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Bayefsky MJ, Berkman BE. Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:4-22. [PMID: 33459580 PMCID: PMC10066540 DOI: 10.1080/15265161.2020.1867933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Prenatal genetic testing is becoming available for an increasingly broad set of diseases, and it is only a matter of time before parents can choose to test for hundreds, if not thousands, of genetic conditions in their fetuses. Should access to certain kinds of fetal genetic information be limited, and if so, on what basis? We evaluate a range of considerations including reproductive autonomy, parental rights, disability rights, and the rights and interests of the fetus as a potential future child. We conclude that parents should be able to access information that could be useful during pregnancy, but that testing for non-medical information should be limited. Next, we argue that the government lacks a compelling state interest in regulating prenatal genetic testing and propose that regulation should occur through medical professional organizations. Finally, we present a framework for determining what testing physicians should recommend, offer neutrally, or not offer at all.
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Affiliation(s)
- Michelle J. Bayefsky
- New York University Langone Health, Department of Obstetrics and Gynecology, New York, NY, USA
| | - Benjamin E. Berkman
- National Institutes of Health, Department of Bioethics, Bethesda, MD, USA
- National Human Genome Research Institute, Bethesda, MD, USA
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Baumann S, Darquy S, Miry C, Duchange N, Moutel G. Termination of pregnancy for foetal indication in the French context analysis of decision-making in a Multidisciplinary Centre For Prenatal Diagnosis. J Gynecol Obstet Hum Reprod 2021; 50:102067. [PMID: 33484935 DOI: 10.1016/j.jogoh.2021.102067] [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: 12/04/2019] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In France, termination of pregnancy (TOP) for medical reasons is legal, regardless of the term, after authorisation by a Multidisciplinary Centre for Prenatal Diagnosis (MCPD). This study analyses the elements supporting the TOP decision-making process faced with a foetal pathology. STUDY DESIGN Medical records of one MCPD were analysed for the period 2013 and 2014 and semi-structured interviews with MCPD members were conducted. RESULTS Out of 265 files concerning foetal indications, all but one resulted in a decision for TOP. The main indications in number for TOP were malformations and chromosomal abnormalities. For indications such as trisomy 21, authorisations are generally given without discussion. Our results underline the importance that professionals attach to the collegiality of decisions, particularly in situations of uncertainty. CONCLUSION This study provides information about the activity of MCPDs within the field of prenatal diagnosis and shows the importance of these structures in supporting women and couples whilst respecting their autonomy. At present, the role of the MCPD is in the process of evolving and could become an information and advisory board for women, based on collegial expertise to guide their decision-making.
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Affiliation(s)
- Sophie Baumann
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France
| | - Sylviane Darquy
- Univ. Bordeaux, Inserm U1219, EPICENE, Cancer et expositions environnementales, 33000 Bordeaux, France.
| | - Claire Miry
- Hôpital Universitaire de Strasbourg, Service de Médecine fœtale, 67091 Strasbourg cedex, France
| | | | - Grégoire Moutel
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France; Espace régional d'éthique, CHU de Caen, Normandie Université, 14000 Caen, France
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Parham L, Michie M, Allyse M. Expanding Use of cfDNA Screening in Pregnancy: Current and Emerging Ethical, Legal, and Social Issues. CURRENT GENETIC MEDICINE REPORTS 2017; 5:44-53. [PMID: 38089918 PMCID: PMC10715629 DOI: 10.1007/s40142-017-0113-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose of Review In 2011, screening platforms became available in the US that detect and analyze fragments of cell-free placental DNA (cfDNA) in maternal blood serum. Marketed as noninvasive prenatal tests (NIPT), cfDNA screening is more accurate than previously available serum screening tests for certain aneuploidies. The combination of a noninvasive procedure, high specificity and sensitivity, and lower false positive rates for some aneuploidies (most notably Down's syndrome) has led to broad clinician and patient adoption. New ethical, legal, and social issues arise from the increased use and expanded implementation of cfDNA in pregnancy. Recent Findings Recently, several professional associations have amended their guidelines on cfDNA, removing language recommending its use in only "high-risk" pregnancies in favor of making cfDNA screening an available option for women with "low-risk" pregnancies as well. At the same time, commercial cfDNA screening laboratories continue to expand the range of available test panels. As a result, the future of prenatal screening will likely include a broader range of genetic tests in a wider range of patients. Summary This article addresses the ethical, legal, and social issues related to the shift in guidance and expanded use of cfDNA in pregnant women, including concerns regarding routinized testing, an unmet and increasing demand for genetic counseling services, social and economic disparities in access, impact on groups living with disabling conditions, and provider liability.
