis
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- * E-mail:
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
| | - Lyn S. Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
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Pariente G, Hasan L, Gadot Y, De Souza LR, Lebovic G, Berger H. Canadian women's attitudes toward noninvasive prenatal testing of fetal DNA in maternal plasma (.). J Matern Fetal Neonatal Med 2016; 29:4008-14. [PMID: 26940147 DOI: 10.3109/14767058.2016.1152253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the perceptions and attitudes of Canadian women to Noninvasive Prenatal Testing of fetal DNA. STUDY DESIGN A designed questionnaire was administered to women attending the outpatient antenatal clinic at a tertiary urban hospital. Attitudes to current and new prenatal screening modalities were assessed using a five-point Likert scale. Bowker's test of symmetry was used to compare individual responses regarding the two screening modalities. Changes in women's responses pre- and post-delivery were also compared. RESULTS One hundred and twenty-nine women were enrolled in this study. 88% of women state that they would perform prenatal screening via fetal DNA in the maternal plasma if available. When compared to conventional screening, significantly less women believe that the NIPT should be available upon request for non-medical traits (36.4% versus 60.4%, p < 0.001). When compared to their answer before delivery, more women agreed that screening with fetal DNA in maternal plasma could be used in a negative way to select for desired non-medical traits such as gender. CONCLUSIONS The use of fetal DNA in the maternal plasma is widely accepted in our Canadian population as a future method of noninvasive prenatal screening despite recognition of certain ethical concerns. This information can be used when implementing new genetic screening programs.
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Affiliation(s)
- Gali Pariente
- a Department of Obstetrics and Gynecology , Saint Michael's Hospital , Toronto , Canada
| | - Lara Hasan
- b Case Western Reserve University , Cleveland , OH , USA
| | - Yifat Gadot
- a Department of Obstetrics and Gynecology , Saint Michael's Hospital , Toronto , Canada
| | - Leanne R De Souza
- a Department of Obstetrics and Gynecology , Saint Michael's Hospital , Toronto , Canada
| | - Gerald Lebovic
- c Li Ka Shing Knowledge Institute of St. Michael's Hospital , Toronto , Canada .,d Institute for Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada , and
| | - Howard Berger
- a Department of Obstetrics and Gynecology , Saint Michael's Hospital , Toronto , Canada .,d Institute for Health Policy, Management and Evaluation, University of Toronto , Toronto , Canada , and.,e Faculty of Medicine , University of Toronto , Toronto , Canada
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Lau J, Yi H, Ahmed S. Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individualvsrelational autonomy. Clin Genet 2016; 89:550-6. [DOI: 10.1111/cge.12743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 01/31/2023]
Affiliation(s)
- J.Y.C. Lau
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
| | - H. Yi
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
- CUHK Centre for Bioethics; The Chinese University of Hong Kong; Hong Kong SAR China
| | - S. Ahmed
- Leeds Institute of Health Sciences; University of Leeds; Leeds United Kingdom
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Walker BS, Jackson BR, LaGrave D, Ashwood ER, Schmidt RL. A cost-effectiveness analysis of cell free DNA as a replacement for serum screening for Down syndrome. Prenat Diagn 2016; 35:440-6. [PMID: 25273838 DOI: 10.1002/pd.4511] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 08/07/2014] [Accepted: 09/26/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of this article is to determine the cost effectiveness of cell free DNA (cfDNA) as a replacement for integrated screening using a societal cost perspective. METHOD This study used Monte-Carlo simulation with one-way and probabilistic sensitivity analysis. RESULTS Cell free DNA is more effective and less costly than integrated screening. The incremental cost-effectiveness ratio for cfDNA relative to the integrated test was -$277 955 per case detected (95th percent confidence interval -$881 882 to $532 785). CONCLUSION Cell free DNA screening is a cost-effective replacement for maternal serum screening when the lifetime costs of Down syndrome live births are considered. The adoption of cfDNA screening would save approximately $277 955 for each additional case detected over integrated screening.
