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Burzynski S, Leonard J, Albrecht JP, Doyle LE, Mills R. Parental questions about sex chromosome aneuploidies regarding sex, gender, and sexual orientation as reported by genetic counselors in a prenatal setting. J Genet Couns 2024. [PMID: 38610065 DOI: 10.1002/jgc4.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/19/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
The introduction of cell-free DNA screening has resulted in increased prenatal identification of sex chromosome aneuploidies (SCAs). This study aimed to evaluate genetic counselor experiences disclosing SCAs positive prenatal screening or testing results and genetic counselor-reported parental questions regarding sex, gender, and sexual orientation. Forty-eight prenatal genetic counselors completed the survey. When asked to quantify their experiences, 97.9% of counselors reported disclosing a SCAs positive screen result within the previous year, and 81.3% disclosed a diagnostic result. Of those counselors, 53.8% reported always or often receiving parental questions about sex, 33% always or often about gender, and 25% always or often regarding sexual orientation. Counselors were asked to share examples of parental questions following a positive screen or diagnostic testing for SCAs. Parental questions were stratified by karyotype and content analysis revealed questions about the fetus' sex, anatomy, reproduction, being cisgender, gender expression, behavior, being transgender, and sexual orientation. The examples of parental questions provided by genetic counselors suggested some parents may have misconceptions about the intersection of SCAs with sex, gender, and sexual orientation following prenatal screening or diagnostic testing. The majority of counselors (83.3%) agreed to some extent that they desired further education on responding to parental questions about SCAs. Findings from this research suggest a need for genetic counseling strategies that accurately and respectfully discuss SCAs in the context of sex, gender, and sexual orientation with prenatal patients.
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Affiliation(s)
- Sarah Burzynski
- MS Genetic Counseling Program, University of North Carolina Greensboro, Greensboro, North Carolina, USA
- Wellstar Health System, Marietta, Georgia, USA
| | - Jaqueline Leonard
- Roberts Individualized Medical Genetics Center, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Lauren E Doyle
- MS Genetic Counseling Program, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Rachel Mills
- MS Genetic Counseling Program, University of North Carolina Greensboro, Greensboro, North Carolina, USA
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2
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Thompson T, Tisher J, Davis S, Miller C, Kirk J, Tartaglia N, Howell S. The emotional journey of adapting to prenatally identified trisomy X. J Genet Couns 2023:10.1002/jgc4.1778. [PMID: 37691399 PMCID: PMC10924744 DOI: 10.1002/jgc4.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023]
Abstract
There is a paucity of research on the experiences of parents of children with trisomy X (47,XXX). Increased prenatal diagnoses associated with advances in noninvasive prenatal screening necessitate a better understanding of how trisomy X impacts family systems. This qualitative investigation aimed to describe the lived experience of parents of young daughters with prenatally identified trisomy X to guide genetic counseling. Semi-structured qualitative interviews were conducted via teleconferencing with parents (n = 11) of girls with trisomy X, ages 6-44 months. A descriptive phenomenological approach was used to code transcripts for significant statements and reduce data into themes describing the experience of receiving a diagnosis of trisomy X and the experience of early parenting in this population. Participants described an emotional journey of adapting to prenatally identified trisomy X. Four descriptive themes included two related, yet distinct, life stages: Negative Diagnostic Experience and a Hopeful Early Childhood, as well as two ongoing experiences: Persistent Ambiguity and Coping with and Adapting to Uncertainty. Results suggest providers should carefully consider word choice and timing in delivery of diagnosis, and genetic counseling should provide expectant parents with current research specific to trisomy X, facilitate connections with other parents of young girls with trisomy X, introduce developmental monitoring approaches, and be prepared to support families with a range of emotional responses to the diagnosis and decisions regarding disclosure.
