Skip to main content
Top
Published in: Journal of Genetic Counseling 3/2014

01-06-2014 | Original Research

Genetic Counselors’ Experience with Cell-Free Fetal DNA Testing as a Prenatal Screening Option for Aneuploidy

Authors: Julie M. H. Horsting, Stephen R. Dlouhy, Katelyn Hanson, Kimberly Quaid, Shaochun Bai, Karrie A. Hines

Published in: Journal of Genetic Counseling | Issue 3/2014

Login to get access

Abstract

First identified in 1997, cell-free fetal DNA (cffDNA) has just recently been used to detect fetal aneuploidy of chromosomes 13, 18, and 21, showing its potential to revolutionize prenatal genetic testing as a non-invasive screening tool. Although this technological advancement is exciting and has certain medical applications, it has been unclear how it will be implemented in a clinical setting. Genetic counselors will likely be instrumental in answering that question, but to date, there is no published research regarding prenatal counselors’ implementation of and experiences with cffDNA testing. We developed a 67 question survey to gather descriptive information from counselors regarding their personal opinions, experiences, thoughts, and concerns regarding the validity, usefulness, and implementation of this new technology. A total of 236 individuals completed a portion of the survey; not all respondents answered all questions. Qualitative questions complemented quantitative survey items, allowing respondents to voice their thoughts directly. Results indicate that counselors value cffDNA testing as a screening option but are concerned regarding how some obstetricians and patients make use of this testing. Further results, discussion, and practice implications are presented.
Footnotes
1
Survey available upon request from the authors
 
