Women Choose Invasive vs Non-Invasive Prenatal Testing Based on Tradeoff Between Risk Taking and Information Seeking

MedicalResearch.com Interview with:

Valerie Seror, PhD French Institute of Health and Medical Research Inserm 

Dr. Seror

Valerie Seror, PhD
French Institute of Health and Medical Research
Inserm

MedicalResearch.com: What is the background for this study?

Response: In the highly sensitive context of prenatal diagnosis where autonomous and informed decision-making is of crucial issue, the present study is a companion study to a prospective clinical trial [ClinicalTrials.gov Identifier: NCT02127515] aiming at comparing clinical benefits involved by invasive vs. non-invasive testing in women at high risk of Down syndrome following routine combined screening.

Our study (involving 2,436 consecutive high-risk pregnant women following combined screening for Down syndrome) confirmed that attitudes towards invasive testing are notably guided by risk aversion to invasive testing-related fetal loss whereas it showed that attitudes towards non-invasive testing are notably guided by aversion to the ambiguity generated by results restricted to the only targeted abnormalities.

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Clinically Silent Maternal Cancer Detectable By Prenatal Testing

Diana W. Bianchi, M.D. Executive Director, Mother Infant Research Institute Vice Chair for Research and Academic Affairs, Department of Pediatrics Tufts Medical CenterMedicalResearch.com Interview with:
Diana W. Bianchi, M.D.

Executive Director, Mother Infant Research Institute
Vice Chair for Research and Academic Affairs
Department of Pediatrics
Tufts Medical Center

Medical Research: What is the background for this study? What are the main findings?

Response: Noninvasive Prenatal Testing (NIPT) is the fastest growing genetic test. It has been available since late 2011. Over 2 million tests have been performed worldwide. Cancer in pregnancy is rare, and only occurs in 1 in 1,000 pregnant women. About 0.2 per cent of noninvasive prenatal tests that use sequencing of maternal plasma DNA have a so-called “false positive” result. In most cases this is not an error, but there is a biological explanation for the discrepancy between the abnormal noninvasive prenatal test result and a normal fetal chromosome result obtained from a diagnostic procedure, such as amniocentesis or chorionic villus sampling (CVS). We are very interested in the underlying biological explanations for the false positive cases, and it turns out that a clinically silent tumor in the mother is one of them. The mother’s tumor is shedding DNA into her blood that is detected by the prenatal test.

In a large clinical dataset of over 125,000 pregnant women who had a DNA sequencing screen for fetal chromosome abnormalities there were 10 women who were subsequently found to have cancer. We retrospectively analyzed the DNA sequencing results in 8 of these women and found that they had abnormalities in multiple areas of the genome, suggesting that it was DNA from the tumor that was shed into the maternal blood and being detected by the prenatal screen.

The noninvasive prenatal sequencing test result that was most suggestive of a cancer risk was the presence of more than one aneuploidy. This finding was present in 7 of the 10 women who had cancer.

In three of the eight women we studied it was the abnormal prenatal test result that triggered a subsequent work-up that led to the diagnosis of cancer.

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