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Affiliation(s)
- Talia Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Jessica Tisher
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
- Avera Health, Sioux Falls, South Dakota
| | - Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Christina Miller
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jillian Kirk
- Genetic Counseling Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- eXtraordinarY Kids Program, Children’s Hospital Colorado, Aurora, Colorado
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Johnston M, Warton C, Pertile MD, Taylor-Sands M, Delatycki MB, Hui L, Savulescu J, Mills C. Ethical issues associated with prenatal screening using non-invasive prenatal testing for sex chromosome aneuploidy. Prenat Diagn 2023; 43:226-234. [PMID: 35929376 DOI: 10.1002/pd.6217] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/24/2022] [Accepted: 07/22/2022] [Indexed: 11/11/2022]
Abstract
Prenatal screening for sex chromosome aneuploidies (SCAs) is increasingly available through expanded non-invasive prenatal testing (NIPT). NIPT for SCAs raises complex ethical issues for clinical providers, prospective parents and future children. This paper discusses the ethical issues that arise around NIPT for SCAs and current guidelines and protocols for management. The first section outlines current practice and the limitations of NIPT for SCAs. It then outlines key guidelines before discussing the ethical issues raised by this use of NIPT. We conclude that while screening for SCAs should be made available for people seeking to use NIPT, its implementation requires careful consideration of what, when and how information is provided to users.
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Affiliation(s)
| | | | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lisa Hui
- University of Melbourne, Melbourne, Victoria, Australia
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Howell S, Davis SM, Thompson T, Brown M, Tanda T, Kowal K, Alston A, Ross J, Tartaglia NR. Noninvasive prenatal screening (NIPS) results for participants of the eXtraordinarY babies study: Screening, counseling, diagnosis, and discordance. J Genet Couns 2023; 32:250-259. [PMID: 36204975 PMCID: PMC11004509 DOI: 10.1002/jgc4.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
Sex chromosome aneuploidies (SCAs), including 47,XXY, 47,XXX, 47,XYY, and supernumerary variants, occur collectively in approximately one of 500 live births. Clinical phenotypes are highly variable resulting in previous ascertainment rates estimated to be only 10%-25% during a lifetime. Historically, prenatal SCA diagnoses were incidental findings, accounting for ≤10% of cases, with the majority of diagnoses occurring postnatally during evaluations for neurodevelopmental, medical, or infertility concerns. The initiation of noninvasive prenatal screening (NIPS) in 2012 and adoption into standardized obstetric care provides a unique opportunity to significantly increase prenatal ascertainment of SCAs. However, the impact NIPS has had on ascertainment of SCAs is understudied, particularly for those who may defer diagnostic testing until after birth. This study evaluates the timing of diagnostic testing following positive NIPS in 152 infants with SCAs and potential factors influencing this decision. Eighty-seven (57%) elected to defer diagnostic testing after a positive NIPS until birth, and 8% (7/87) of those confirmed after birth were found to have discordant results on postnatal diagnostic testing, most of which would have influenced genetic counseling.
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Affiliation(s)
- Susan Howell
- Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Shanlee M. Davis
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Talia Thompson
- Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Mariah Brown
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
- Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tanea Tanda
- Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Karen Kowal
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Nemours DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Amanda Alston
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Nemours DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Judith Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Nemours DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Nicole R. Tartaglia
- Developmental Pediatrics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- eXtraordinarY Kids Clinic and Research Program, Children’s Hospital Colorado, Aurora, Colorado, USA
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Fisher J, McInnes-Dean H. When a sex chromosome aneuploidy is diagnosed-views from a parent support organisation. Prenat Diagn 2023; 43:235-239. [PMID: 35962480 DOI: 10.1002/pd.6222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Hannah McInnes-Dean
- Antenatal Results and Choices, London, UK.,NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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De Falco L, Suero T, Savarese G, Savarese P, Ruggiero R, Di Carlo A, Bruno M, Petrillo N, Ianniello M, Scarpato C, Sarli C, Fico A. Non-Invasive Prenatal Screening: The First Report of Pentasomy X Detected by Plasma Cell-Free DNA and Karyotype Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071591. [PMID: 35885497 PMCID: PMC9321121 DOI: 10.3390/diagnostics12071591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Pentasomy X is a sex chromosome anomaly caused by the presence of three extra X chromosomes in females (49,XXXXX instead of 46,XX) and is probably due to a nondisjunction during the meiosis. So far, only five cases prenatally diagnosed were described. The main features in 49,XXXXX karyotype include severe intellectual disability with delayed speech development, short stature, facial dysmorphisms, osseous and articular abnormalities, congenital heart malformations, and skeletal and limb abnormalities. Prenatal diagnosis is often difficult due to the lack of a clear echographic sign like nuchal translucency (NT), and mostly cases were postnatally described. We report the first case of a 49,XXXXX female that was detected by non-invasive prenatal screening (NIPS), quantitative fluorescence polymerase chain reaction (QF-PCR) and a fetal karyotype.