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Affiliation(s)
- Lindsay Parham
- School of Law, Department of Jurisprudence and Social Policy, University of California, Berkeley, Berkeley, CA, USA
| | - Marsha Michie
- School of Nursing, Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA
| | - Megan Allyse
- Biomedical Ethics, Mayo Clinic, Rochester, MN, USA
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Pietropolli A, Capogna MV, Cascella R, Germani C, Bruno V, Strafella C, Sarta S, Ticconi C, Marmo G, Gallaro S, Longo G, Marsella LT, Novelli A, Novelli G, Piccione E, Giardina E. Three-hour analysis of non-invasive foetal sex determination: application of Plexor chemistry. Hum Genomics 2016; 10:9. [PMID: 27044517 PMCID: PMC4820952 DOI: 10.1186/s40246-016-0066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022] Open
Abstract
Background The knowledge of the individual genetic “status” in the prenatal era is particularly relevant in the case of positive family history for genetic diseases, in advanced maternal age and in the general screening for foetal abnormalities. In this context, here, we report an innovative molecular assay which utilizes the cell-free foetal DNA (cffDNA) as a source for the early and fast detection of the foetal sex. The study involved 132 pregnant women in their first 3 months of pregnancy, who agreed to give a blood sample. All the collected samples were immediately subjected to the separation of the plasma, which was utilized for the extraction of the cffDNA. Successively, the extracted cffDNA was analysed by a quantitative PCR (qPCR) method based on Plexor-HY chemistry, which is able to simultaneously identify, quantify and discriminate the autosomal DNA from the sex-linked DNA. Results Overall, the Plexor-HY assay demonstrated to be sensitive and specific for the determination of low-template DNA, such as the cffDNA. In fact, the Plexor-HY assay has been successfully performed in all the samples, identifying 70 males and 62 females. As the foetal sex can be provided in 120 min just by utilizing a maternal blood sample as cffDNA source, the assay represents a very fast, safe and non-invasive prenatal method. Conclusions The possibility of determining the foetal sex in the early prenatal life consents the application of our assay as a helpful screening test for subjects and families at risk of sex-linked disorders. Moreover, the early knowledge of the foetal sex may be of great help even for the specialist, who might promptly advise the patients concerning the foetal risk of inheriting sex-linked disorders and the clinical utility of performing an invasive prenatal diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s40246-016-0066-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adalgisa Pietropolli
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Maria Vittoria Capogna
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Raffaella Cascella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy. .,Emotest Laboratory, M. Licola Patria Street, 60, 80078, Pozzuoli, NA, Italy.
| | - Chiara Germani
- Molecular Genetics Laboratory UILDM, Santa Lucia Foundation, Ardeatina Street, 306, 00142, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Claudia Strafella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Simona Sarta
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Carlo Ticconi
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Giusy Marmo
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Sara Gallaro
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Giuliana Longo
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Antonio Novelli
- Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square, 4, Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy.,Clinical Department of Surgery, "Tor Vergata" University Hospital, Oxford Street, 81, 00133, Rome, Italy
| | - Emiliano Giardina
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata", Montpelier Street, 1, 00133, Rome, Italy.,Molecular Genetics Laboratory UILDM, Santa Lucia Foundation, Ardeatina Street, 306, 00142, Rome, Italy
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