1
|
Johnston M, Hui L, Bowman-Smart H, Taylor-Sands M, Pertile MD, Mills C. Disparities in integrating non-invasive prenatal testing into antenatal healthcare in Australia: a survey of healthcare professionals. BMC Pregnancy Childbirth 2024; 24:355. [PMID: 38745131 PMCID: PMC11092221 DOI: 10.1186/s12884-024-06565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Non-invasive prenatal testing (NIPT) has been clinically available in Australia on a user-pays basis since 2012. There are numerous providers, with available tests ranging from targeted NIPT (only trisomies 21, 18, and 13 +/- sex chromosome aneuploidy) to genome-wide NIPT. While NIPT is being implemented in the public health care systems of other countries, in Australia, the implementation of NIPT has proceeded without public funding. The aim of this study was to investigate how NIPT has been integrated into antenatal care across Australia and reveal the successes and challenges in its implementation in this context. METHODS An anonymous online survey was conducted from September to October 2022. Invitations to participate were sent to healthcare professionals (HCPs) involved in the provision of NIPT in Australia through professional society mailing lists and networks. Participants were asked questions on their knowledge of NIPT, delivery of NIPT, and post-test management of results. RESULTS A total of 475 HCPs responded, comprising 232 (48.8%) obstetricians, 167 (35.2%) general practitioners, 32 (6.7%) midwives, and 44 (9.3%) genetic specialists. NIPT was most commonly offered as a first-tier test, with most HCPs (n = 279; 60.3%) offering it to patients as a choice between NIPT and combined first-trimester screening. Fifty-three percent (n = 245) of respondents always offered patients a choice between NIPT for the common autosomal trisomies and expanded (including genome-wide) NIPT. This choice was understood as supporting patient autonomy and informed consent. Cost was seen as a major barrier to access to NIPT, for both targeted and expanded tests. Equitable access, increasing time demands on HCPs, and staying up to date with advances were frequently reported as major challenges in delivering NIPT. CONCLUSIONS Our findings demonstrate substantial variation in the clinical implementation of NIPT in Australia, including in the offers of expanded screening options. After a decade of clinical use, Australian clinicians still report ongoing challenges in the clinical and equitable provision of NIPT.
Collapse
Affiliation(s)
- Molly Johnston
- Monash Bioethics Centre, Monash University, Wellington Rd, Clayton, 3800, Australia.
| | - Lisa Hui
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, 3010, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, 3052, Australia
- Mercy Hospital for Women, Heidelberg, 3084, Australia
- Northern Health, Epping, 3076, Australia
| | - Hilary Bowman-Smart
- Monash Bioethics Centre, Monash University, Wellington Rd, Clayton, 3800, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, 5061, Australia
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, 3052, Australia
| | | | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
| | - Catherine Mills
- Monash Bioethics Centre, Monash University, Wellington Rd, Clayton, 3800, Australia
| |
Collapse
|
2
|
Amiel A, Tarabeih M. Prenatal Tests Undertaken by Muslim Women Who Underwent IVF Treatment, Secular Versus Religious: An Israeli Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:3204-3214. [PMID: 36890359 DOI: 10.1007/s10943-023-01786-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Our goal was to determine if differences exist in the attitudes of religious Muslim women living in Israel toward prenatal testing and pregnancy termination after undergoing in vitro fertilization (IVF) compared to the secular Muslim women who had undergone IVF. Six hundred and ninety-nine Muslim women from cities and villages participated, 47% city-dwellers; 53% village-dwellers; 50%-secular; 50%-religious. Secular women who had undergone IVF performed more invasive tests and terminated more pregnancies due to an abnormal fetus than religious women. More genetic counseling must be provided explaining the different prenatal tests and the problems in raising an abnormal child.
Collapse
Affiliation(s)
- Aliza Amiel
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St., P.O.B 8401, 61083, Tel-Aviv, Israel.
| | - Mahdi Tarabeih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St., P.O.B 8401, 61083, Tel-Aviv, Israel
| |
Collapse
|
3
|
Amiel A, Na’amnih W, Tarabeih M. Prenatal Diagnosis and Pregnancy Termination in Jewish and Muslim Women with a Deaf Child in Israel. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1438. [PMID: 37761399 PMCID: PMC10528870 DOI: 10.3390/children10091438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Deafness is the most common sensory disability in humans, influencing all aspects of life, However, early diagnosis of hearing impairment and initiating the rehabilitation process are of great importance to enable the development of language and communication as soon as possible. We examined the differences in attitudes towards performing prenatal invasive tests and pregnancy terminations in Jewish and Muslim women in Israel due to deafness. Overall, 953 Israeli women, aged 18-46 years with a mean age of 32.0 (SD = 7.12), were enrolled. Of those, 68.7% were city dwellers and 31.3% were village dwellers, and 60.2% were Muslim women and 39.8% were Jewish women. All participants had a child with a hearing impairment or deafness. The group with no genetic hearing loss performed more prenatal invasive tests and pregnancy terminations than those with genetic hearing loss in both ethnic groups. Jewish women performed more invasive prenatal tests and, consequently, a pregnancy termination. Secular Jewish women more frequently underwent pregnancy terminations due to fetal deafness. Further genetic counseling and information concerning IVF and PGD procedures should be provided to the Muslim population.
Collapse
Affiliation(s)
- Aliza Amiel
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv 64044, Israel; (W.N.); (M.T.)
| | - Wasef Na’amnih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv 64044, Israel; (W.N.); (M.T.)
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Mahdi Tarabeih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv 64044, Israel; (W.N.); (M.T.)
| |
Collapse
|
4
|
Bet BB, Wielart L, Ravelli ACJ, van Wely M, van Leeuwen E, Pajkrt E. Financial contribution as reason to opt out of non-invasive prenatal testing. Eur J Obstet Gynecol Reprod Biol 2023; 287:130-136. [PMID: 37311275 DOI: 10.1016/j.ejogrb.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE First trimester non-invasive prenatal testing (NIPT) provides pregnant women with a reliable, non-invasive method to screen for fetal aneuploidies. In the Netherlands, there is a nationwide prenatal screening program in which pregnant women and their partners are counseled about their options around 10 weeks of pregnancy. The first trimester and second trimester scan are fully reimbursed but the NIPT has an own financial contribution of €175 per participant, irrespective of type of insurance. The arguments for this own contribution are fear of uncritical use of NIPT or routinization. NIPT has a relatively stable uptake of 51%, against over 95% for second trimester anomaly scan. We aimed to explore the effect of this financial contribution on the decision to opt out of NIPT. STUDY DESIGN We performed a survey among 350 pregnant women undergoing a second trimester anomaly scan in our center, Amsterdam UMC, between January 2021 and April 2022. All pregnant women who declined NIPT in the first trimester, were asked to participate and answered 11-13 questions about the decision-making process, the reasons to opt out and the financial contribution. RESULTS Information about NIPT was desired in 92% of women and 96% felt sufficiently informed. Most women took the decision not to perform NIPT with their partner and did not experience difficulties in taking this decision. The most important reason to decline NIPT was: "Every child is welcome" (69%). "The test was too expensive" was answered in 12% and was significantly correlated with lower maternal age. Additionally, one in five women (19%) said they would have done NIPT if it had been for free, which was significantly higher in younger women. CONCLUSIONS The own financial contribution plays a role in the decision-making to decline NIPT and partly explains the low uptake in the Netherlands. This suggests that there is no equal access to fetal aneuploidy screening. To overcome this inequality, this own contribution should be abandoned. We speculate that this will have a positive effect on the uptake, which will increase to at least 70% and potentially 94%.