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Affiliation(s)
- Luigia De Falco
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Correspondence:
| | - Teresa Suero
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Giovanni Savarese
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Pasquale Savarese
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Raffaella Ruggiero
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Antonella Di Carlo
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Mariasole Bruno
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Nadia Petrillo
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Monica Ianniello
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
| | - Ciro Scarpato
- Responsabile Ambulatorio Medicina Prenatale, P.O.S. Giuliano, 80014 Naples, Italy;
| | - Camilla Sarli
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80138 Naples, Italy;
- CEINGE Biotecnologie Avanzate, 80131 Naples, Italy
| | - Antonio Fico
- AMES-Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (T.S.); (G.S.); (P.S.); (R.R.); (A.D.C.); (M.B.); (N.P.); (M.I.); (A.F.)
- Fondazione Genetica per la Vita Onlus, 80132 Naples, Italy
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Cell-Free DNA Screening for Sex Chromosome Abnormalities and Pregnancy Outcomes, 2018-2020: A Retrospective Analysis. J Pers Med 2022; 12:jpm12010048. [PMID: 35055363 PMCID: PMC8780735 DOI: 10.3390/jpm12010048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022] Open
Abstract
To evaluate the efficacy of non-invasive prenatal screening (NIPT) for detecting fetal sex chromosome abnormalities, a total of 639 women carrying sex chromosome abnormalities were selected from 222,107 pregnant women who participated in free NIPT from April 2018 to December 2020. The clinical data, prenatal diagnosis results, and follow-up pregnancy outcomes of participants were collected. The positive predictive value (PPV) was used to analyze the performance of NIPT. Around 235 cases were confirmed with sex chromosome abnormalities, including 229 cases with sex chromosome aneuploidy (45, X (n = 37), 47, XXX (n = 37), 47, XXY (n = 110), 47, XYY (n = 42)) and 6 cases with structural abnormalities. The total incidence rate was 0.11% (235/222,107). The PPV of NIPT was 45.37% (235/518). NIPT accuracy for detecting sex chromosome polysomes was higher than that for sex chromosome monomers. The termination of pregnancy rate for fetal diagnosis of 45, X, and 47, XXY was higher than that of 47, XXX, and 47, XYY. The detection rate of fetal sex chromosome abnormalities was higher in 2018–2020 than in 2010–2012 (χ2 = 69.708, P < 2.2 × 10−16), indicating that NIPT is greatly efficient to detect fetal sex chromosome abnormalities.
