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Published in: Journal of Genetic Counseling 3/2017

01-06-2017 | Original Research

A Pilot Study of Fragile X Syndrome Screening in Pregnant Women and Women Planning Pregnancy: Implementation, Acceptance, Awareness, and Geographic Factors

Authors: Ramona Alfaro Arenas, Jordi Rosell Andreo, Damián Heine Suñer, Group for the study of FXS in the Balearic Islands

Published in: Journal of Genetic Counseling | Issue 3/2017

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Abstract

We report herein results of a study performed in the Balearic Islands which had the following goals: 1) Determine the proportion of pregnant or non-pregnant women planning pregnancy, who would choose to undergo a screening test for Fragile X Syndrome (FXS), if it is accompanied by the appropriate information; 2) Assess satisfaction and any increase in stress among women who participate in screening; 3) Collect epidemiological information about the incidence of the disease in our population; and 4) Collect demographic and health history data and assess participants’ awareness of the disease. Screening was performed on 3,731 pregnant and non-pregnant women of childbearing age and the results indicate: a very high voluntary rate of participation; a high level of self-reported satisfaction and low levels of stress because of the test; a very high incidence of premutation (1/106) in our population; and a low level of awareness about the existence of FXS (25 %). Additional findings indicate no significant correlation between self-reported health history and premutation detection, and the high premutation incidence does not seem to be specific to the indigenous Balearic population. Based on these results, we discuss the pros and cons of an implementation of preconception and pregnant women screening for FXS within a public health screening program.
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Literature
go back to reference Abrams, L., Cronister, A., Brown, W. T., Tassone, F., Sherman, S. L., Finucane, B., et al. (2012). Newborn, carrier, and early childhood screening recommendations for fragile X. Pediatrics, 130(6), 1126–1135. doi:10.1542/peds.2012-0693.CrossRefPubMed Abrams, L., Cronister, A., Brown, W. T., Tassone, F., Sherman, S. L., Finucane, B., et al. (2012). Newborn, carrier, and early childhood screening recommendations for fragile X. Pediatrics, 130(6), 1126–1135. doi:10.​1542/​peds.​2012-0693.CrossRefPubMed
go back to reference Alfaro Arenas, R., Rosell Andreo, J., Heine Suñer, D., & Group for the study of FXS in the Balearic Islands. (2016). Fragile X syndrome screening in pregnant women and women planning pregnancy shows a remarkably high FMR1 premutation prevalence in the Balearic Islands. American Journal of Medical Genetics. Part B, 9999, 1–9. Alfaro Arenas, R., Rosell Andreo, J., Heine Suñer, D., & Group for the study of FXS in the Balearic Islands. (2016). Fragile X syndrome screening in pregnant women and women planning pregnancy shows a remarkably high FMR1 premutation prevalence in the Balearic Islands. American Journal of Medical Genetics. Part B, 9999, 1–9.
go back to reference Basehore, M. J., Marlowe, N. M., Jones, J. R., Behlendorf, D. E., Laver, T. A., & Friez, M. J. (2012). Validation of a screening tool for the rapid and reliable detection of CGG trinucleotide repeat expansions in FMR1. Genetic Testing and Molecular Biomarkers, 16(6), 465–470. doi:10.1089/gtmb.2011.0134.CrossRefPubMed Basehore, M. J., Marlowe, N. M., Jones, J. R., Behlendorf, D. E., Laver, T. A., & Friez, M. J. (2012). Validation of a screening tool for the rapid and reliable detection of CGG trinucleotide repeat expansions in FMR1. Genetic Testing and Molecular Biomarkers, 16(6), 465–470. doi:10.​1089/​gtmb.​2011.​0134.CrossRefPubMed
go back to reference Berkenstadt, M., Ries-Levavi, L., Cuckle, H., Peleg, L., & Barkai, G. (2007). Preconceptional and prenatal screening for fragile X syndrome: experience with 40,000 tests. Prenatal Diagnosis, 27(11), 991–994. doi:10.1002/pd.1815.CrossRefPubMed Berkenstadt, M., Ries-Levavi, L., Cuckle, H., Peleg, L., & Barkai, G. (2007). Preconceptional and prenatal screening for fragile X syndrome: experience with 40,000 tests. Prenatal Diagnosis, 27(11), 991–994. doi:10.​1002/​pd.​1815.CrossRefPubMed
