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Groden CM, Vetter CJ, Salih ZNI. Parental Experiences of Genetic Testing. Neoreviews 2024; 25:e151-e158. [PMID: 38425197 DOI: 10.1542/neo.25-3-e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Genetic testing is increasingly used in clinical practice in the neonatal period, including in NICUs. This testing may have psychological consequences for parents. To best support families, neonatal clinicians should be aware of the various ways in which parents view and respond to genetic testing. In this review, we summarize research on the parental experience of having a newborn infant undergo genetic testing.
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Affiliation(s)
| | - Cecelia J Vetter
- Ruth Lily Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Zeynep N I Salih
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
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Pereira S, Smith HS, Frankel LA, Christensen KD, Islam R, Robinson JO, Genetti CA, Blout Zawatsky CL, Zettler B, Parad RB, Waisbren SE, Beggs AH, Green RC, Holm IA, McGuire AL. Psychosocial Effect of Newborn Genomic Sequencing on Families in the BabySeq Project: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:1132-1141. [PMID: 34424265 PMCID: PMC8383160 DOI: 10.1001/jamapediatrics.2021.2829] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Newborn genomic sequencing (nGS) may provide health benefits throughout the life span, but there are concerns that it could also have an unfavorable (ie, negative) psychosocial effect on families. OBJECTIVE To assess the psychosocial effect of nGS on families from the BabySeq Project, a randomized clinical trial evaluating the effect of nGS on the clinical care of newborns from well-baby nurseries and intensive care units. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted from May 14, 2015, to May 21, 2019, at well-baby nurseries and intensive care units at 3 Boston, Massachusetts, area hospitals, 519 parents of 325 infants completed surveys at enrollment, immediately after disclosure of nGS results, and 3 and 10 months after results disclosure. Statistical analysis was performed on a per-protocol basis from January 16, 2019, to December 1, 2019. INTERVENTION Newborns were randomized to receive either standard newborn screening and a family history report (control group) or the same plus an nGS report of childhood-onset conditions and highly actionable adult-onset conditions (nGS group). MAIN OUTCOMES AND MEASURES Mean responses were compared between groups and, within the nGS group, between parents of children who received a monogenic disease risk finding and those who did not in 3 domains of psychosocial impact: parent-child relationship (Mother-to-Infant Bonding Scale), parents' relationship (Kansas Marital Satisfaction Scale), and parents' psychological distress (Edinburgh Postnatal Depression Scale anxiety subscale). RESULTS A total of 519 parents (275 women [53.0%]; mean [SD] age, 35.1 [4.5] years) were included in this study. Although mean scores differed for some outcomes at singular time points, generalized estimating equations models did not show meaningful differences in parent-child relationship (between-group difference in adjusted mean [SE] Mother-to-Infant Bonding Scale scores: postdisclosure, 0.04 [0.15]; 3 months, -0.18 [0.18]; 10 months, -0.07 [0.20]; joint P = .57) or parents' psychological distress (between-group ratio of adjusted mean [SE] Edinburgh Postnatal Depression Scale anxiety subscale scores: postdisclosure, 1.04 [0.08]; 3 months, 1.07 [0.11]; joint P = .80) response patterns between study groups over time for any measures analyzed in these 2 domains. Response patterns on one parents' relationship measure differed between groups over time (between-group difference in adjusted mean [SE] Kansas Marital Satisfaction Scale scores: postdisclosure, -0.19 [0.07]; 3 months, -0.04 [0.07]; and 10 months, -0.01 [0.08]; joint P = .02), but the effect decreased over time and no difference was observed on the conflict measure responses over time. We found no evidence of persistent negative psychosocial effect in any domain. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of nGS, there was no persistent negative psychosocial effect on families among those who received nGS nor among those who received a monogenic disease risk finding for their infant. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02422511.