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Luo Y, Hu H, Zhang R, Ma Y, Pan Y, Long Y, Hu B, Yao H, Liang Z. An assessment of the analytical performance of non-invasive prenatal testing (NIPT) in detecting sex chromosome aneuploidies: 34,717-patient sample in a single prenatal diagnosis Centre in China. J Gene Med 2021; 23:e3362. [PMID: 33973298 DOI: 10.1002/jgm.3362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate the efficacy of a non-invasive prenatal test (NIPT) in the detection of the sex chromosome aneuploidies (SCAs) at our prenatal diagnosis centre. METHODS Among a cohort of 34,717 pregnancies, maternal plasma samples from our prenatal diagnosis centre were subject to analysis of SCAs using NIPT detection. Pregnant women with NIPT positive results of SCAs were recommended to undergo an invasive prenatal diagnosis (i.e. karyotyping and fluorescence in situ hybridization) to validate the prediction value of NIPT. RESULTS From 34,717 clinical pregnancies, 229 (0.66%) pregnancies were identified with SCAs. Of these, 78 (34.1%) cases were positive for 45,X and 151 (65.9%) cases comprised a sex chromosome trisomy. Of the 229 positive NIPT results, 193 (84.3%) cases had accepted an invasive diagnosis involving karyotyping analysis of the amniotic fluid, which confirmed 67 cases (34.7%) as true positive, as well as 126 cases (65.3%) as false positive. The positive predictive values were 23.07%, 50%, 36% and 27.27% respectively. The remaining 36 (15.7%) cases declined a prenatal diagnosis. The termination rates of 45,X, 47,XXY, 47,XXX and 47,XYY were 20.5%,46%,12.9% and 11.5% respectively. CONCLUSIONS NIPT demonstrated a lower accuracy in predicting monosomy X than sex chromosome trisomies. After invasive testing, the fetal chromosome with 45,X and 47,XXY were terminated more often than those with 47,XXX, 47,XYY. Because NIPT is a screening test, false positive/negative cases exist, and pre- and post-test counselling is essential for informing patients about the benefits and limitations of the test. Confirmatory testing of abnormal results is recommended prenatally or after birth, and the importance of confirmatory testing and benefits of early diagnosis should be addressed.
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Affiliation(s)
- Yanmei Luo
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huamei Hu
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rong Zhang
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yongyi Ma
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yan Pan
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Long
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Bin Hu
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Yao
- Department of Gynecology & Obstetrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiqing Liang
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Deng C, Cheung SW, Liu H. Noninvasive prenatal screening for fetal sex chromosome aneuploidies. Expert Rev Mol Diagn 2021; 21:405-415. [PMID: 33787433 DOI: 10.1080/14737159.2021.1911651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sex chromosome aneuploidies (SCAs) are among the most common chromosome abnormalities observed in humans. Manifestations include low fertility, infertility, delayed language development, and dysfunction in motor development. Noninvasive prenatal screening (NIPS) based on cell-free fetal DNA from the peripheral blood of pregnant women is increasingly used for the screening of fetal chromosome abnormalities, including screening for fetal gender and fetal sex chromosome aneuploidy. A systematic review of the literature about NIPS for SCAs is needed. AREAS COVERED This review evaluated a vast array of published studies focusing on the clinical significance, detection methods, performance of NIPS for SCAs, and the management of positive SCA results following screening with the aim of facilitating a comprehensive and systematic understanding of NIPS for SCAs. EXPERT COMMENTARY Looking forward, NIPS is expected to become the primary screening test for common aneuploidies as well as other chromosome abnormalities, including some micro-deletions and micro-duplications, with the potential to transition from a screening test to a prenatal diagnosis method. Ultimately, the goal is to provide a safe and accurate method for increasing early diagnosis to improve long-term outcomes for the SCA patients and families by well- informed health care providers.
