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Sanchez G, Hashmi SS, Bednar E, Horvath S, Kumar B, Sagaser K, Singletary CN, Ramdaney A. Status of abortion curriculum in genetic counseling: Survey of graduate programs and recent graduates in the United States. J Genet Couns 2024. [PMID: 38410885 DOI: 10.1002/jgc4.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
Genetic counselors (GCs) are trained to help individuals navigate the medical and psychological implications of genetic test results, familial conditions, and ultrasound anomalies. Therefore, familiarity with reproductive options, including abortion, is vital. However, previous studies have found gaps in GCs' knowledge regarding abortion care and there are currently no recommendations regarding abortion curriculum. This study aimed to assess the state of abortion curriculum in genetic counseling graduate programs in the United States and to examine and compare the satisfaction levels of program representatives and recent graduates. Program representatives and recent graduates were invited to complete an anonymous survey evaluating the abortion curriculum, satisfaction with said curriculum, and perceived preparedness to counsel on abortion. Quantitative data from 46 program representatives and 123 recent graduates were analyzed using descriptive statistics and appropriate statistical analyses, including the Mann-Whitney U-test and the Kruskal-Wallis test. Large variability existed in the amount and types of abortion training. Results showed greater satisfaction and feelings of preparation to counsel on abortion in graduates whose program provided a dedicated abortion curriculum (p < 0.001, p = 0.005). In addition, graduates with abortion counseling experience felt less prepared to counsel on abortion than their programs believed them to be (p = 0.04). Graduates perceived procedural timing, facilitation of genetic testing, and resources/support desired by patients before, during, or after an abortion, to be the most important topics, although these were not included in all programs' curriculum. Program representatives and recent graduates alike noted that variability in clinical training is a barrier to abortion education. Our results demonstrate a need for curricular reform to reduce variability in training and ensure that all graduates receive the same foundational abortion education. Further research is needed to determine the scope of GCs in abortion care, as well as which topics and education formats are most helpful in graduate education.
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Affiliation(s)
- Gina Sanchez
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
| | - S Shahrukh Hashmi
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Erica Bednar
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Gynecologic Oncology Center, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Horvath
- Department of Obstetrics and Gynecology Division of Women's Health at Penn State, Hershey, Pennsylvania, USA
| | - Bhavik Kumar
- Planned Parenthood Gulf Coast, Houston, Texas, USA
| | | | - Claire N Singletary
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Aarti Ramdaney
- The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Texas McGovern Medical School, Houston, Texas, USA
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Findley TO, Parchem JG, Ramdaney A, Morton SU. Challenges in the clinical understanding of genetic testing in birth defects and pediatric diseases. Transl Pediatr 2023; 12:1028-1040. [PMID: 37305724 PMCID: PMC10248941 DOI: 10.21037/tp-23-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023] Open
Abstract
Advances in prenatal/neonatal genetic screening practices and next generation sequencing (NGS) technologies have made the detection of molecular causes of pediatric diseases increasingly more affordable, accessible, and rapid in return of results. In the past, families searching for answers often required diagnostic journeys leading to delays in targeted care and missed diagnoses. Non-invasive prenatal NGS is now used routinely in pregnancy, significantly altering the obstetric approach to early screening and evaluation of fetal anomalies. Similarly, exome sequencing (ES) and genome sequencing (GS) were once only available for research but are now used in patient care, impacting neonatal care and the field of neonatology as a whole. In this review we will summarize the growing body of literature on the role of ES/GS in prenatal/neonatal care, specifically in neonatal intensive care units (NICU), and the molecular diagnostic yield. Furthermore, we will discuss the impact of advances in genetic testing in prenatal/neonatal care and discuss challenges faced by clinicians and families. Clinical application of NGS has come with many challenges in counseling families on interpretation of diagnostic results and incidental findings, as well as re-interpretation of prior genetic test results. How genetic results may influence medical decision-making is highly nuanced and needs further study. The ethics of parental consent and disclosure of genetic conditions with limited therapeutic options continue to be debated in the medical genetics community. While these questions remain unanswered, the benefits of a standardized approach to genetic testing in the NICU will be highlighted by two case vignettes.
