Prenatal DNA test raises both hopes and worries

Roger Collier

doi:10.1503/cmaj.090349

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Invasive Prenatal Testing
Julie L Lauzon

Published on: 20 April 2009
re prenatal dna test
eric e brown

Published on: 15 April 2009
Renate E Lindeman

Published on: 07 April 2009
PRENATAL DNA TESTING FOR INTELLIGENT BUT CRIMINAL GENES
ABDUL MAJID WANI

Published on: 06 April 2009
Re: DNA test raises both hopes and worries CMAJ March 31 2009 180(7)
Harry J van Bommel

Published on: 01 April 2009

Published on: (20 April 2009)

Invasive Prenatal Testing
Julie L Lauzon
We read with great interest the recent News item “Prenatal DNA test raises both hopes and worries” [1] in the CMAJ. This thoughtful and timely piece covers many important issues regarding the implementation of new genetic technologies in clinical practice.
Specifically this article discusses the availability of microarray testing in a prenatal setting. As indicated, this technology is increasingly available in t...
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We read with great interest the recent News item “Prenatal DNA test raises both hopes and worries” [1] in the CMAJ. This thoughtful and timely piece covers many important issues regarding the implementation of new genetic technologies in clinical practice.
Specifically this article discusses the availability of microarray testing in a prenatal setting. As indicated, this technology is increasingly available in the pediatric clinic, where it is providing approximately a twofold increase in diagnostic yield over conventional cytogenetics techniques (karyotype). Diagnostic microarrays are now available for prenatal testing in some US laboratories. We do however wish to highlight a potential significant misperception of this article. It is stated “In microarray testing, fetal DNA is obtained from a pregnant woman’s blood. This eliminates the need to perform amniocentesis, a test that slightly increases the risk of miscarriage.” Certainly to our knowledge clinical prenatal microarray testing using fetal DNA from maternal blood is not available in North America. At the present time, if prenatal microarray testing is being offered in Canada, it is being done through conventional invasive prenatal techniques such as chorionic villus sampling (CVS) or amniocentesis. As such, this test does carry a risk of pregnancy loss and as such should be only offered in pregnancies at increased risk. We think this is an important distinction to be made to readers of the journal many of whom may be in a position of offering such testing to their patients.
We agree with Dr Friedman that the use of prenatal microarray in Canada should be limited for now to “clinical trials or for pregnancies in which fetuses are at high risk of having chromosomal abnormalities.” As implied by Mr Trevors, Dr Friedman and others it is important that pre- test and post-test counseling be provided to expectant parents prior to offering this test in a prenatal setting. However, as previously discussed in the journal [2] there are significant shortages of clinical genetics, genetic counsellors and clinical laboratory geneticists as well as resources which will remain barriers to the provision of these services to all couples.
A Micheil Innes Clinical Geneticist Alberta Children's Hospital, University of Calgary
Julie L Lauzon Clinical Geneticist Alberta Children’s Hospital
References:
1.Collier R. Prenatal DNA test raises both hopes and worries. CMAJ 2009; 180: 705-706.
2.Silversides A. The wide gap between genetic research and clinical needs. CMAJ 2007; 176: 315-316.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (15 April 2009)

re prenatal dna test
eric e brown
sir,
"do we want a society, some ask, in which disabled people will eventually be found only in history books?" - absolutely. who would argue against polio vaccination saying that post-polio syndrome adds to the diversity of society?
if the testing in question were possible pre-conception what parent would knowingly choose gametes destine to confer a significant disability on their child ? the ethical...
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sir,
"do we want a society, some ask, in which disabled people will eventually be found only in history books?" - absolutely. who would argue against polio vaccination saying that post-polio syndrome adds to the diversity of society?
if the testing in question were possible pre-conception what parent would knowingly choose gametes destine to confer a significant disability on their child ? the ethical debate exists because of a belief by some that once two gametes fuse they become a sacred, right-entitled human individual. it's the abortion debate all over again.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (7 April 2009)
Renate E Lindeman
As a mother of two young children with Down syndrome, and a dedicated women's rights activist, I do not automatically condemn prenatal screening. However, if used without proper caution and legislation it can easily lead to excesses and further marginalization of groups of people.
The article mentions the number of children born with Down syndrome has dropped almost 90% since prenatal screening became widespread....
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As a mother of two young children with Down syndrome, and a dedicated women's rights activist, I do not automatically condemn prenatal screening. However, if used without proper caution and legislation it can easily lead to excesses and further marginalization of groups of people.
The article mentions the number of children born with Down syndrome has dropped almost 90% since prenatal screening became widespread. Most Canadians provinces were quick to adopt the February 2007 SOGC guidelines to routinely offer, government funded, screening for Down syndrome, but this expansion was not accompanied by an appropriate increase in public awareness campaigns, education, counseling and support. Furthermore, the 'routine nature' of the tests (a drop of blood) does little to make women aware their fetuses are actually screened for Down syndrome, and many are not prepared for the results these screens reveal.
Countries like the UK and the Netherlands, that also adopted widespread screening programs for Down syndrome, have reported an INCREASE of babies born with the condition in recent years. The difference is that the expansion of prenatal screening programs has been accompanied by a growing public awareness of genetic testing. Investments are made to improve information, education, and research aimed at improving the lives of people with Down syndrome.
The article continues: "There are no treatments for many of the genetic disorders the test will uncover." But does prenatal screening negatively influence treatments, research and opportunities for people with genetic conditions, or vice versa in Canada? In recent years I experienced fewer services for my children, growing waitlists, no -or very little- new treatments and therapies are developed and little research is done. In our province of Nova Scotia, my children face a bleak future with high unemployment rates and poor housing options. It looks like the Canadian (medical) society given up on Down syndrome and other genetic conditions because the 'cure' has been found in screening and prevention. Soon the pleasure of knowingly choosing for a child with an identifiable genetic condition will become exclusive for the wealthy or strict pro-life community in Canada, because for others (like me) the financial, emotional or social consequences of knowingly choosing for a child with an identified condition will become too great.
As genetic science progresses, it creates economic, social and emotional dilemmas that affect all of us. This great article underlines the urgent need for a widespread public debate, and creation of transparent guidelines that will ensure the rights of ALL Canadians, including pregnant women and disabled.
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Competing Interests: None declared.
Published on: (6 April 2009)