go back to reference Biancalana, V., Glaeser, D., McQuaid, S., & Steinbach, P. (2015). EMQN best practice guidelines for the molecular genetic testing and reporting of fragile X syndrome and other fragile X-associated disorders. European Journal of Human Genetics, 23(4), 417–425.CrossRefPubMed Biancalana, V., Glaeser, D., McQuaid, S., & Steinbach, P. (2015). EMQN best practice guidelines for the molecular genetic testing and reporting of fragile X syndrome and other fragile X-associated disorders. European Journal of Human Genetics, 23(4), 417–425.CrossRefPubMed
go back to reference Gutierrez, J. F., Bajaj, K., & Klugman, S. D. (2013). Prenatal screening for fragile X: carriers, controversies, and counseling. Reviews in Obstetrics & Gynecology, 6(1), e1–e7. doi:10.3909/riog0203. Gutierrez, J. F., Bajaj, K., & Klugman, S. D. (2013). Prenatal screening for fragile X: carriers, controversies, and counseling. Reviews in Obstetrics & Gynecology, 6(1), e1–e7. doi:10.​3909/​riog0203.
go back to reference Hantash, F. M., Goos, D. M., Crossley, B., Anderson, B., Zhang, K., Sun, W., et al. (2011). FMR1 premutation carrier frequency in patients undergoing routine population-based carrier screening: insights into the prevalence of fragile X syndrome, fragile X-associated tremor/ataxia syndrome, and fragile X-associated primary ovarian insufficiency i. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 13(1), 39–45. doi:10.1097/GIM.0b013e3181fa9fad.CrossRef Hantash, F. M., Goos, D. M., Crossley, B., Anderson, B., Zhang, K., Sun, W., et al. (2011). FMR1 premutation carrier frequency in patients undergoing routine population-based carrier screening: insights into the prevalence of fragile X syndrome, fragile X-associated tremor/ataxia syndrome, and fragile X-associated primary ovarian insufficiency i. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 13(1), 39–45. doi:10.​1097/​GIM.​0b013e3181fa9fad​.CrossRef
go back to reference Hill, M. K., Archibald, A. D., Cohen, J., & Metcalfe, S. A. (2010). A systematic review of population screening for fragile X syndrome. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 12(7), 396–410. doi:10.1097/GIM.0b013e3181e38fb6.CrossRef Hill, M. K., Archibald, A. D., Cohen, J., & Metcalfe, S. A. (2010). A systematic review of population screening for fragile X syndrome. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 12(7), 396–410. doi:10.​1097/​GIM.​0b013e3181e38fb6​.CrossRef
go back to reference Hunter, J., Rivero-Arias, O., Angelov, A., Kim, E., Fotheringham, I., & Leal, J. (2014). Epidemiology of fragile X syndrome: a systematic review and meta-analysis. American Journal of Medical Genetics Part A, 164(7), 1648–1658. doi:10.1002/ajmg.a.36511.CrossRef Hunter, J., Rivero-Arias, O., Angelov, A., Kim, E., Fotheringham, I., & Leal, J. (2014). Epidemiology of fragile X syndrome: a systematic review and meta-analysis. American Journal of Medical Genetics Part A, 164(7), 1648–1658. doi:10.​1002/​ajmg.​a.​36511.CrossRef
go back to reference Jang, J.-H. H., Lee, K., Cho, E.-H. H., Lee, E.-H. H., Kim, J.-W. W., & Ki, C.-S. S. (2014). Frequency of FMR1 premutation carriers and rate of expansion to full mutation in a retrospective diagnostic FMR1 Korean sample. Clinical Genetics, 85(1), 441–445. doi:10.1111/cge.12195.CrossRefPubMed Jang, J.-H. H., Lee, K., Cho, E.-H. H., Lee, E.-H. H., Kim, J.-W. W., & Ki, C.-S. S. (2014). Frequency of FMR1 premutation carriers and rate of expansion to full mutation in a retrospective diagnostic FMR1 Korean sample. Clinical Genetics, 85(1), 441–445. doi:10.​1111/​cge.​12195.CrossRefPubMed
go back to reference Kuppermann, M., Nakagawa, S., Cohen, S. R., Dominguez-Pareto, I., Shaffer, B. L., & Holloway, S. D. (2011). Attitudes toward prenatal testing and pregnancy termination among a diverse population of parents of children with intellectual disabilities. Prenatal Diagnosis, 31(13), 1251–1258. doi:10.1002/pd.2880.CrossRefPubMed Kuppermann, M., Nakagawa, S., Cohen, S. R., Dominguez-Pareto, I., Shaffer, B. L., & Holloway, S. D. (2011). Attitudes toward prenatal testing and pregnancy termination among a diverse population of parents of children with intellectual disabilities. Prenatal Diagnosis, 31(13), 1251–1258. doi:10.​1002/​pd.​2880.CrossRefPubMed