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Affiliation(s)
- Tina O. Findley
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jacqueline G. Parchem
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, Texas, USA
| | - Aarti Ramdaney
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, Texas, USA
| | - Sarah U. Morton
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Stevens B, Wagner C, Choates M, Harkenrider J, Montgomery S, Mulligan S, Ramdaney A, Jenna L. Informed Consent for Routine Genetic Screening: Realistic or Idealistic? Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Stevens BK, Nunley PB, Wagner C, Murphy L, Wittman T, Ramdaney A, Jones M, Choates MG. Utility of Expanded Carrier Screening in Pregnancies With Ultrasound Abnormalities. Obstet Gynecol Surv 2022. [DOI: 10.1097/01.ogx.0000852744.86014.4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramdaney A, Mulligan S, Wittman T, Wagner C. First Trimester Ultrasound in the Age of Cell-Free DNA Screening: What Are We Missing? Prenat Diagn 2022; 42:542-548. [PMID: 35357018 DOI: 10.1002/pd.6139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the utility of first trimester (FT) ultrasound (US) between 10 to 14 weeks gestation in identifying fetal findings that would impact clinical management. METHODS We performed a retrospective review of FT US associated with an abnormal ICD-10 code from August 2016 to December 2018. Results of FT US, genetic testing, and management decisions were abstracted from the electronic health record. RESULTS A total of 20,594 FT US were performed within our study period, representing 6,064 unique patients. Of these, 278 ultrasounds were noted to have fetal findings (278/6064, 4.6%). The most frequent fetal finding were fetal demises (98, 35.3%), followed by increased NT/cystic hygroma (67, 24.1%), and multiple anomalies (35, 12.6%). There was a significant difference between the frequency of fetal findings between patients considered advanced maternal age (AMA) and those who were not (p=0.017). However, there was no significant difference in the frequency of specific anomalies between these two groups (p=0.103). CONCLUSION FT US provides clinical information outside the scope of cfDNA screening in both AMA and non-AMA populations regarding viability and fetal anatomy. Earlier detection of these findings is crucial to allow for the opportunity of informed discussion of testing strategy and decision making. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Shannon Mulligan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Theresa Wittman
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston
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Ramdaney A, Lichten L, Propst L, Mann C, Lazarin GA, Jones M, Taylor A, Malinowski J. Expanded carrier screening in the United States: A systematic evidence review exploring client and provider experiences. J Genet Couns 2022; 31:937-948. [PMID: 35212439 DOI: 10.1002/jgc4.1566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022]
Abstract
The aim of carrier screening is to identify prospective parents at risk of having a pregnancy affected with an autosomal recessive or X-linked disorder. Though minimal guideline-based screening is available, expanded carrier screening (ECS) is quickly becoming a feasible option for the general population due to its growing availability and affordability. However, the impact of ECS on clients and providers remains relatively unexplored. We performed a systematic evidence review to identify publications describing client-, provider-, and test-related outcomes. We searched several biomedical databases for articles published between January 1, 2003 and May 31, 2021. Studies were eligible for inclusion if they described genetic counseling and/or genetic testing for carrier screening (minimal guideline-based or ECS) in a prenatal or preconception setting in the United States. Title and abstract screening were performed using the Raayan web application or customized Google Forms. Full-text review and data extraction of included articles were performed using custom Google Forms. Two researchers performed a multistep selection process independently for validation purposes. Of 5413 unique articles screened, 36 studies were included with several studies contributing to multiple outcomes. Twenty described outcomes relating to patients/clients, 10 described provider-based outcomes, and 16 described test-based outcomes. Findings suggest that client and provider perceptions of ECS and minimal guideline-based carrier screening are multifaceted. Though clients have expressed desire for ECS, clinical uptake and impact on reproductive decision-making varies. Additionally, though genetic counselors seem to be comfortable with ECS, most other reproductive care providers seem to prefer minimal guideline or ancestry-based screening due to perceived barriers, such as time needed for ECS results disclosure and follow-up, as well as the desire to have panels set by professional societies/recommendations. There are limitations within the gathered literature, leading to potential uncertainty in the generalizability of our review. We outline several recommendations for future studies, including the need to examine variant interpretation and use of next-generation sequencing.