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Affiliation(s)
- Cechuan Deng
- Medical Genetics Department/Prenatal Diagnostic Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Hongqian Liu
- Medical Genetics Department/Prenatal Diagnostic Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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Ronzoni L, Bedeschi MF, Silibello G, Accurti V, Di Segni M, Nicotra V, Vizziello P, Lalatta F. Increased RISK for 47,XXY on cell-free DNA screen: Not always Klinefelter syndrome. Prenat Diagn 2020; 41:1255-1257. [PMID: 33370473 DOI: 10.1002/pd.5890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Luisa Ronzoni
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gaia Silibello
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Accurti
- Department of Obstetrics and Gynecology, Fetal Medicine and Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Di Segni
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Nicotra
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vizziello
- Child and Adolescent Neuropsychiatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Faustina Lalatta
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Riggan KA, Close S, Allyse MA. Family experiences and attitudes about receiving the diagnosis of sex chromosome aneuploidy in a child. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:404-413. [PMID: 32181570 DOI: 10.1002/ajmg.c.31781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 01/03/2023]
Abstract
The most common sex chromosome aneuploidies (SCA) (47, XXY; 47, XYY; 47, XXX) frequently result in a milder phenotype than autosomal aneuploidies. Nevertheless, these conditions are highly variable and more symptomatic phenotypes may require significant clinical involvement, including specialty care. While historically most individuals with mild phenotypes remained undiagnosed during their lifetime, the increasing use of genetic testing in clinical care has increased the prenatal and postnatal diagnosis of SCAs. These genetic tests are frequently ordered by nongenetic providers who are also responsible for delivering the diagnosis. We surveyed parents of children (n = 308) to evaluate their experience of receiving a diagnosis and their support needs. The majority (73.3%) received the diagnosis from a nongenetic medical provider. Following a prenatal diagnosis parents reported experiencing depression, anxiety, and less optimism than those receiving a postnatal diagnosis. Few parents reported receiving materials explaining their child's condition that they found to be up-to-date, accurate, and unbiased. The frequently negative reported experiences of parents at time of diagnosis suggests more educational opportunities should be provided for nongenetic providers in order to become more informed about these conditions and communicate the diagnosis in a way parents experience as supportive.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharron Close
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
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12
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Cognitive Profile, Emotional-Behavioral Features, and Parental Stress in Boys With 47,XYY Syndrome. Cogn Behav Neurol 2020; 32:87-94. [PMID: 31205122 DOI: 10.1097/wnn.0000000000000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe (a) the observed cognitive, emotional, and behavioral phenotype in a cohort of male children with 47,XYY syndrome and (b) stress levels in their parents. METHODS We conducted a cross-sectional observational study of 11 boys diagnosed with 47,XYY syndrome and compared them with 11 age-matched boys with normal karyotype (46,XY). The participants performed standardized assessments of cognitive function, emotional state, and behavioral features; the parents completed a questionnaire evaluating parental stress. All data were analyzed using parametric and nonparametric statistical methods. RESULTS All of the boys exhibited a normal cognitive profile. However, emotional-behavioral profiling revealed that internalizing and externalizing problems were more prevalent in the 47,XYY group. In addition, the stress levels of the parents of the 47,XYY group were reportedly higher than those of the parents of the 46,XY group. We also found that the time of the diagnosis had an effect on the mothers' stress levels; that is, postnatal fetal 47,XYY diagnosis was associated with higher maternal stress, whereas prenatal fetal 47,XYY diagnosis was not. CONCLUSIONS Generally, 47,XYY syndrome is associated with certain cognitive, emotional, and behavioral features. High stress levels have been reported by the mothers of 47,XYY boys who had been diagnosed postnatally because of unexpected developmental delay and/or learning difficulties. The present study highlights the need to better define the neuropsychiatric phenotype of 47,XYY children; namely, the effect of the chromosomal abnormality on their cognitive function and emotional-behavioral (internalizing and externalizing) features. This study could improve prenatal counseling and pediatric surveillance.