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Affiliation(s)
- Brandon S Walker
- Department of Pathology and ARUP Laboratories, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Anselem O, Keroui S, Deput-Rampon C, Chartier M, Costa JM, Goffinet F, Tsatsaris V. [Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 in high-risk population: Couples acceptance and grounds for refusal]. ACTA ACUST UNITED AC 2016; 45:918-923. [PMID: 26780844 DOI: 10.1016/j.jgyn.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/29/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the determinants associated with the use of analysis of cell-free DNA in maternal blood for detection of trisomy 21 in high-risk women. MATERIALS AND METHODS Prospective study conducted in a single center between July 15, 2014 and December 15, 2014 on 99 consecutive women with increased risk of trisomy 21 above 1/250. RESULTS Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 was proposed to 95 women out of 99, among them, 43 women (45.3%) required the test. Among these 43 women, 17 (38.6%) had a higher socio-economic status versus 10 (19.2%) among the women who did not request the test (P=0.03). The most common reason given by the 52 women who did not request the analysis of cell-free DNA was the cost, for 30 of them (57.7%), then because the test was not providing certainty for the diagnostic of trisomy 21 for 23 women (44.2%). CONCLUSION Analysis of cell-free DNA on maternal blood for detection of trisomy 21 does not seem accepted by the majority of women. The cost is probably the main reason for not using this test, but it seems that the lack of diagnostic certainty is also an obstacle for some women.
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Affiliation(s)
- O Anselem
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - S Keroui
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Deput-Rampon
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - M Chartier
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - J-M Costa
- Département de biologie spécialisée et de génétique, laboratoire Cerba, 95310 Saint-Ouen l'Aumône, France
| | - F Goffinet
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UPMC, 53, avenue de l'Observatoire, 75014 Paris, France
| | - V Tsatsaris
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UPMC, 53, avenue de l'Observatoire, 75014 Paris, France
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Abstract
Cell-free DNA (cfDNA) testing has recently become indispensable in diagnostic testing and screening. In the prenatal setting, this type of testing is often called noninvasive prenatal testing (NIPT). With a number of techniques, using either next-generation sequencing or single nucleotide polymorphism-based approaches, fetal cfDNA in maternal plasma can be analyzed to screen for rhesus D genotype, common chromosomal aneuploidies, and increasingly for testing other conditions, including monogenic disorders. With regard to screening for common aneuploidies, challenges arise when implementing NIPT in current prenatal settings. Depending on the method used (targeted or nontargeted), chromosomal anomalies other than trisomy 21, 18, or 13 can be detected, either of fetal or maternal origin, also referred to as unsolicited or incidental findings. For various biological reasons, there is a small chance of having either a false-positive or false-negative NIPT result, or no result, also referred to as a "no-call." Both pre- and posttest counseling for NIPT should include discussing potential discrepancies. Since NIPT remains a screening test, a positive NIPT result should be confirmed by invasive diagnostic testing (either by chorionic villus biopsy or by amniocentesis). As the scope of NIPT is widening, professional guidelines need to discuss the ethics of what to offer and how to offer. In this review, we discuss the current biochemical, clinical, and ethical challenges of cfDNA testing in the prenatal setting and its future perspectives including novel applications that target RNA instead of DNA.
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Abstract
Prenatal diagnosis and screening have undergone rapid development in recent years, with advances in molecular technology driving the change. Noninvasive prenatal testing (NIPT) for Down syndrome as a highly sensitive screening test is now available worldwide through the commercial sector with many countries moving toward implementation into their publically funded maternity systems. Noninvasive prenatal diagnosis (NIPD) can now be performed for definitive diagnosis of some recessive and X-linked conditions, rather than just paternally inherited dominant and de novo conditions. NIPD/T offers pregnant couples greater choice during their pregnancy as these safer methods avoid the risk of miscarriage associated with invasive testing. As the cost of sequencing falls and technology develops further, there may well be potential for whole exome and whole genome sequencing of the unborn fetus using cell-free DNA in the maternal plasma. How such assays can or should be implemented into the clinical setting remain an area of significant debate, but it is clear that the progress made to date for safer prenatal testing has been welcomed by expectant couples and their healthcare professionals.
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Vanstone M, Yacoub K, Giacomini M, Hulan D, McDonald S. Women's Experiences of Publicly Funded Non-Invasive Prenatal Testing in Ontario, Canada: Considerations for Health Technology Policy-Making. QUALITATIVE HEALTH RESEARCH 2015; 25:1069-84. [PMID: 26063605 DOI: 10.1177/1049732315589745] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Non-invasive prenatal testing (NIPT) via fetal DNA in maternal blood has been publicly funded in Ontario, Canada, for high-risk women since 2014. We solicited women's experiences and values related to this new health technology to describe how this test is currently being used in Ontario and to provide information about patient priorities to inform future policy decisions about the use of NIPT. Guided by constructivist grounded theory methodology, we interviewed 38 women who had diverse personal experiences with NIPT. Participants' accounts of their values for decision making about NIPT heavily relied on three mutually modulating factors: timing, accuracy, and risk. The values expressed by women conflict with the way that publicly funded NIPT has typically been implemented in Ontario. We offer recommendations for how NIPT might be integrated into prenatal care pathways in a way more consistent with women's values.
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