Maternal serum AFP: educating physicians and the public

Optimizing use of existing prenatal genetic tests: Screening and diagnostic testing for aneuploidy

Screening and diagnostic testing for detection of fetal aneuploidy has been an integral part of prenatal care for over three decades. The recent introduction of new technologies, such as cell free DNA (cfDNA) screening and preimplantation genetic screening, has created increased complexity for obstetrical care providers. Inconsistencies among the professional society recommendations have caused confusion and disparities in practice. As we work to responsibly incorporate new technologies, clear guidelines with consensus among relevant professional societies are needed. In January of 2017, a workshop was convened during the Society for Maternal-Fetal Medicine Pregnancy Meeting. Representatives from many stakeholder groups were present with the goal to develop a framework for introduction of new genetic tests into clinical practice. This paper provides consensus recommendations from this workshop on the use of existing prenatal screening and diagnostic testing for aneuploidy.

Maternal serum screening for fetal genetic disorders

Maternal serum analyte screening is an integral component of contemporary antenatal care. Based on elevated MSAFP levels, 85% to 90% of NTDs (e.g., anencephaly or spina bifida) can be detected. Using a combination of serum analytes (e.g., MSAFP, hCG, UE3) 55% to 60% of fetal Down's syndrome can be detected. Future strategies for Down's syndrome screening may include the use of new markers such as dimeric inhibin-A and urinary beta-core fragment of hCG, as well as first-trimester screening, particularly with PAPP-A and free beta-hCG.

Parental autonomy and the obligation not to harm one's child genetically

Examines the potential use of genetic information by parents in ways that offer no preventive or curative effects and that may in fact inflict harm on children.

Carrier screening for cystic fibrosis: implications for obstetric and gynecologic practice

Cystic fibrosis, which is one of the most common autosomal recessive disorders, has a carrier frequency of approximately 1 in 25 among whites in the United States. In this population approximately 75% of the mutations in patients with cystic fibrosis correspond to a 3 base pair deletion that results in the loss of a phenylalanine residue at amino acid position 508 (designated delta F508) from the coding region of the cystic fibrosis gene. Currently, only about half of the couples at risk can be identified as cystic fibrosis carriers. We support conclusions of the National Institutes of Health Workshop on Population Screening for the Cystic Fibrosis Gene, which state that carrier testing should be offered to all individuals or couples with a family history of cystic fibrosis. Good science and solid educational and counseling strategies must be in place before screening for cystic fibrosis is routinely offered to those with a negative family history. Pilot programs that investigate research questions in the delivery of population screening for cystic fibrosis carriers are urgently needed.

Factors affecting the uptake of screening for neural tube defect

A questionnaire concerning pregnant women's knowledge of, and attitudes to, serum alpha fetoprotein (AFP) screening for spina bifida was sent to all pregnant women receiving a health education leaflet on AFP screening who booked at the Birmingham Maternity Hospital in the first quarter of 1984. The majority said that they would accept the test, and subsequently did so. This suggests that low uptake of the test is not a result of patients' resistance, and the results indicated that the provision of early information about the test is likely to improve uptake and decrease anxiety. With the increasing clinical usefulness of the AFP test, routine screening of pregnant women with an 'opt-out' system is becoming clinically desirable, and the survey suggests that it would be acceptable to the patients.