Literature
go back to reference American College of Obstetricians and Gynecologists. (2012). Noninvasive prenatal testing for fetal aneuploidy. Committee Opinion No. 545. Obstetrics and Gynecology, 120, 1532–1534.CrossRef American College of Obstetricians and Gynecologists. (2012). Noninvasive prenatal testing for fetal aneuploidy. Committee Opinion No. 545. Obstetrics and Gynecology, 120, 1532–1534.CrossRef
go back to reference Benn, P., Cuckle, H., & Pergament, E. (2013). Non-invasive prenatal testing for aneuploidy: current status and future prospects. Ultrasound in Obstetrics and Gynecology. doi:10.1002/uog.12513.PubMed Benn, P., Cuckle, H., & Pergament, E. (2013). Non-invasive prenatal testing for aneuploidy: current status and future prospects. Ultrasound in Obstetrics and Gynecology. doi:10.​1002/​uog.​12513.PubMed
go back to reference Bensend, T. A., Veach, P. M., & Niendorf, K. B. (2013). What’s the harm? Genetic counselor perceptions of adverse effects of genetics service provision by non-genetics professionals. Journal of Genetic Counseling. doi:10.1007/s10897-013-9605-3. Bensend, T. A., Veach, P. M., & Niendorf, K. B. (2013). What’s the harm? Genetic counselor perceptions of adverse effects of genetics service provision by non-genetics professionals. Journal of Genetic Counseling. doi:10.​1007/​s10897-013-9605-3.
go back to reference Bianchi, D. W., Platt, L. D., Goldberg, J. D., Abuhamad, A. Z., Sehnert, A. J., & Rava, R. P. (2012). Genome-wide fetal aneuploidy detection by maternal plasma DNA sequencing. MatErnal Blood Is Source to Accurately diagnose fetal aneuploidy (MELISSA) Study Group. Obstetrics and Gynecology, 119, 890–901.PubMedCrossRef Bianchi, D. W., Platt, L. D., Goldberg, J. D., Abuhamad, A. Z., Sehnert, A. J., & Rava, R. P. (2012). Genome-wide fetal aneuploidy detection by maternal plasma DNA sequencing. MatErnal Blood Is Source to Accurately diagnose fetal aneuploidy (MELISSA) Study Group. Obstetrics and Gynecology, 119, 890–901.PubMedCrossRef
go back to reference Chen, E. Z., Chiu, R. W., SUN, H., Akolekar, R., Chan, K. C., Leung, T. Y., et al. (2011). Noninvasive prenatal diagnosis of fetal trisomy 18 and trisomy 13 by maternal plasma DNA sequencing. PLoS ONE, 6, e21791.PubMedCentralPubMedCrossRef Chen, E. Z., Chiu, R. W., SUN, H., Akolekar, R., Chan, K. C., Leung, T. Y., et al. (2011). Noninvasive prenatal diagnosis of fetal trisomy 18 and trisomy 13 by maternal plasma DNA sequencing. PLoS ONE, 6, e21791.PubMedCentralPubMedCrossRef
go back to reference Chiu, R. W., Akolekar, R., Zheng, Y. W., LeungTY, S. H., Chan, K. C., et al. (2011). Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: large scale validation study. BMJ, 342, c7401.PubMedCentralPubMedCrossRef Chiu, R. W., Akolekar, R., Zheng, Y. W., LeungTY, S. H., Chan, K. C., et al. (2011). Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: large scale validation study. BMJ, 342, c7401.PubMedCentralPubMedCrossRef
go back to reference Devers, P. L., Cronister, A., Ormond, K. E., Facio, F., Brasington, C. K., & Flodman, P. (2012). Noninvasive prenatal testing/noninvasive prenatal diagnosis: the position of the national society of genetic counselors. Journal of Genetic Counseling. doi:10.1007/s10897-012-9564-0.PubMed Devers, P. L., Cronister, A., Ormond, K. E., Facio, F., Brasington, C. K., & Flodman, P. (2012). Noninvasive prenatal testing/noninvasive prenatal diagnosis: the position of the national society of genetic counselors. Journal of Genetic Counseling. doi:10.​1007/​s10897-012-9564-0.PubMed
go back to reference Ehrich, M., Deciu, C., Zwiefelhofer, T., Tynan, J. A., Cagasan, L., Tim, R., et al. (2011). Noninvasive detection of fetal trisomy 21 by sequencing of DNA in maternal blood: a study in a clinical setting. American Journal of Obstetrics and Gynecology, 204, 205.e1–11.CrossRef Ehrich, M., Deciu, C., Zwiefelhofer, T., Tynan, J. A., Cagasan, L., Tim, R., et al. (2011). Noninvasive detection of fetal trisomy 21 by sequencing of DNA in maternal blood: a study in a clinical setting. American Journal of Obstetrics and Gynecology, 204, 205.e1–11.CrossRef