Collapse
Affiliation(s)
- Bo B Bet
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
| | - Lot Wielart
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Anita C J Ravelli
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Madelon van Wely
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands; Centre for Reproductive Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Bowman-Smart H, Gyngell C, Mand C, Amor DJ, Delatycki MB, Savulescu J. Non-Invasive Prenatal Testing for "Non-Medical" Traits: Ensuring Consistency in Ethical Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:3-20. [PMID: 34846986 PMCID: PMC7614328 DOI: 10.1080/15265161.2021.1996659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including "non-medical" traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as "non-medical"; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework.
Collapse
Affiliation(s)
- Hilary Bowman-Smart
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Corresponding author: Hilary Bowman-Smart Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville Victoria Australia 3052, , (03) 8341 6200
| | - Christopher Gyngell
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
| | - Cara Mand
- Murdoch Children’s Research Institute, Parkville, Australia
| | - David J. Amor
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Martin B. Delatycki
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Victorian Clinical Genetics Services, Parkville, Australia
| | - Julian Savulescu
- Murdoch Children’s Research Institute, Parkville, Australia
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
6
|
Adams AD, Jumah N, Okun N, Bonham VL. Equitable delivery of expanded genetic technologies: Considerations for prenatal and reproductive care. Prenat Diagn 2023; 43:435-442. [PMID: 36825328 DOI: 10.1002/pd.6338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Naana Jumah
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, Ontario, Canada
| | - Nanette Okun
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
7
|
Steffensen EH, Skakkebaek A, Gadsbøll K, Petersen OB, Westover T, Strange H, Vogel I. Inclusion of sex chromosomes in noninvasive prenatal testing in Asia, Australia, Europe and the USA: A survey study. Prenat Diagn 2023; 43:144-155. [PMID: 36703254 DOI: 10.1002/pd.6322] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the extent to which sex chromosomes are included in current noninvasive prenatal testing (NIPT) and the reporting practices with respect to fetal chromosomal sex and sex chromosome aberrations (SCAs), in addition to an update on the general implementation of NIPT. METHOD A questionnaire addressing the research objectives was distributed by email to fetal medicine and clinical genetics experts in Asia, Australia, Europe and the USA. RESULTS Guidelines on NIPT are available in the majority of the included countries. Not all existing guidelines address reporting of fetal chromosomal sex and SCAs. In most settings, NIPT frequently includes sex chromosomes (five Australian states, China, Hong Kong, Israel, Singapore, Thailand, USA and 23 of 31 European countries). This occurs most often by default or when parents wish to know fetal sex. In most settings, a potential SCA is reported by stating the risk hereof as "low" or "high" and/or by naming the SCA. Less than 50% of all pregnant women receive NIPT according to respondents from three Australian states, China, Israel, Singapore, Thailand and 24 of 31 European countries. However, this percentage, the genomic coverage of NIPT and its application as primary or secondary screening vary by setting. CONCLUSION In most of the studied countries/states, NIPT commonly includes sex chromosomes. The reporting practices concerning fetal chromosomal sex and SCAs are diverse and most commonly not addressed by guidelines. In general, NIPT is variably implemented across countries/states.
Collapse
Affiliation(s)
- Ellen Hollands Steffensen
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Skakkebaek
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Gadsbøll
- Department of Obstetrics, Center for Fetal Medicine, Pregnancy and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics, Center for Fetal Medicine, Pregnancy and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Westover
- Maternal-Fetal Medicine and Perinatal Genetics, Capital Health, Cooper Medical School, Rowan University, Camden, New Jersey, USA
| | | | | | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
8
|
Lewit-Mendes MF, Robson H, Kelley J, Elliott J, Brown E, Menezes M, Archibald AD. Experiences of receiving an increased chance of sex chromosome aneuploidy result from non-invasive prenatal testing in Australia: "A more complicated scenario than what I had ever realized". J Genet Couns 2023; 32:213-223. [PMID: 36114608 DOI: 10.1002/jgc4.1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
Many non-invasive prenatal testing (NIPT) platforms screen for sex chromosome aneuploidy (SCA) and SCA analysis is generally included in Australia where NIPT is available as a self-funded test. Little is known about the experience of receiving an NIPT result indicating an increased chance of SCA. This study aimed to explore the experiences of people who received this result and their perspectives on the information, care, and support they received from healthcare practitioners (HCPs). Semi-structured interviews were conducted with people who received an NIPT result indicating an increased chance of SCA and continued their pregnancy. Most participants only had contact with a genetic counselor after receiving their result. Transcribed data were analyzed using rigorous thematic analysis to identify important patterns and themes. Participants (18 women, 2 male partners) described embarking on NIPT, primarily based on advice from their HCP and without much consideration. Consequently, participants expressed feeling unprepared for the unanticipated complexity of their NIPT result and were faced with making a time-sensitive decision about a condition they had not previously considered. While more pre-test information was desired, timely access to genetic counseling post-test assisted with adjustment to the result. These findings suggest that routinization of NIPT may be compromising informed decision-making, resulting in unpreparedness for an increased chance result. Given the increasing uptake and expanding scope of NIPT, resources should be dedicated to educating HCPs offering NIPT and ensuring timely access to genetic counseling post-result. With appropriate funding, genetics services may be able to play a central role in offering information and support to both people who undertake NIPT and their HCPs ordering the testing. Implementing a publicly funded screening program in Australia could assist with standardizing prenatal screening care pathways and consequently better access to appropriate resources.