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Affiliation(s)
- Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lauren Lichten
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Caitlin Mann
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Malorie Jones
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amy Taylor
- Houston Methodist Hospital, Houston, Texas, USA
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Stevens BK, Nunley PB, Wagner C, Murphy L, Wittman T, Ramdaney A, Jones M, Choates MG. Utility of expanded carrier screening in pregnancies with ultrasound abnormalities. Prenat Diagn 2021; 42:60-78. [PMID: 34792213 DOI: 10.1002/pd.6069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Explore the utility of expanded carrier screening in evaluating heritable causes of congenital anomalies detected by prenatal ultrasound. METHOD A retrospective chart review was conducted to collect structural abnormality and genetic testing data on infants who were evaluated postnatally by a medical geneticist. These were used to determine if expanded carrier screening could have determined the etiology prior to delivery. Additionally, recessive and X-linked conditions on clinically available carrier screening panels were evaluated to determine the number of conditions associated with abnormal ultrasound findings. RESULTS Our retrospective chart review found 222 patients with genetic etiologies, including eight unique autosomal recessive conditions and six X-linked conditions in the 23% who underwent exome sequencing. Of these 14 unique conditions detected, three were included on a list of 271 conditions for which screening was available in 2019 and five were included on a 500 condition panel available in 2020. A literature review was performed on the list of 271 conditions and 88 were reported to be associated with one or more ultrasound abnormalities. CONCLUSION This study demonstrates limited but potential utility for expanded carrier screening to determine the underlying etiology of congenital anomalies.
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Affiliation(s)
- Blair K Stevens
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Chelsea Wagner
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lauren Murphy
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Theresa Wittman
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Malorie Jones
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Meagan Giles Choates
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
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Smith C, Hashmi SS, Czerwinski J, Wagner VF, Promecene P, Milentijevic I, Ramdaney A. The impact of genetic counseling on women's grief and coping following termination of pregnancy for fetal anomaly. J Genet Couns 2020; 30:522-532. [PMID: 33103308 DOI: 10.1002/jgc4.1338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022]
Abstract
Pregnancy termination for fetal anomaly (TFA) is a unique experience that can cause women to develop long-term complicated grief. Although a woman's experience with her healthcare providers has been previously identified as an important factor in coping, studies have shown that many women report their health care as lacking to some extent. Given the overlap in women's needs and the practice scope of a genetic counselor (GC), this study aimed to examine how genetic counseling may impact coping and explore women's expectations of GCs pre- and post-TFA. An online survey, which included the brief COPE and the short version of the Perinatal Grief Scale, was distributed among private online support groups. Appropriate statistical analysis tools, such as the Wilcoxon rank-sum and t test, were utilized for quantitative analysis of the 124 responses, and inductive content analysis was utilized for qualitative analysis. Of those who underwent TFA within the last two years, women who saw a GC utilized active coping, planning, and positive reframing significantly more than women who did not see a GC (p = 0.001, p = 0.031, p = 0.027, respectively). GCs were perceived to have a positive impact on coping when providing information, objective care, emotional support, support resources, and follow-up care; these practices encouraged confidence in their personal decision-making and gave women hope for the future. This study not only identified key counseling roles for GCs prior to a TFA, but also demonstrated that genetic counseling prior to TFA may be beneficial to coping. Further studies are warranted to explore the needs of a more diverse population and to identify appropriate genetic counseling training methods to support women pursuing TFA.