PRENATAL DNA TESTING FOR INTELLIGENT BUT CRIMINAL GENES
ABDUL MAJID WANI
Dear editor,
Having gone through this interesting article, we reach a conclusion that prenatal DNA testing increases feticide(1). The free or easy access to the test will create a society free of disabled and mentally retarded and free of syndromes (2).This is we who care for human values on one-hand and exploit the same on the other.The most intelligent and those with ‘perfect genetic makeup ’become either em...
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Dear editor,
Having gone through this interesting article, we reach a conclusion that prenatal DNA testing increases feticide(1). The free or easy access to the test will create a society free of disabled and mentally retarded and free of syndromes (2).This is we who care for human values on one-hand and exploit the same on the other.The most intelligent and those with ‘perfect genetic makeup ’become either emprorers, presidents, prime ministers, dictators and those in power, supposed to be caretakers of humanity. But what do these intelligent genes do for mankind is in front of us and as history. Count the deaths and disabilities brought by intelligent genes in wars most recently...Iraq War, Afghan War, (3,4)Gaza War,Darfour,Chicneya, Bosnia,Kambodia,Ravanda,World war- I and World War - II and .......I will not make a comment about Hitler, Polpot,Mussolini ,Bush etc.Will any sensible human being explain who were disabled and who were suffering from syndromes. Are these “intelligent genes ”the “criminal genes ”(5)and if so let our genetic technology be directed to detect these genes to avoid death, destruction and disabilities for which there is no remedy rather than“the most social Down’s Syndrome” who are harmless.
COAUTHOR DR MUBEENA AKHTAR
1.Pre-Natal DNA Testing: Issues and Concerns! | Testing It Up – Drug ... If answer to any of these questions is yes, perhaps DNA testing can come to your rescue! ... has been officially banned due to increased female feticide. ... hometestingblog.testcountry.com/?p=1240 - 26k
2.Roger Collier Prenatal DNA test raises both hopes and worries CMAJ 2009; 180: 705-706 [Full text] [PDF]
3.War on Iraq will Result in Disabilities - Abilities Canada ... War on Iraq will Result in Disabilities - Abilities Canada - Abilities ... a war, "the incidence of disability will increase significantly not only due to ... www.abilities.ca/travel/2004/04/15/war_on_iraq_will_result/ - 21k -
4.Taking stock of the Afghan war, seven years on: Rediff.com news ... but death and destruction to civilized nations where ever it has gone. .... Taking stock of the Afghan war, by samit vats on Oct 11, 2008 03:59 PM There ... world.rediff.com/news/article/www/news/2008/oct/10guest1.htm - 47k -
5.Times Higher Education - In Reckless Hands: Skinner v Oklahoma and ... 15 Jan 2009 ... The war against 'criminal genes'. Susan Currell examines the story behind the legal battle against forced sterilisation of convicts ... www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=405018&c=1 - 26k
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (1 April 2009)

Re: DNA test raises both hopes and worries CMAJ March 31 2009 180(7)
Harry J van Bommel
In 1992 when my wife was pregnant with our son, we were offered prenatal testing for genetic abnormalities. If we agreed, we would have needed to sign a consent form. Asked what would happen if the test was positive for Down Syndrome, Spina Bifida and other disabling conditions the physician said a amniocentesis would be the next step even though there was some danger to the pregnancy in performing that test. If that te...
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In 1992 when my wife was pregnant with our son, we were offered prenatal testing for genetic abnormalities. If we agreed, we would have needed to sign a consent form. Asked what would happen if the test was positive for Down Syndrome, Spina Bifida and other disabling conditions the physician said a amniocentesis would be the next step even though there was some danger to the pregnancy in performing that test. If that test was positive the 'natural' followup would be termination of the pregnancy.We refused all tests.
In 1995 when my wife was pregnant with our daughter the process had dramatically changed. Now when we were told about prenatal testing and we refused, we had to sign a consent form saying we did not want the test.
In other words, within the span of 3 years, the default position on testing went from requiring consent to have the test to requiring a signed declaration that we did not want the test. The presumption had become that everyone would want the test (this was evident since the physician couldn't find the form for refusing the test).
There is no doubt that society's default has become testing with probable termination upon any 'positive' results. For those of us with family and friends who have these same labels, there is no doubt this is a move to eugenics. What is even sadder is that those of us with these labels, reading such articles can only be afraid as they watch infants with similar conditions as they have being aborted before even having a chance to live. Many of these readers will be among the last to live with these conditions.
Conflict of Interest:
None declared
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Competing Interests: None declared.