Collapse
Affiliation(s)
- Miranda F Lewit-Mendes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Genetics, Monash Health, Melbourne, Victoria, Australia
| | - Hazel Robson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Genetics Department, Number 1 Fertility, Melbourne, Victoria, Australia
| | - Joanne Kelley
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Erica Brown
- Genetics Clinic, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Melody Menezes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Ultrasound for Women, Monash IVF, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Loughry L, Pynaker C, White M, Halliday J, Hui L. State-wide increase in prenatal diagnosis of klinefelter syndrome on amniocentesis and chorionic villus sampling: Impact of non-invasive prenatal testing for sex chromosome conditions. Prenat Diagn 2023; 43:156-161. [PMID: 35048400 PMCID: PMC11251400 DOI: 10.1002/pd.6103] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/30/2021] [Accepted: 01/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND To analyze population-based trends in the prenatal diagnosis of sex chromosome aneuploidy (SCA) since the availability of non-invasive prenatal testing (NIPT). METHODS Retrospective state-wide data for all prenatal diagnoses performed <25 weeks gestation from 2005 to 2020 in Victoria, Australia. Non-invasive prenatal testing became locally available from 2012. The prenatal diagnosis rates of SCA as proportions of all prenatal diagnostic tests and all births were calculated. Statistical significance was assessed with the χ2 test for trend, with p < 0.05 considered significant. RESULTS 46,518 amniocentesis and chorionic villus sampling were performed during the study period, detecting 617 SCAs. There was a significant increase in the rate of prenatal SCAs from 5.8 per 10,000 births in 2005 to 8.7 per 10,000 births in 2020 (p < 0.0001). This increase was predominantly due to 47,XXY cases, 91% of which were ascertained via positive NIPT for this condition in 2020. The prenatal diagnosis rate of 47,XXY significantly increased from 0.8 per 10,000 births in 2005 to 4.3 per 10,000 births in 2020 (p < 0.0001). CONCLUSION Screening for SCAs using NIPT has directly led to an increase in their prenatal diagnosis on a population-wide basis, especially 47,XXY. This has implications for clinician education, genetic counselling, and pediatric services.
Collapse
Affiliation(s)
- Lulu Loughry
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Cecilia Pynaker
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Mary White
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Endocrinology & DiabetesThe Royal Children's HospitalParkvilleVictoriaAustralia
- Health Services Research UnitThe Royal Children's HospitalParkvilleVictoriaAustralia
| | - Jane Halliday
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Lisa Hui
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneParkvilleVictoriaAustralia
- Department of Perinatal MedicineMercy Hospital for WomenHeidelbergVictoriaAustralia
- Department of Obstetrics and GynaecologyNorthern Health, EppingMelbourneVictoriaAustralia
| |
Collapse
|
10
|
Ghiasi M, Armour C, Walker M, Shaver N, Bennett A, Little J. Issues associated with possible implementation of Non-Invasive Prenatal Testing (NIPT) in first-tier screening: A rapid scoping review. Prenat Diagn 2023; 43:62-71. [PMID: 36461628 DOI: 10.1002/pd.6278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/24/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
In recent years, as the implementation and use of Non-Invasive Prenatal Testing (NIPT) have increased, the cost of the test has been decreasing. The cost of NIPT is expected to fall further in the upcoming years. As a result of the decreasing cost of NIPT, many jurisdictions may change their prenatal screening policies toward abandoning serum-based screening and instead, implement and support NIPT as the first-tier screening for all women. There are several concerns in replacing first-trimester screening with NIPT. In this scoping review, we aimed to map the existing knowledge about possible issues in the systematic implementation of NIPT as the primary method of first-tier screening and to assess if any jurisdiction has altered its policy and discontinued serum-based prenatal screening in exchange for NIPT. The Medline database (Ovid) and Google Scholar was searched and all the studies discussing, investigating, or reporting on the systematic implementation of NIPT as the primary method of first-tier screening were included. All the studies went through a two-stage screening process and included full-text articles were reviewed. We did not find any articles indicating a country or region that replaced traditional prenatal screening by NIPT. The included articles were charted, and the data about the possible issues in the systematic implementation of NIPT as the primary method of first-tier screening are summarized narratively and presented in tables in four categories. The findings of this scoping review may be informative for stakeholders and policymakers regarding recent changes in NIPT implementation policies around the world and may aid with developing policy for NIPT implementation with a broader perspective.
Collapse
Affiliation(s)
- Maryam Ghiasi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Armour
- Department of Medical Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Prenatal Screening Ontario (PSO), Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nicole Shaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
11
|
Hui L, Halliday J. A decade of non-invasive prenatal screening in Australia: National impact on prenatal screening and diagnostic testing. Aust N Z J Obstet Gynaecol 2022; 63:264-267. [PMID: 36529142 PMCID: PMC10952159 DOI: 10.1111/ajo.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
Prenatal screening for aneuploidy has undergone immense changes over the past two decades. In 2013 cell-free DNA-based non-invasive prenatal testing (NIPT) became a new self-funded option primarily for Down syndrome screening, but also other aneuploidies and genetic conditions. The numbers of Medicare item claims for prenatal diagnostic procedures have halved since the introduction of NIPT, while billings for serum screening fell by 40% over the same period, on a background of steady births. Australia is now observing historically low rates of prenatal diagnostic testing. These data provide an informative snapshot of historic changes in prenatal screening and diagnosis, as our sector prepares for the impending impacts of other advances in genomics on maternity care. They also highlight the need to address equity and quality issues that arise when consumers must bear the full costs of improved genomic tests in the absence of Medicare funding.
Collapse
Affiliation(s)
- Lisa Hui
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Perinatal MedicineMercy Hospital for WomenMelbourneVictoriaAustralia
- Department of Obstetrics and GynaecologyNorthern HealthMelbourneVictoriaAustralia
| | - Jane Halliday
- Reproductive Epidemiology GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
12
|
Tweneboa Kodua AA, Fell DB, Armour C, Dougan S, Bellai-Dussault K, Little J. The impact of maternal and geographical factors on the uptake of non-invasive prenatal testing: A retrospective cohort study. Prenat Diagn 2022; 42:1594-1605. [PMID: 36314119 DOI: 10.1002/pd.6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate recent trends in non-invasive prenatal testing (NIPT) utilisation, including factors associated with geographical variation, and to determine whether maternal or regional characteristics are associated with uptake the of NIPT. METHODS This retrospective cohort study included pregnant individuals in Ontario with an expected date of delivery from August 1st, 2016 to March 31st, 2020. Modified Poisson regression was used to estimate rate ratios for NIPT use adjusted for maternal and healthcare covariates. RESULTS We found substantial variation in NIPT uptake between regions within the province. The highest uptake was found in urban areas, highest quintile of neighbourhood income and education, for those who were ≥40 years of age and had a history of previous aneuploidy, for those with a prenatal care visit in the first trimester, multiple pregnancy, multigravidity and body mass index within the normal range (18.5-24.9 kg/m2 ). CONCLUSION Our study demonstrated significant regional and maternal differences in NIPT uptake across Ontario. Given the large sample size and diverse population, our study may have implications for other jurisdictions with large, socio-demographically and geographically diverse populations.