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Affiliation(s)
- Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Leslie A. Frankel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Kurt D. Christensen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts,Department of Population Medicine, Harvard Medical School, Boston, Massachusetts,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Rubaiya Islam
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Jill Oliver Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Casie A. Genetti
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Carrie L. Blout Zawatsky
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Bethany Zettler
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Richard B. Parad
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Susan E. Waisbren
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alan H. Beggs
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert C. Green
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts,Precision Population Health Initiative, Ariadne Labs, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Ingrid A. Holm
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts,The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
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Kleinberger JW, Maloney KA, Pollin TI. The Genetic Architecture of Diabetes in Pregnancy: Implications for Clinical Practice. Am J Perinatol 2016; 33:1319-1326. [PMID: 27571483 PMCID: PMC5507691 DOI: 10.1055/s-0036-1592078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The genetic architecture of diabetes mellitus in general and in pregnancy is complex, owing to the multiple types of diabetes that comprise both complex/polygenic forms and monogenic (largely caused by a mutation in a single gene) forms such as maturity-onset diabetes of the young (MODY). Type 1 diabetes (T1D) and type 2 diabetes (T2D) have complex genetic etiologies, with over 40 and 90 genes/loci, respectively, implicated that interact with environmental/lifestyle factors. The genetic etiology of gestational diabetes mellitus has largely been found to overlap that of T2D. Genetic testing for complex forms of diabetes is not currently useful clinically, but genetic testing for monogenic forms, particularly MODY, has important utility for determining treatment, managing risk in family members, and pregnancy management. In particular, diagnosing MODY2, caused by GCK mutations, indicates that insulin should not be used, including during pregnancy, with the possible exception of an unaffected pregnancy during the third trimester to prevent macrosomia. A relatively simple method for identifying women with MODY2 has been piloted. MODY1, caused by HNF4A mutations, can paradoxically cause neonatal hyperinsulinemic hypoglycemia and macrosomia, indicating that detecting these cases is also clinically important. Diagnosing all MODY types provides opportunities for diagnosing other family members.
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Affiliation(s)
| | | | - Toni I. Pollin
- To Whom Correspondence May Be Addressed: Toni I. Pollin, MS, PhD, 660 West Redwood Street, Room 445C, Baltimore, MD 21201, 410-706-1630,
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Roth R, Lynch K, Lernmark B, Baxter J, Simell T, Smith L, Swartling U, Ziegler AG, Johnson SB. Maternal anxiety about a child's diabetes risk in the TEDDY study: the potential role of life stress, postpartum depression, and risk perception. Pediatr Diabetes 2015; 16:287-98. [PMID: 25082392 PMCID: PMC4312746 DOI: 10.1111/pedi.12168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/14/2014] [Accepted: 05/21/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To understand the association between life stress, postpartum depression (PD), maternal perception of her child's risk for type 1 diabetes (T1D) and a mother's anxiety about her child's T1D risk in mothers of genetically at risk children in The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHODS A short form of the state component (SAI) of the State-Trait Anxiety Inventory, negative life events (LE), the Edinburgh Postnatal Depression Scale (EPDS), and one question about the child's risk of developing T1D risk perceptions (RP) were given to mothers at the 6-month TEDDY clinic visit. The relationship between the four measures was modeled using multiple regressions. RESULTS Controlling for sociodemographic factors, significant country differences in SAI, LE, EPDS, and RP emerged. LE - particularly interpersonal LE - had a strong association to maternal anxiety about the baby's risk of diabetes. Both evidence of PD and accurate risk perceptions (RPs) about the child's T1D risk were associated with increased maternal anxiety about the child's T1D risk. CONCLUSION Heightened maternal anxiety in response to the news that a child is at increased risk for T1D is common. Mothers who have experienced recent negative LE, who experience PD and who accurately understand their child's risk may be particularly vulnerable to high levels of anxiety. The findings reported here need to be confirmed in future prospective studies.
