The emerging new paradigm in pregnancy care. Reproductive Genetic Carrier Screening: a review of 12,000 cases shows high clinical utility. Trent Burgess Senior scientist, Victorian Clinical Genetics Services Murdoch Children’s Research Institute Honorary Fellow, Department of Paediatrics, University of Melbourne
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The emerging new paradigm in pregnancy care. Reproductive ... · The emerging new paradigm in pregnancy care. Reproductive Genetic Carrier Screening: a review of 12,000 cases shows
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The emerging new paradigm in pregnancy
care. Reproductive Genetic Carrier Screening:
a review of 12,000 cases shows high clinical
utility.
Trent Burgess
Senior scientist,
Victorian Clinical Genetics Services
Murdoch Children’s Research Institute
Honorary Fellow, Department of Paediatrics, University of Melbourne
MCRI
VCGS
Not-for profit subsidiary of Murdoch Children’s Research Institute at Royal Children’s Hospital
Comprehensive laboratory and clinical genetics service
Key role in research and development, translational research, and policy development
Service provider for public & private Non-invasive Prenatal Testing & carrier screening in New Zealand
RCH
Population screening programs
1960-70’s
Newborn screening• Severe childhood onset metabolic conditions• Interventions can result in normal/greatly improved development outcomes• >20 conditions screened for in Aus and NZ - government funded programs
Haemoglobinopathies• Mediterranean countries. Ad hoc reproductive screening
Tay-Sachs (1970’s internationally)• School age screening within local Ashkenazi Jewish comm.• 2003 nation wide program in Israel - 90% reduction in Tay-Sach’s
Cystic fibrosis• Population based reproductive screening
2013
1970’s
1990’s
2005
Reproductive Genetic Carrier Screening• Fragile X syndrome and spinal muscular atrophy
2015 Expanded screening• 100’s of autosomal recessive and X-linked genetic conditions
Maternal serum screening/NIPT• 2nd trimester, CFTs and Non-invasive prenatal testing
1990-2012
Carrier screening - the shifting landscape
“Every baby is at a small risk of having a chromosomal or genetic
condition. Prenatal screening for some chromosomal conditions is
offered in maternity care to provide the pregnant woman with more
information about her unborn baby. All such testing should be voluntary
and only undertaken when the pregnant woman has been informed
about the nature of the screening test, the possible result, and the
option available to her.”
April 2015
All patients who are considering pregnancy or arealready pregnant, regardless of screening strategyand ethnicity, should be offered carrier screening forcystic fibrosis and spinal muscular atrophy, as wellas a complete blood count and screening for thalassemia'sand hemoglobinopathies.
March 2017
Consensus-based recommendation: Where available, screening of low risk women for carrier status of the more common genetic conditions (e.g. cystic fibrosis, spinal muscular atrophy, fragile X syndrome) may be offered.