Collapse
Affiliation(s)
| | - Deshayne Blayre Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Christine Armour
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Shelley Dougan
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Kara Bellai-Dussault
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
13
|
Leibowitz R, Lewis S, Emery J, Massie J, Smith M, Delatycki M, Archibald A. Reproductive genetic carrier screening for cystic fibrosis, fragile X syndrome and spinal muscular atrophy: patterns of community and healthcare provider participation in a Victorian screening program. Aust J Prim Health 2022; 28:580-587. [PMID: 36192111 DOI: 10.1071/py21247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and The Royal Australian College of General Practice recommend that information on carrier screening for at least the most common inherited genetic conditions in our population, that is, thalassaemia, cystic fibrosis (CF), spinal muscular atrophy (SMA), and fragile X syndrome (FXS), should be offered to all women planning pregnancy or in early pregnancy regardless of family history or ethnicity. The aim of this study was to investigate patterns of participation by healthcare providers (HCP) and the community in screening. METHODS Participation in a Victorian program screening for CF, SMA and FXS between September 2013 and October 2018 was analysed. Requesting HCP and patient data were extracted from screening request forms. Data were analysed with respect to profession of requesting HCP, and characteristics of women screened (age, pregnancy status, socioeconomic status, geographic location, and family history of CF, SMA or FXS). In total, 21 172 women and 1288 HCPs participated in the program over this period. RESULTS There was a steep socioeconomic gradient in screening uptake, with nearly half the women screened (10 349) being in the highest socioeconomic quintile. The screening rate was much higher in metropolitan areas than in regional areas. Obstetricians made most of the requests for screening, whereas 20% of requests were by GPs. Most participating GPs only made a single screening request (78%) and very few GPs made >100 screening requests compared with obstetricians (0.2% vs 17%). GPs were more likely to screen women before pregnancy compared with obstetricians (47% vs 11%). Approximately 1.5% of Victorian women of child-bearing age and 3% of pregnant Victorian women were screened by this program over the period of this study. CONCLUSION This study highlights the translation gap between recommendations and practice, with marked inequity of access to reproductive genetic carrier screening in relation to socioeconomic status and geography. Increased participation by GPs could improve community access to reproductive genetic carrier screening, particularly access to preconception screening. Addressing the causes of inequity of access will allow more women and couples the opportunity to make informed choices about participation in screening.
Collapse
Affiliation(s)
- Ruth Leibowitz
- Department of General Practice, University of Melbourne, Melbourne, Vic., Australia
| | - Sharon Lewis
- Department of Paediatrics, Melbourne Medical School, Royal Children's Hospital, Parkville, Vic., Australia; and Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Vic., Australia
| | - John Massie
- Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Vic., Australia; and Children's Bioethics Centre, Parkville, Vic., Australia; and Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Melanie Smith
- Victorian Clinical Genetics Services, Parkville, Vic., Australia
| | - Martin Delatycki
- Victorian Clinical Genetics Services, Parkville, Vic., Australia; and Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Flemington Road, Parkville, Vic. 3052 Australia; and Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Alison Archibald
- Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia; and Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| |
Collapse
|
14
|
Tiller JM, Bakshi A, Brotchie AR, Green RC, Winship IM, Lacaze P. Public willingness to participate in population DNA screening in Australia. J Med Genet 2022:jmg-2022-108921. [DOI: 10.1136/jmg-2022-108921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 12/02/2022]
Abstract
BackgroundPopulation-based DNA screening for medically actionable conditions has the potential to improve public health by enabling early detection, treatment and/or prevention; however, public attitudes and willingness to participate in DNA screening have not been well investigated.MethodsWe presented a scenario to members of the Australian public, randomly selected from the electoral roll via the Australian Survey of Societal Attitudes, describing an adult population DNA screening programme currently under development, to detect risk of medically actionable cancers and heart disease. We asked questions regarding willingness to participate and pay, preferred delivery methods and concerns.ResultsWe received 1060 completed questionnaires (response rate 23%, mean age 58 years). The vast majority (>92%) expressed willingness to undertake DNA screening. When asked about the optimal age of screening, most (56%) favoured early adulthood (aged 18–40 years) rather than at birth or childhood. Many respondents would prefer samples and data be kept for re-screening (36%) or research use (43%); some preferred samples to be destroyed (21%). Issues that decrease likelihood of participation included privacy (75%) and insurance (86%) implications.ConclusionOur study demonstrates public willingness to participate in population DNA screening in Australia, and identifies barriers to participation, to be addressed in the design of screening programmes. Results are informing the development of a pilot national DNA screening programme.
Collapse
|
15
|
van Prooyen Schuurman L, van der Meij K, van Ravesteyn N, Crombag N, van der Wal JG, Kooij C, Martin L, Peters I, Polak M, van Vliet‐Lachotzki E, Galjaard R, Henneman L. Factors involved in the decision to decline prenatal screening with non‐invasive prenatal testing (NIPT). Prenat Diagn 2022; 43:467-476. [PMID: 36109868 DOI: 10.1002/pd.6242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate factors involved in the decision to decline prenatal screening with noninvasive prenatal testing (NIPT). METHOD A questionnaire study was conducted among 219 pregnant women in the Netherlands who had declined prenatal screening with NIPT (TRIDENT-2 study). Respondents were selectively recruited from three hospitals and 19 midwifery practices, primarily located in or near socioeconomically disadvantaged neighborhoods. 44.3% of the respondents were of non-Western ethnic origin and 64.4% were religious. RESULTS Most respondents (77.2%) found the decision to decline NIPT easy to make, and 59.8% had already made the decision before information about NIPT was offered. These respondents were more often religious, multigravida, and had adequate health literacy. The main reasons to decline NIPT were "I would never terminate my pregnancy" (57.1%) and "every child is welcome" (56.2%). For 16.9% of respondents, the out-of-pocket costs (175 euros) played a role in the decision, and the women in this group were more often nonreligious, primigravida, and had inadequate health literacy. CONCLUSION The primary factors involved in the decision to decline NIPT were related to personal values and beliefs, consistent with autonomous choice. Out-of-pocket costs of NIPT hinder equal access for some pregnant women.