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Affiliation(s)
- Cayleen Smith
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Pediatrix Medical Group of the Mid-Atlantic, Fairfax, VA, USA
| | - Syed S Hashmi
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Pediatrics at McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Jennifer Czerwinski
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Victoria F Wagner
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Pediatrics at McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Pamela Promecene
- Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | | | - Aarti Ramdaney
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
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Ramdaney A, Hoskovec J, Harkenrider J, Soto E, Murphy L. Clinical experience with sex chromosome aneuploidies detected by noninvasive prenatal testing (NIPT): Accuracy and patient decision-making. Prenat Diagn 2018; 38:841-848. [PMID: 30068017 DOI: 10.1002/pd.5339] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/21/2018] [Accepted: 07/21/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objectives of the study are to assess the accuracy of noninvasive prenatal testing (NIPT) for sex chromosome aneuploidies (SCAs) and to investigate patient decision-making in clinical practice. STUDY DESIGN This is a retrospective cohort study review of positive NIPT results for SCAs from January 2013 to September 2017. RESULTS Of the 136 positive NIPT results for SCAs, 73 (53.7%) were positive for 45,X, 62 (45.6%) were a sex chromosome trisomy, and 1 was a sex chromosome tetrasomy. Of the 134 viable pregnancies, 46 (34.3%) elected to pursue prenatal diagnosis. Fewer women underwent invasive prenatal testing when counseled regarding a positive NIPT for monosomy X in the presence of suggestive ultrasound findings (4/23; 17.4%) compared with those who had a positive NIPT result without ultrasound findings (24/46, 52.2%). Abnormal karyotypes consistent with the NIPT result were confirmed in 30/64 (46.9%). Even in the context of ultrasound abnormalities, there was not 100% concordance. CONCLUSIONS The majority (88/134; 65.7%) of patients in our cohort declined prenatal diagnosis even in the presence of associated ultrasound findings. Comprehensive pretest and posttest counseling is recommended and should address the importance of confirmatory testing and benefits of early diagnosis. Practice guidelines are needed to address provider responsibilities about postnatal testing.
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Affiliation(s)
- Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer Hoskovec
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jacqueline Harkenrider
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Eleazar Soto
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Lauren Murphy
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Sagaser KG, Stevens B, Davis J, Northrup H, Ramdaney A. Close but not quite: Two cases of sex chromosome aneuploidies outside the scope of cell free DNA screening. Prenat Diagn 2018; 38:617-619. [PMID: 29644704 DOI: 10.1002/pd.5264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/23/2018] [Accepted: 03/31/2018] [Indexed: 01/12/2023]
Abstract
WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?
cfDNA screening reports high sensitivities and specificities for autosomal trisomies, yet challenges still exist in accurate detection of sex chromosome aneuploidies.
WHAT DOES THIS STUDY ADD?
Sex chromosome tetrasomy or pentasomy may be incorrectly reported as a sex chromosome trisomy by cfDNA screening.
Patients with abnormal cfDNA results for sex chromosome trisomies should be counseled on the possibility of sex chromosome tetrasomies or pentasomies and the differences in clinical implications and predicted prognoses with such diagnoses.
All patients with an abnormal cfDNA result for a sex chromosome aneuploidy should be offered prenatal diagnosis and postnatal testing.
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Affiliation(s)
- Katelynn G Sagaser
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Blair Stevens
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jessica Davis
- Department of Specialty Pediatrics, Carle Foundation Hospital, Urbana, IL, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - Aarti Ramdaney
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
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Ramdaney A, Hashmi SS, Monga M, Carter R, Czerwinski J. Support Desired by Women Following Termination of Pregnancy for a Fetal Anomaly. J Genet Couns 2015; 24:952-60. [DOI: 10.1007/s10897-015-9832-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
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