go back to reference Newcombe, R. G. (1998). Two-sided confidence intervals for the single proportion: comparison of seven methods. Statistics in Medicine, 17(8), 857–872.CrossRefPubMed Newcombe, R. G. (1998). Two-sided confidence intervals for the single proportion: comparison of seven methods. Statistics in Medicine, 17(8), 857–872.CrossRefPubMed
go back to reference Nolin, S. L., Sah, S., Glicksman, A., Sherman, S. L., Allen, E., Berry-Kravis, E., et al. (2013). Fragile X AGG analysis provides new risk predictions for 45–69 repeat alleles. American Journal of Medical Genetics Part A, 161(4), 771–778. doi:10.1002/ajmg.a.35833.CrossRef Nolin, S. L., Sah, S., Glicksman, A., Sherman, S. L., Allen, E., Berry-Kravis, E., et al. (2013). Fragile X AGG analysis provides new risk predictions for 45–69 repeat alleles. American Journal of Medical Genetics Part A, 161(4), 771–778. doi:10.​1002/​ajmg.​a.​35833.CrossRef
go back to reference Seltzer, M. M., Baker, M. W., Hong, J., Maenner, M., Greenberg, J., & Mandel, D. (2012). Prevalence of CGG expansions of the FMR1 gene in a US population-based sample. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : The Official Publication of the International Society of Psychiatric Genetics, 159B(5), 589–597. doi:10.1002/ajmg.b.32065.CrossRef Seltzer, M. M., Baker, M. W., Hong, J., Maenner, M., Greenberg, J., & Mandel, D. (2012). Prevalence of CGG expansions of the FMR1 gene in a US population-based sample. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : The Official Publication of the International Society of Psychiatric Genetics, 159B(5), 589–597. doi:10.​1002/​ajmg.​b.​32065.CrossRef
go back to reference Tassone, F., Iong, K. P., Tong, T.-H., Lo, J., Gane, L. W., Berry-Kravis, E., et al. (2012). FMR1 CGG allele size and prevalence ascertained through newborn screening in the United States. Genome Medicine, 4(12), 100. doi:10.1186/gm401.CrossRefPubMedPubMedCentral Tassone, F., Iong, K. P., Tong, T.-H., Lo, J., Gane, L. W., Berry-Kravis, E., et al. (2012). FMR1 CGG allele size and prevalence ascertained through newborn screening in the United States. Genome Medicine, 4(12), 100. doi:10.​1186/​gm401.CrossRefPubMedPubMedCentral
go back to reference Toledano-Alhadef, H., Basel-Vanagaite, L., Magal, N., Davidov, B., Ehrlich, S., Drasinover, V., et al. (2001). Fragile-X carrier screening and the prevalence of premutation and full-mutation carriers in Israel. The American Journal of Human Genetics, 69, 351–360.CrossRefPubMed Toledano-Alhadef, H., Basel-Vanagaite, L., Magal, N., Davidov, B., Ehrlich, S., Drasinover, V., et al. (2001). Fragile-X carrier screening and the prevalence of premutation and full-mutation carriers in Israel. The American Journal of Human Genetics, 69, 351–360.CrossRefPubMed
go back to reference Yrigollen, C. M., Durbin-Johnson, B., Gane, L., Nelson, D. L., Hagerman, R., Hagerman, P. J., & Tassone, F. (2012). AGG interruptions within the maternal FMR1 gene reduce the risk of offspring with fragile X syndrome. Genetics in Medicine, 14, 729–736. doi:10.1038/gim.2012.34.CrossRefPubMedPubMedCentral Yrigollen, C. M., Durbin-Johnson, B., Gane, L., Nelson, D. L., Hagerman, R., Hagerman, P. J., & Tassone, F. (2012). AGG interruptions within the maternal FMR1 gene reduce the risk of offspring with fragile X syndrome. Genetics in Medicine, 14, 729–736. doi:10.​1038/​gim.​2012.​34.CrossRefPubMedPubMedCentral
Metadata
Title
A Pilot Study of Fragile X Syndrome Screening in Pregnant Women and Women Planning Pregnancy: Implementation, Acceptance, Awareness, and Geographic Factors
Authors
Ramona Alfaro Arenas
Jordi Rosell Andreo
Damián Heine Suñer
Group for the study of FXS in the Balearic Islands
Publication date
01-06-2017
Publisher
Springer US
Published in
Journal of Genetic Counseling / Issue 3/2017
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI
https://doi.org/10.1007/s10897-016-0005-3

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