Collapse
Affiliation(s)
- Lisanne van Prooyen Schuurman
- Department of Clinical Genetics Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Karuna van der Meij
- Department of Human Genetics Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Amsterdam Reproduction and Development research institute Amsterdam the Netherlands
| | - Nicolien van Ravesteyn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Neeltje Crombag
- Department of Development and Regeneration Cluster Woman and Child Biomedical Sciences KU Leuven Leuven Belgium
- Department of Obstetrics and Gynaecology UMC Utrecht, University Medical Center Utrecht Utrecht the Netherlands
| | - Janneke Gitsels van der Wal
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Caroline Kooij
- Midwifery and Ultrasound Centre "Verloskundigen Vida" Amsterdam the Netherlands
| | - Linda Martin
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam the Netherlands
| | - Ingrid Peters
- Department of Quality and Patient Care Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | - Marike Polak
- Department of Psychology Education and Child Studies (DPECS), Erasmus University Rotterdam Rotterdam the Netherlands
| | | | - Robert‐Jan Galjaard
- Department of Clinical Genetics Erasmus MC, University Medical Center Rotterdam Rotterdam the Netherlands
| | - Lidewij Henneman
- Department of Human Genetics Amsterdam UMC location Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Amsterdam Reproduction and Development research institute Amsterdam the Netherlands
| | | |
Collapse
|
16
|
Sim WS, Yeo SH, Choi C, Yeo TW, Lee JJ, Huynh VA, Finkelstein EA, Ozdemir S. Preferences for a non‐invasive prenatal test as first‐line screening for Down Syndrome: A discrete choice experiment. Prenat Diagn 2022; 42:1368-1376. [DOI: 10.1002/pd.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Wen Shan Sim
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Seow Heong Yeo
- Department of Maternal Fetal Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Christina Choi
- Antenatal Diagnostic Centre KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Tai Wai Yeo
- Department of Pathology and Laboratory Medicine KK Women’s and Children’s Hospital 100 Bukit Timah Road Singapore Singapore229899
| | - Jia Jia Lee
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Vinh Anh Huynh
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
| | - Eric Andrew Finkelstein
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Duke Global Health Institute Duke University 310 Trent Drive Durham NC USA27710
| | - Semra Ozdemir
- Signature Programme in Health Services and Systems Research Duke‐NUS Medical School 8 College Road Singapore Singapore169857
- Saw Swee Hock School of Public Health National University of Singapore 12 Science Drive Singapore Singapore117549
| |
Collapse
|
17
|
Ellison J, Wang C, Yarrington C, Connors P, Hanchate A. Insurance and Geographic Variations in Non-invasive Prenatal Testing. Prenat Diagn 2022; 42:1004-1007. [PMID: 35484945 DOI: 10.1002/pd.6155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jacqueline Ellison
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, United States, Rhode Island
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, United States, Massachusetts
| | - Christina Yarrington
- Boston Medical Center, Department of Obstetrics and Gynecology, Boston, United States, Massachusetts
| | - Philip Connors
- Boston Medical Center, Department of Obstetrics and Gynecology, Boston, United States, Massachusetts
| | - Amresh Hanchate
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Boston, United States, Massachusetts
| |
Collapse
|
18
|
Toft CLF, Diemer T, Ingerslev HJ, Pedersen IS, Adrian SW, Kesmodel US. Patients' choices and opinions on chorionic villous sampling and non-invasive alternatives for prenatal testing following preimplantation genetic testing for hereditary disorders: A cross-sectional questionnaire study. Prenat Diagn 2022; 42:212-225. [PMID: 34997771 DOI: 10.1002/pd.6088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate choices of and reasoning behind chorionic villous sampling and opinions on non-invasive prenatal testing among women and men achieving pregnancy following preimplantation genetic testing (PGT) for hereditary disorders. METHODS A questionnaire was electronically submitted to patients who had achieved a clinical pregnancy following PGT at the Center for Preimplantation Genetic Testing, Aalborg University Hospital, Denmark, between 2017 and 2020. RESULTS Chorionic villous sampling was declined by approximately half of the patients. The primary reason for declining was the perceived risk of miscarriage due to the procedure. Nine out of 10 patients responded that they would have opted for a non-invasive prenatal test if it had been offered. Some patients were not aware that the nuchal translucency scan offered to all pregnant women in the early second trimester only rarely provides information on the hereditary disorder for which PGT was performed. CONCLUSION Improved counseling on the array of prenatal tests and screenings available might be required to assist patients in making better informed decisions regarding prenatal testing. Non-invasive prenatal testing is welcomed by the patients and will likely increase the number of patients opting for confirmatory prenatal testing following PGT for hereditary disorders.
Collapse
Affiliation(s)
- Christian L F Toft
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tue Diemer
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Hans J Ingerslev
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Inge S Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stine W Adrian
- Department of Culture and Learning, Aalborg University, Aalborg, Denmark
| | - Ulrik S Kesmodel
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.,Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
19
|
van der Meij KRM, Kooij C, Bekker MN, Galjaard RJH, Henneman L. Non-invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods. Prenat Diagn 2021; 41:1395-1400. [PMID: 34505288 PMCID: PMC9291196 DOI: 10.1002/pd.6043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Non-Invasive Prenatal Testing (NIPT) is increasingly being implemented worldwide. In public health programs, equitable access to healthcare is a fundamental principle which also applies to fetal aneuploidy screening. However, the out-of-pocket costs of NIPT may lead to sociodemographic disparities in uptake of screening. This study assessed whether there is a difference in the uptake of NIPT in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, where NIPT is implemented in a national screening program (TRIDENT-2 study). METHOD NIPT uptake, postal code and age of 156,562 pregnant women who received pre-test counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used as a proxy to categorize neighborhoods as being either socioeconomically disadvantaged or other. The out-of-pocket costs for NIPT were €175. RESULTS NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% whereas uptake in all other neighborhoods was 47.6% (p < 0.001). The difference in NIPT uptake between socioeconomic disadvantaged neighborhoods and other areas was smaller for the youngest maternal age-group (≤25 years) compared to other age-groups. CONCLUSION The variation in uptake suggest underlying disparities in NIPT uptake, which undermines the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access. This has ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.
Collapse
Affiliation(s)
- Karuna R M van der Meij
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Kooij
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
20
|
Ravitsky V, Roy MC, Haidar H, Henneman L, Marshall J, Newson AJ, Ngan OMY, Nov-Klaiman T. The Emergence and Global Spread of Noninvasive Prenatal Testing. Annu Rev Genomics Hum Genet 2021; 22:309-338. [PMID: 33848430 DOI: 10.1146/annurev-genom-083118-015053] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since its introduction in 2011, noninvasive prenatal testing (NIPT) has spread rapidly around the world. It carries numerous benefits but also raises challenges, often related to sociocultural, legal, and economic contexts. This article describes the implementation of NIPT in nine countries, each with its own unique characteristics: Australia, Canada, China and Hong Kong, India, Israel, Lebanon, the Netherlands, the United Kingdom, and the United States. Themes covered for each country include the structure of the healthcare system, how NIPT is offered, counseling needs and resources, and cultural and legal context regarding disability and pregnancytermination. Some common issues emerge, including cost as a barrier to equitable access, the complexity of decision-making about public funding, and a shortage of appropriate resources that promote informed choice. Conversely, sociocultural values that underlie the use of NIPT vary greatly among countries. The issues described will become even more challenging as NIPT evolves from a second-tier to a first-tier screening test with expanded use.
Collapse
Affiliation(s)
- Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
| | - Marie-Christine Roy
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
| | - Hazar Haidar
- Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A3, Canada;
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - John Marshall
- United Kingdom National Screening Committee, London SE1 8UG, United Kingdom;
| | - Ainsley J Newson
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia;
| | - Olivia M Y Ngan
- Centre for Bioethics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China;
| | - Tamar Nov-Klaiman
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
| |
Collapse
|
21
|
Dong D, Ahmed S, Nichini E, Yi H, Jafri H, Rashid Y, Ahmed M, Zhu J. Decision making on antenatal screening results: A comparative Q-method study of women from two Chinese cities. Health Expect 2020; 24:363-376. [PMID: 33316122 PMCID: PMC8077134 DOI: 10.1111/hex.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background Although an integral part of ethical and quality health care, little is known about the informed decision making of Chinese women with different socioeconomic backgrounds within the context of antenatal testing. Methods To explore women's viewpoints on informed decision making regarding antenatal screening, a Q‐methodology study that combines both quantitative factor analysis and interviews was conducted between June 2016 and February 2017 in Shanghai and Duyun. A total of 169 women (84 Shanghai and 85 Duyun) participated in the study of 41 ranked statements along a Q‐sorting grid. Results Using by‐person factor analysis, five distinct viewpoints are identified: (a) choice is shared with the partner/husband, but the mother has the right to make the final decision; (b) having antenatal tests is not about choice but about a mother's responsibility; (c) choice is a shared decision led primarily by the partner/husband and secondarily by the doctors; (d) choice should be made using the advice of doctors, but the decision should be made with the partner/husband; and (e) choice is a responsibility shared with the partner, family and doctors. Conclusions The study reveals that women with better education and higher incomes demonstrate more autonomy than those with less education. The nuclear family clearly emerges as the main decision makers in health‐care services in China. Patient and Public Contribution The 169 participants shared their views and stories for at least an hour. They were debriefed after the interviews and contributed their thoughts on our study design and interpretation of the data.