go back to reference Hall, A. L., Drendel, H. M., Verbrugge, J. L., Reese, A. M., Schumacher, K. L., Griffith, C. B., et al. (2013). Positive cell-free fetal DNA testing for trisomy 13 reveals confined placental mosaicism. Genetics in Medicine. doi:10.1038/gim.2013.26. Hall, A. L., Drendel, H. M., Verbrugge, J. L., Reese, A. M., Schumacher, K. L., Griffith, C. B., et al. (2013). Positive cell-free fetal DNA testing for trisomy 13 reveals confined placental mosaicism. Genetics in Medicine. doi:10.​1038/​gim.​2013.​26.
go back to reference Lo, Y. M., Corbetta, N., Chamberlain, P. F., Rai, V., Sargent, I. L., Redman, C. W., et al. (1997). Presence of fetal DNA in maternal plasma and serum. Lancet, 350, 485–487.PubMedCrossRef Lo, Y. M., Corbetta, N., Chamberlain, P. F., Rai, V., Sargent, I. L., Redman, C. W., et al. (1997). Presence of fetal DNA in maternal plasma and serum. Lancet, 350, 485–487.PubMedCrossRef
go back to reference McPherson, E., Thomas, G. D., Manlick, C., Zaleski, C. A., Reynolds, K. K., Rasmussen, K., et al. (2011). Extreme values of maternal serum analytes in second trimester screening: Looking beyond trisomy and NTD’s. Journal of Genetic Counseling, 20, 396–403.PubMedCrossRef McPherson, E., Thomas, G. D., Manlick, C., Zaleski, C. A., Reynolds, K. K., Rasmussen, K., et al. (2011). Extreme values of maternal serum analytes in second trimester screening: Looking beyond trisomy and NTD’s. Journal of Genetic Counseling, 20, 396–403.PubMedCrossRef
go back to reference Mennuti, M. T., Cherry, A. M., Morrissette, J. J., & Dugoff, L. (2013). Is it time to sound an alarm about false positive cell-free DNA testing for fetal aneuploidy? American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2013.03.027.PubMed Mennuti, M. T., Cherry, A. M., Morrissette, J. J., & Dugoff, L. (2013). Is it time to sound an alarm about false positive cell-free DNA testing for fetal aneuploidy? American Journal of Obstetrics and Gynecology. doi:10.​1016/​j.​ajog.​2013.​03.​027.PubMed
go back to reference Musci, T. J., Fairbrother, G., Batey, A., Bruursema, J., Struble, C., & Song, K. (2013). Non-invasive prenatal testing with cell-free DNA: US physician attitudes toward implementation in clinical practice. Prenatal Diagnosis, 33(5), 424–428.PubMedCrossRef Musci, T. J., Fairbrother, G., Batey, A., Bruursema, J., Struble, C., & Song, K. (2013). Non-invasive prenatal testing with cell-free DNA: US physician attitudes toward implementation in clinical practice. Prenatal Diagnosis, 33(5), 424–428.PubMedCrossRef
go back to reference Norton, M. E., Brar, H., Meiss, J., Karimi, A., Laurent, L. C., Caughey, A. B., et al. (2012). Non-Invasive Chromosomal Evaluation (NICE) study: results of a multicenter, prospective, cohort study for detection of fetal trisomy 18. American Journal of Obstetrics and Gynecology, 207(2), 137.e1–137.e8.CrossRef Norton, M. E., Brar, H., Meiss, J., Karimi, A., Laurent, L. C., Caughey, A. B., et al. (2012). Non-Invasive Chromosomal Evaluation (NICE) study: results of a multicenter, prospective, cohort study for detection of fetal trisomy 18. American Journal of Obstetrics and Gynecology, 207(2), 137.e1–137.e8.CrossRef
go back to reference Norton, M. E., Rose, N. C., & Benn, P. (2013). Noninvasive prenatal testing for fetal aneuploidy: clinical assessment and a plea for restraint. Obstetrics and Gynecology, 121(4), 847–850.PubMedCrossRef Norton, M. E., Rose, N. C., & Benn, P. (2013). Noninvasive prenatal testing for fetal aneuploidy: clinical assessment and a plea for restraint. Obstetrics and Gynecology, 121(4), 847–850.PubMedCrossRef
go back to reference Palomaki, G. E., Kloza, E. M., Lambert-Messerlian, G. M., Haddow, J. E., Neveux, L. M., Ehrich, M., et al. (2011). DNA sequencing of maternal plasma to detect Down syndrome: an international clinical validation study. Genetics in Medicine, 13, 913–920.PubMedCrossRef Palomaki, G. E., Kloza, E. M., Lambert-Messerlian, G. M., Haddow, J. E., Neveux, L. M., Ehrich, M., et al. (2011). DNA sequencing of maternal plasma to detect Down syndrome: an international clinical validation study. Genetics in Medicine, 13, 913–920.PubMedCrossRef