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Affiliation(s)
- Roswith Roth
- Institut für Diabetesforschung, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, GERMANY,Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, AUSTRIA
| | - Kristian Lynch
- Pediatrics Epidemiology Centre, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa FL 33612 USA
| | - Barbro Lernmark
- Department of Clinical Sciences, Lund University, University Hospital MAS, CRC 72-60-11, 20502 Malmö, SWEDEN
| | - Judy Baxter
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Denver-AMC, Mail Stop F527, 1775 Aurora Court, Aurora CO, 80045 USA,Colorado School of Public Health, Dept. of Community and Behavioral Health, University of Colorado Denver-AMC, Aurora, CO, 80045 USA
| | - Tuula Simell
- Department of Pediatrics, University of Turku, Turku University Hospital, Klinamyllynkatu 4-8 FIN-20520 Turku, FINLAND
| | - Laura Smith
- Department of Pediatrics, University of South Florida,12901 Bruce B. Down Blvd, MCD 62, Tampa, FL 33612, USA
| | - Ulrica Swartling
- Department of Clinical Sciences, Lund University, University Hospital MAS, CRC 72-60-11, 20502 Malmö, SWEDEN
| | - Anette-G. Ziegler
- Institut für Diabetesforschung, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, GERMANY
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, 1115 West Call Street, Talahassee FL 32306-4300 USA
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Bjørk MH, Veiby G, Reiter SC, Berle JØ, Daltveit AK, Spigset O, Engelsen BA, Gilhus NE. Depression and anxiety in women with epilepsy during pregnancy and after delivery: A prospective population-based cohort study on frequency, risk factors, medication, and prognosis. Epilepsia 2014; 56:28-39. [DOI: 10.1111/epi.12884] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Marte Helene Bjørk
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - Gyri Veiby
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - Simone C. Reiter
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - Jan Øystein Berle
- Division of Psychiatry; Bergen Mental Health Research Centre; Haukeland University Hospital; Bergen Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Division of Epidemiology; Norwegian Institute of Public Health; Bergen Norway
| | - Olav Spigset
- Department of Clinical Pharmacology; St. Olav University Hospital; Trondheim Norway
- Department of Laboratory Medicine; Children's and Women's Health; Norwegian University of Science and Technology; Trondheim Norway
| | - Bernt A. Engelsen
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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Nicholls SG, Wilson BJ, Craigie SM, Etchegary H, Castle D, Carroll JC, Potter BK, Lemyre L, Little J. Public attitudes towards genomic risk profiling as a component of routine population screening. Genome 2013; 56:626-33. [PMID: 24237344 DOI: 10.1139/gen-2013-0070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Including low penetrance genomic variants in population-based screening might enable personalization of screening intensity and follow up. The application of genomics in this way requires formal evaluation. Even if clinically beneficial, uptake would still depend on the attitudes of target populations. We developed a deliberative workshop on two hypothetical applications (in colorectal cancer and newborn screening) in which we applied stepped, neutrally-framed, information sets. Data were collected using nonparticipant observation, free-text comments by individual participants, and a structured survey. Qualitative data were transcribed and analyzed using thematic content analysis. Eight workshops were conducted with 170 individuals (120 colorectal cancer screening and 50 newborn screening for type 1 diabetes). The use of information sets promoted informed deliberation. In both contexts, attitudes appeared to be heavily informed by assessments of the likely validity of the test results and its personal and health care utility. Perceived benefits included the potential for early intervention, prevention, and closer monitoring while concerns related to costs, education needs regarding the probabilistic nature of risk, the potential for worry, and control of access to personal genomic information. Differences between the colorectal cancer and newborn screening groups appeared to reflect different assessments of potential personal utility, particularly regarding prevention.
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Affiliation(s)
- S G Nicholls
- a Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
Screening programs designed to identify persons at risk for type 1 diabetes via genetic and antibody testing are controversial because they typically target children, provide only a crude estimate of type 1 diabetes risk, and offer no means of preventing the disease. For this reason, genetic and antibody testing for type 1 diabetes risk is usually limited to carefully conducted research studies. The psychological impact of such screening programs include cognitive, emotional, and behavioral sequelae; the available literature has focused primarily on parents, and usually mothers, since the target of screening is usually infants or young children. Diabetes risk is a difficult construct to effectively communicate. Many individuals fail to accurately understand risk; inaccurate risk perceptions may increase over time and have been associated with early study withdrawal. Simply asking study participants if they understand the risk information provided is insufficient. Anxiety and worry are common reactions to learning that you or a loved one is at increased risk for type 1 diabetes. For most people, anxiety and worry dissipate with time but some individuals may be particularly vulnerable to prolonged anxiety or depression. Although there is no known means to prevent type 1 diabetes in at-risk individuals, families often report increased surveillance of those at risk and behavior changes to prevent the disease, potentially threatening the internal validity of the study.
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Affiliation(s)
- Suzanne Bennett Johnson
- Department of Medical Humanities and Social Science, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.
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