Collapse
Affiliation(s)
- Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elena Nichini
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | | | - Mushtaq Ahmed
- Yorkshire Regional Genetics Service, Leeds NHS Teaching Hospitals Trust, Leeds, UK
| | - Jianfeng Zhu
- Anthropological and Ethnological Research Institute, Fudan-Harvard Medical Anthropology Collaborative Research Center, School of Social Development and Public Policy, Fudan University, Shanghai, China
| |
Collapse
|
22
|
Wang Z, Cheng L, Sun Y, Wei X, Cai B, Liao L, Zhang Y, Zhao XZ. Enhanced Isolation of Fetal Nucleated Red Blood Cells by Enythrocyte-Leukocyte Hybrid Membrane-Coated Magnetic Nanoparticles for Noninvasive Pregnant Diagnostics. Anal Chem 2020; 93:1033-1042. [PMID: 33296189 DOI: 10.1021/acs.analchem.0c03933] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fetal nucleated red blood cells (fNRBCs) in maternal peripheral blood containing the whole genetic information of the fetus may serve for noninvasive pregnant diagnostics (NIPD). However, the fetal cell-based NIPD is seriously limited by the poor purity of the isolated fNRBCs. Recently, the biomimetic cell membrane-camouflaged nanoparticles containing outstanding features have been widely used to detect and isolate rare cells from the peripheral blood samples. In this work, enythrocyte (RBC) and leukocyte (WBC) membranes are fused and coated onto magnet nanoparticles and then modified with anti-CD147 to isolate fNRBCs from the maternal peripheral blood with significant efficiency (∼90%) and purity (∼87%) in simulated spiked blood samples. Further, fNRBCs were isolated and identified from a series of maternal peripheral blood samples coming from pregnant women of 11-13 gestational weeks, and different chromosomal aneuploidies were diagnosed using fNRBCs isolated from maternal blood in early pregnancy. Our strategy may offer additional opportunity to overcome the limitations of current cell-based NIPD platforms.
Collapse
Affiliation(s)
- Zixiang Wang
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, China
| | - Lin Cheng
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yue Sun
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, China
| | - Xiaoyun Wei
- Key Laboratory of Medical Information and 3D Bioprinting of Zhejiang Province, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lei Liao
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, China
| | - Yuanzhen Zhang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xing-Zhong Zhao
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan 430072, China
| |
Collapse
|
23
|
Sobering AK, Li D, Beighley JS, Carey JC, Donald T, Elsea SH, Figueroa KP, Gerdts J, Hamlet A, Mirzaa GM, Nelson B, Pulst SM, Smith JL, Tassone F, Toriello HV, Walker RH, Yearwood KR, Bhoj EJ. Experiences with offering pro bono medical genetics services in the West Indies: Benefits to patients, physicians, and the community. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:1030-1041. [PMID: 33274544 DOI: 10.1002/ajmg.c.31871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
We describe our experiences with organizing pro bono medical genetics and neurology outreach programs on several different resource-limited islands in the West Indies. Due to geographic isolation, small population sizes, and socioeconomic disparities, most Caribbean islands lack medical services for managing, diagnosing, and counseling individuals with genetic disorders. From 2015 to 2019, we organized 2-3 clinics per year on various islands in the Caribbean. We also organized a week-long clinic to provide evaluations for children suspected of having autism spectrum disorder. Consultations for over 100 different individuals with suspected genetic disorders were performed in clinics or during home visits following referral by locally registered physicians. When possible, follow-up visits were attempted. When available and appropriate, clinical samples were shipped to collaborating laboratories for molecular analysis. Laboratory tests included karyotyping, cytogenomic microarray analysis, exome sequencing, triplet repeat expansion testing, blood amino acid level determination, biochemical assaying, and metabolomic profiling. We believe that significant contributions to healthcare by genetics professionals can be made even if availability is limited. Visiting geneticists may help by providing continuing medical education seminars. Clinical teaching rounds help to inform local physicians regarding the management of genetic disorders with the aim of generating awareness of genetic conditions. Even when only periodically available, a visiting geneticist may benefit affected individuals, their families, their local physicians, and the community at large.
Collapse
Affiliation(s)
- Andrew K Sobering
- Department of Biochemistry, St. George's University School of Medicine, St. George's, Grenada.,Windward Islands Research and Education Foundation, True Blue, St. George's, Grenada
| | - Dong Li
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer S Beighley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - John C Carey
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tyhiesia Donald
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Karla P Figueroa
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Andre Hamlet
- Grenada General Hospital, Pediatrics Ward, St. George's, Grenada.,Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Ghayda M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
| | - Beverly Nelson
- Clinical Teaching Unit, St. George's University School of Medicine, St. George's, Grenada
| | - Stefan M Pulst
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Janice L Smith
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, School of Medicine, Sacramento, California, USA.,MIND Institute, University of California Davis Medical Center, Sacramento, California, USA
| | - Helga V Toriello
- Department of Pediatrics/Human Development College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Department of Neurology, Mount Sinai School of Medicine, New York City, New York, USA
| | | | - Elizabeth J Bhoj
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
24
|
Huang T, Gibbons C, Rashid S, Priston MK, Bedford HM, Mak-Tam E, Meschino WS. Prenatal screening for trisomy 21: a comparative performance and cost analysis of different screening strategies. BMC Pregnancy Childbirth 2020; 20:713. [PMID: 33228595 PMCID: PMC7686697 DOI: 10.1186/s12884-020-03394-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background Prenatal screening for chromosome aneuploidies have constantly been evolving, especially with the introduction of cell-free fetal DNA (cfDNA) screening in the most recent years. This study compares the performance, costs and timing of test results of three cfDNA screening implementation strategies: contingent, reflex and primary. Methods We modelled enhanced first trimester screening (eFTS) as the first-tier test in contingent or reflex strategies. cfDNA test was performed contingent on or reflex from eFTS results. A comparison was made between cfDNA screening using sequencing technology and Rolling Circle Amplification (RCA)/imaging solution. All model assumptions were based on results from previous publications or information from the Ontario prenatal screening population. Results At an eFTS risk cut-off of ≥1/1000, contingent and reflex cfDNA screening have the same detection rate (DR) (94%) for trisomy 21. Reflex cfDNA screening using RCA/Imaging solution provided the lowest false positive rate and cost. The number of women requiring genetic counselling and diagnostic testing was significantly reduced and women received their cfDNA screening result 9 days sooner compared with the contingent model. While primary cfDNA screening improved the trisomy 21 DR by 3–5%, it was more costly and more women required diagnostic testing. Conclusion Reflex cfDNA screening is the most cost-effective prenatal screening strategy. It can improve the efficiency of prenatal aneuploidy screening by reducing the number of patient visits and providing more timely results.