go back to reference Palomaki, G. E., Deciu, C., Kloza, E. M., Lambert-Messerlian, G. M., Haddow, J. E., Neveux, L. M., et al. (2012). DNA sequencing of maternal plasma reliably identifies trisomy 18 and trisomy 13 as well as Down syndrome: an international collaborative study. Genetics in Medicine, 14, 296–305.PubMedCentralPubMedCrossRef Palomaki, G. E., Deciu, C., Kloza, E. M., Lambert-Messerlian, G. M., Haddow, J. E., Neveux, L. M., et al. (2012). DNA sequencing of maternal plasma reliably identifies trisomy 18 and trisomy 13 as well as Down syndrome: an international collaborative study. Genetics in Medicine, 14, 296–305.PubMedCentralPubMedCrossRef
go back to reference Patton, M. Q. (2001). Qualitative evaluation and research methods. Thousand Oaks: Sage. Patton, M. Q. (2001). Qualitative evaluation and research methods. Thousand Oaks: Sage.
go back to reference Sayres, L., Allyse, M., Norton, M., & Cho, M. (2011). Cell-free fetal DNA testing: A pilot study of obstetric healthcare provider attitudes towards clinical implementation. Prenatal Diagnosis, 31(11), 1070–1076.PubMedCentralPubMedCrossRef Sayres, L., Allyse, M., Norton, M., & Cho, M. (2011). Cell-free fetal DNA testing: A pilot study of obstetric healthcare provider attitudes towards clinical implementation. Prenatal Diagnosis, 31(11), 1070–1076.PubMedCentralPubMedCrossRef
go back to reference Sparks, A. B., Wang, E. T., Struble, C. A., Barrett, W., Stolowski, R., McBride, C., et al. (2012). Selective analysis of cell-free DNA in maternal blood for evaluation of fetal trisomy. Prenatal Diagnosis, 32, 3–9.PubMedCentralPubMedCrossRef Sparks, A. B., Wang, E. T., Struble, C. A., Barrett, W., Stolowski, R., McBride, C., et al. (2012). Selective analysis of cell-free DNA in maternal blood for evaluation of fetal trisomy. Prenatal Diagnosis, 32, 3–9.PubMedCentralPubMedCrossRef
go back to reference Taylor, J.B., Chock, V.Y., Hudgins, L. (2013). NIPT in a clinical setting: an analysis of uptake in the first months of clinical availability. Journal of Genetic Counseling [Epub ahead of print]. Taylor, J.B., Chock, V.Y., Hudgins, L. (2013). NIPT in a clinical setting: an analysis of uptake in the first months of clinical availability. Journal of Genetic Counseling [Epub ahead of print].
go back to reference Vahanian, S.A., Baraa, A.M., Yeh, C., Chavez, M.R., Kinzler, W.L., Vintzileos, A.M. (2013). Patient acceptance of non-invasive testing for fetal aneuploidy via cell-free fetal DNA. Journal of Maternal-Fetal and Neonatal Medicine. PMID: 23687914. Vahanian, S.A., Baraa, A.M., Yeh, C., Chavez, M.R., Kinzler, W.L., Vintzileos, A.M. (2013). Patient acceptance of non-invasive testing for fetal aneuploidy via cell-free fetal DNA. Journal of Maternal-Fetal and Neonatal Medicine. PMID: 23687914.
go back to reference Wapner, R. J., Martin, C. L., Levy, B., Ballif, B. C., Eng, C. M., Zachary, J. M., et al. (2012). Chromosomal microarray versus karyotyping for prenatal diagnosis. The New England Journal of Medicine, 367(23), 2175–2184.PubMedCentralPubMedCrossRef Wapner, R. J., Martin, C. L., Levy, B., Ballif, B. C., Eng, C. M., Zachary, J. M., et al. (2012). Chromosomal microarray versus karyotyping for prenatal diagnosis. The New England Journal of Medicine, 367(23), 2175–2184.PubMedCentralPubMedCrossRef
go back to reference Wright, C. F., & Burton, H. (2009). The use of cell-free fetal nucleic acids in maternal blood for non-invasive prenatal diagnosis. Human Reproduction Update, 15(1), 139–151.PubMedCrossRef Wright, C. F., & Burton, H. (2009). The use of cell-free fetal nucleic acids in maternal blood for non-invasive prenatal diagnosis. Human Reproduction Update, 15(1), 139–151.PubMedCrossRef
Metadata
Title
Genetic Counselors’ Experience with Cell-Free Fetal DNA Testing as a Prenatal Screening Option for Aneuploidy
Authors
Julie M. H. Horsting
Stephen R. Dlouhy
Katelyn Hanson
Kimberly Quaid
Shaochun Bai
Karrie A. Hines
Publication date
01-06-2014
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 3/2014
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-013-9673-4

Other articles of this Issue 3/2014

Journal of Genetic Counseling 3/2014 Go to the issue