Prenatal genetic testing for cystic fibrosis: a systematic review of clinical effectiveness and an ethics review

Simple item page
dc.contributor.authorKessels, S.
dc.contributor.authorCarter, D.A.
dc.contributor.authorEllery, B.
dc.contributor.authorNewton, S.
dc.contributor.authorMerlin, T.
dc.date.issued2020
dc.description.abstractPurpose: We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection. Methods: To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations. Results: The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor shortterm parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented. Conclusion: CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.
dc.description.statementofresponsibilitySharon J. M. Kessels, Drew Carter, Benjamin Ellery, Skye Newton, and Tracy L. Merlin
dc.identifier.citationGenetics in Medicine, 2020; 22(2):258-267
dc.identifier.doi10.1038/s41436-019-0641-8
dc.identifier.issn1098-3600
dc.identifier.issn1530-0366
dc.identifier.orcidKessels, S. [0000-0002-1598-3201]
dc.identifier.orcidCarter, D.A. [0000-0002-1221-6656]
dc.identifier.orcidMerlin, T. [0000-0002-7293-4262]
dc.identifier.urihttps://hdl.handle.net/2440/146185
dc.language.isoen
dc.publisherSpringer Nature [academic journals on nature.com]
dc.rights© American College of Medical Genetics and Genomics
dc.source.urihttps://doi.org/10.1038/s41436-019-0641-8
dc.subjectprenatal testing; cystic fibrosis (CF); ethics; endpoint selection.
dc.subject.meshFetus
dc.subject.meshHumans
dc.subject.meshCystic Fibrosis
dc.subject.meshUltrasonography, Prenatal
dc.subject.meshPrenatal Diagnosis
dc.subject.meshTreatment Outcome
dc.subject.meshPregnancy
dc.subject.meshFemale
dc.subject.meshGenetic Testing
dc.subject.meshGenetic Carrier Screening
dc.titlePrenatal genetic testing for cystic fibrosis: a systematic review of clinical effectiveness and an ethics review
dc.typeJournal article
pubs.publication-statusPublished

Files

Collections

Research Outputs