Collapse
Affiliation(s)
- Tianhua Huang
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada. .,Prenatal Screening Ontario, Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada. .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
| | - Clare Gibbons
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Shamim Rashid
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - Megan K Priston
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - H Melanie Bedford
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ellen Mak-Tam
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Wang Z, Cheng L, Wei X, Cai B, Sun Y, Zhang Y, Liao L, Zhao XZ. High-throughput isolation of fetal nucleated red blood cells by multifunctional microsphere-assisted inertial microfluidics. Biomed Microdevices 2020; 22:75. [PMID: 33079273 DOI: 10.1007/s10544-020-00531-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Being easy, safe and reliable, non-invasive prenatal diagnosis (NIPD) has been greatly pursued in recent years. Holding the complete genetic information of the fetus, fetal nucleated red blood cells (fNRBCs) are viewed as a suitable target for NIPD application. However, effective separating fNRBCs from maternal peripheral blood for clinic use still faces great challenges, given that fNRBCs are extremely rare in maternal blood circulation. Here, by combining the high-throughput inertial microfluidic chip with multifunctional microspheres as size amplification, we develop a novel method to isolate fNRBCs with high performance. To enlarge the size difference between fNRBCs and normal blood cells, we use the gelatin coated microspheres to capture fNRBCs with anti-CD147 as specific recognizer at first. The size difference between fNRBCs captured by the microspheres and normal blood cells makes it easy to purify the captured fNRBCs through the spiral microfluidic chip. Finally, the purified fNRBCs are mildly released from the microspheres by enzymatically degrading the gelatin coating. Cell capture efficiency about 81%, high purity of 83%, as well as cell release viability over 80% were achieved using spiked samples by this approach. Additionally, fNRBCs were successfully detected from peripheral blood of pregnant women with an average of 24 fNRBCs per mL, suggesting the great potential of this method for clinical non-invasive prenatal diagnosis.
Collapse
Affiliation(s)
- Zixiang Wang
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Lin Cheng
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China
| | - Xiaoyun Wei
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Sun
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, People's Republic of China.
| | - Lei Liao
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.
| | - Xing-Zhong Zhao
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, 430072, China.
| |
Collapse
|
26
|
Current Status of Noninvasive Prenatal Testing and Counselling Considerations: An Indian Perspective. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00228-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Kluckow E, Halliday J, Poulton A, Lindquist A, Hutchinson B, Bethune M, Bonacquisto L, Da Silva Costa F, Gugasyan L, Harraway J, Howden A, Kulkarni A, Martin N, McCoy R, Menezes M, Nisbet D, Palma-Dias R, Pertile MD, Poulakis Z, Hui L. Association between timing of diagnosis of trisomy 21, 18, and 13 and maternal socio-economic status in Victoria, Australia: A population-based cohort study from 2015 to 2016. Prenat Diagn 2019; 39:1254-1261. [PMID: 31691307 DOI: 10.1002/pd.5577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To explore the association between timing of diagnosis of common autosomal trisomies, maternal age, and socio-economic status (SES). DESIGN Retrospective study of cytogenetic diagnoses of trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13) in Victoria, Australia, in 2015 to 2016, stratified by timing (prenatal less than 17 weeks gestation, prenatal including or greater than or 17 weeks gestation, and postnatal before 12 months of age), maternal age, and SES region. Utilisation of prenatal testing following a live-born T21 infant was ascertained via record linkage. RESULTS Among 160 230 total births were 571 diagnoses of T21 and 246 of T18/T13. The overall and live birth prevalences of T21 were 3.56 and 0.47 per 1000 births, respectively. Compared with women from disadvantaged SES regions, women from high SES regions were more likely to have a prenatal diagnosis of a trisomy before 17 weeks than after (P < .01) and less likely to have a live-born T21 infant than a prenatal diagnosis (P < .01). There was a significant trend to higher live birth rates of T21 with lower SES (P = .004). The majority (68.5%) of women who gave birth to a live infant with T21 did not utilise prenatal testing. CONCLUSION There is a significant relationship between lower SES, later prenatal diagnosis of trisomy, and higher live birth rate of T21 in Victoria.
Collapse
Affiliation(s)
- Eliza Kluckow
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jane Halliday
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Alice Poulton
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anthea Lindquist
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Briohny Hutchinson
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michael Bethune
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Specialist Women's Ultrasound, Box Hill, Victoria, Australia
| | - Leonard Bonacquisto
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fabricio Da Silva Costa
- Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lucy Gugasyan
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | - James Harraway
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Amanda Howden
- Cytogenetics, Melbourne Pathology, Collingwood, Victoria, Australia
| | - Abhijit Kulkarni
- Cytogenetics, Monash Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | | | - Richard McCoy
- Molecular Genetics, Australian Clinical Labs, Clayton, Victoria, Australia
| | - Melody Menezes
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Monash Ultrasound for Women, Richmond, Victoria, Australia
| | - Debbie Nisbet
- Women's Ultrasound Melbourne, East Melbourne, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Medicine and Radiology, University of Melbourne, Parkville, Victoria, Australia
| | - Ricardo Palma-Dias
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Women's Ultrasound Melbourne, East Melbourne, Victoria, Australia.,Ultrasound Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Mark D Pertile
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Zeffie Poulakis
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Infant Hearing Screening Program, Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia.,Prevention Innovation Group, Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lisa Hui
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, Victoria, Australia
| |
Collapse
|
29
|
Maxwell S, O'Leary P. Public funding for non-invasive prenatal testing for fetal aneuploidy - It's time. Aust N Z J Obstet Gynaecol 2019; 58:385-387. [PMID: 30133740 DOI: 10.1111/ajo.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Susannah Maxwell
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Peter O'Leary
- Health Systems and Health Economics, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine, QE2 Medical Centre, Perth, Western Australia, Australia
| |
Collapse
|
30
|
Lostchuck E, Poulton A, Halliday J, Hui L. Population-based trends in invasive prenatal diagnosis for ultrasound-based indications: two decades of change from 1994 to 2016. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:503-511. [PMID: 29877030 DOI: 10.1002/uog.19107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/29/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess trends in ultrasound-indicated prenatal diagnostic testing performed over the past two decades in the Australian state of Victoria, in the context of rapidly changing practices in aneuploidy screening and chromosome analysis. METHODS This was a retrospective analysis of all ultrasound-indicated prenatal diagnostic testing (amniocentesis and chorionic villus sampling) performed in the state of Victoria between 1994 and 2016. Ultrasound indications for testing included: fetal structural abnormality, fetal death, fetal growth restriction, abnormal amniotic fluid volume, genetic 'soft marker' and unspecified ultrasound abnormality. Maternal age, indication for testing, type of diagnostic procedure, gestational age, type of chromosome analysis (G-banded karyotyping or chromosomal microarray (CMA)) and test results were obtained. Diagnostic yield (i.e. percentage of tests yielding a major abnormality) was analyzed by year, maternal age and gestational age. Statistical analysis was performed using the χ2 tests for trend or difference in proportions, as appropriate. RESULTS During the 23-year study period, 1 533 317 births were recorded and 16 152 diagnostic procedures were performed for the primary indication of ultrasound abnormality. In recent years, ultrasound abnormality became the most common indication for prenatal invasive testing (29.4% of diagnostic tests between 2013 and 2016) due to a steep decline in testing for other indications such as positive result on combined first-trimester screening or advanced maternal age alone. In 2016, over 95% of ultrasound-indicated procedures were performed with CMA; among these, pathogenic copy number variant (CNV) was the most common (3.5%) abnormality detected, followed by trisomy 21 (2.8%). The diagnostic yield of ultrasound-indicated tests performed < 16 weeks was significantly higher than that of tests performed after 20 weeks (31.5% vs 9.0%). CONCLUSIONS Ultrasound-indicated invasive testing is contributing to prenatal diagnosis in new ways in the genomic era. A pathogenic CNV is now the most likely diagnosis after ultrasound-indicated testing, rather than trisomy 21 or other whole-chromosome aneuploidy. Despite steady improvements in first-trimester screening for aneuploidy, the diagnostic yield of ultrasound-indicated tests > 20 weeks has remained stable due to increased utilization of CMA. Procedures performed for structural abnormalities < 16 weeks continue to have the highest diagnostic yield, supporting the benefits of early fetal structural assessment at 11-13 weeks. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- E Lostchuck
- MD Undergraduate Program, University of British Columbia, BC, Canada
| | - A Poulton
- Reproductive Epidemiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - J Halliday
- Reproductive Epidemiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - L Hui
- Reproductive Epidemiology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Northern Hospital, Epping, Victoria, Australia
| |
Collapse
|
31
|
Belcher A, Mangelsdorf M, McDonald F, Curtis C, Waddell N, Hussey K. What does Australia's investment in genomics mean for public health? Aust N Z J Public Health 2019; 43:204-206. [PMID: 30830712 DOI: 10.1111/1753-6405.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Fiona McDonald
- Australian Centre for Health Law Research, Queensland University of Technology
| | | | - Nicola Waddell
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland
| | - Karen Hussey
- Centre for Policy Futures, The University of Queensland
| |
Collapse
|
32
|
Bowman-Smart H, Savulescu J, Mand C, Gyngell C, Pertile MD, Lewis S, Delatycki MB. 'Small cost to pay for peace of mind': Women's experiences with non-invasive prenatal testing. Aust N Z J Obstet Gynaecol 2019; 59:649-655. [PMID: 30724335 PMCID: PMC6850570 DOI: 10.1111/ajo.12945] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/09/2018] [Indexed: 01/17/2023]
Abstract
Background Non‐invasive prenatal testing (NIPT) has been available in Australia on a user‐pays basis since 2012. Since its introduction, it has grown in popularity as a screening method for fetal aneuploidy and may become publicly funded. Aims To assess the motivations and experiences of women who have undergone NIPT in a user‐pays system in Australia. Materials and methods One thousand women who had undergone NIPT through the Victorian Clinical Genetics Services in Melbourne, Australia were contacted and asked to complete a mixed‐methods survey. The number of eligible responses received was 235. Quantitative data analysis was performed in STATA IC 15.1, and qualitative data were examined using content analysis. Results Women reported generally positive experiences with NIPT and 95% of respondents indicated they would undergo NIPT in a future pregnancy. Most respondents received a low‐risk result, with 2.2% receiving a high‐risk result. Respondents viewed NIPT favourably compared to invasive testing and cited reassurance as a key reason they sought it. However, a small minority of women reported negative experiences with the testing process. Women were also supportive of NIPT becoming publicly funded, with 93% of respondents indicating support. Pre‐ and post‐test counselling were identified as possible areas for improvement to ensure informed consent. Conclusion In support of the existing literature, these results indicate that Australian women generally report positive experiences with NIPT. As NIPT becomes more common, with possible integration into public healthcare, further qualitative research would be valuable to examine the motivations and experiences of women undergoing NIPT.
Collapse
Affiliation(s)
- Hilary Bowman-Smart
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Cara Mand
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark D Pertile
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Abdalla O, Woods C, de Costa C. A clinical audit of combined first trimester screening and non-invasive prenatal testing offered to pregnant women in a regional Australian hospital. Aust N Z J Obstet Gynaecol 2018; 59:157-160. [PMID: 29984834 DOI: 10.1111/ajo.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
The records of women attending a large Australian regional hospital for antenatal care were retrospectively analysed to determine what proportion had undergone or been offered first trimester screening for fetal abnormalities; only 609 (54%) of 1114 women had undergone or been offered screening. Younger women, multiparous women and women living in rural Australia were less likely to be offered screening. Barriers to screening and solutions for overcoming these need to be identified to improve access and equality in antenatal screening for all women.
Collapse
Affiliation(s)
- Orit Abdalla
- James Cook University College of Medicine, Cairns, Queensland, Australia.,Obstetrics and Gynaecology Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Cindy Woods
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Caroline de Costa
- James Cook University College of Medicine, Cairns, Queensland, Australia
| |
Collapse
|
34
|
Hui L, Norton M. What is the real "price" of more prenatal screening and fewer diagnostic procedures? Costs and trade-offs in the genomic era. Prenat Diagn 2018; 38:246-249. [PMID: 29441593 DOI: 10.1002/pd.5228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 01/16/2023]
Abstract
Any screening approach, including with cell-free DNA, will have an inferior detection rate compared with 100% diagnostic testing with chromosomal microarrays. Cell-free DNA-based screening, however, should not be seen as a threat to informed choice or maximising the benefits of diagnostic testing. Screening methods have become so much better that more women are now comfortable relying on such screening and do not need the certainty of a diagnostic test. This has not lead to a decline in detection of fetal chromosome abnormalities-in fact, we are now seeing historically high yields from prenatal screening. There are both economic and ethical consequences of offering universal diagnostic testing and abandoning the presumption of a normal infant in otherwise uncomplicated pregnancies. However, for some women, comprehensive information and diagnostic accuracy are important. Offering these women all options, with a careful and comprehensive explanation of the risks and benefits of each, results in outcomes that are best aligned with woman's preferences while at the same time requiring fewer diagnostic tests and lowering costs. It is one of the primary challenges of the modern era of prenatal testing to ensure that women receive sufficient information on which to make informed decisions.
Collapse
Affiliation(s)
- Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, VIC, Australia.,Public Health Genetics Group, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia.,Dept. of Obstetrics and Gynaecology, The Northern Hospital, Epping, VIC, Australia
| | - Mary Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|