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Rigamonti C, Vizziello P, Monti F, Dall'ara F, Ajmone PF, Giavoli C, Silibello G, Lalatta F. Klinefelter Syndrome in preschool children: the importance of an early multidisciplinary approach for patients and families. Minerva Pediatr 2019; 71:395-403. [DOI: 10.23736/s0026-4946.16.04412-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Xu Y, Chen L, Liu Y, Hao Y, Xu Z, Deng L, Xie J. Screening, prenatal diagnosis, and prenatal decision for sex chromosome aneuploidy. Expert Rev Mol Diagn 2019; 19:537-542. [PMID: 31081704 DOI: 10.1080/14737159.2019.1613154] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the performance of non-invasive prenatal testing (NIPT) in screening sex chromosome aneuploidy (SCA), and explore prenatal decision-making in NIPT positive cases. Methods: The study retrospectively analyses singleton pregnancies who underwent NIPT screening. Clinical data, diagnostic results, and pregnancy outcomes were also collected. Results: There were 140 positive screens for SCA, including 62 cases of 45,X, 29 cases with 47,XXX, 28 cases of 47,XXY, 20 cases of 47,XYY, and one case of lower X chromosome. Karyotypic information was available in 103 cases. The positive predictive value was 26.09% for 45,X, 85.00% for 47,XXX, 85.00% for 47,XXY, and 68.75% for 47,XYY. The termination rates of 45,X, 47,XXX, 47,XXY, 47,XYY were 83.33%, 26.67%, 82.35%, and 54.54%, respectively (not including mosaic cases). Conclusion: Our findings demonstrated that the NIPT performed better in predicting sex chromosome trisomies than monosomy X even though false-positive cases do exist in NIPT. For prenatal decisions, pregnancies with diagnoses of fetal 45,X and 47,XXY were terminated more often than those with 47,XXX, 47,XYY. To better guide positive screening pregnancies, pre- and post-test counseling are essential in telling patients the benefits and limitations of the test, comforting their anxiety and giving them the choice for further diagnosis and pregnancy decision.
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Affiliation(s)
- Yong Xu
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
| | - Liyuan Chen
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
| | - Yang Liu
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
| | - Ying Hao
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
| | - Zhiyong Xu
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
| | - Liyanyan Deng
- b Department of Interventional Radiology , Shenzhen Traditional Chinese Medicine Hospital , Shenzhen , Guangdong , China
| | - Jiansheng Xie
- a Medical Genetics Center, Affiliated Shenzhen Maternity & Child Healthcare Hospital , Southern Medical University , Shenzhen , Guangdong , China
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Jaramillo C, Nyquist C, Riggan KA, Egginton J, Phelan S, Allyse M. Delivering the Diagnosis of Sex Chromosome Aneuploidy: Experiences and Preferences of Parents and Individuals. Clin Pediatr (Phila) 2019; 58:336-342. [PMID: 30516062 DOI: 10.1177/0009922818817310] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increased prenatal diagnoses of sex chromosome aneuploidies (SCAs) amid limited knowledge of their prognoses heighten the need to understand how families contend with the implications of an SCA. To explore the experiences of parents and individuals who received a genetic diagnosis of an SCA (excluding Turner syndrome), we conducted semistructured qualitative telephone interviews with 43 participants affected by these conditions. Parents (n = 35) and individuals (n = 8) expressed almost unanimous interest in more optimistic portrayals of their condition from their providers, even when the prognosis is uncertain. While some participants reported success in receiving accurate information from their provider and identifying supportive resources, numerous families received outdated or misleading information about their condition and lacked direction in accessing follow-up care and support. Parents desire greater coordination of their child's medical care and access to care that approaches an SCA holistically. Opportunities remain to improve the diagnosis and care of individuals with SCAs.
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16
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Kanakis GA, Nieschlag E. Klinefelter syndrome: more than hypogonadism. Metabolism 2018; 86:135-144. [PMID: 29382506 DOI: 10.1016/j.metabol.2017.09.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
Klinefelter syndrome (KS) is the most frequent chromosome disorder in males (1:650 newborn males), defined by 47,XXY karyotype. The classical phenotype is that of a tall male with relatively long legs, small, firm testes and gynecomastia. Azoospermia and infertility are almost inevitably present, but may be overcome by TESE and ICSI. Nevertheless, a broad spectrum of phenotypes has been described and more than 70% of the actually existing KS men may remain undiagnosed throughout their lifespan. Accordingly, hypogonadism is usually not evident until early adulthood and progresses with ageing. KS patients present a series of comorbidities that increase morbidity and mortality by 40%. Such disturbances are the impaired metabolic profile (obesity, dyslipidemia, insulin resistance) and a tendency to thrombosis, which all favor cardiovascular disease. They also present susceptibility for specific neoplasias (breast cancer, extragonadal germ cell tumors), autoimmune diseases as well as osteoporosis and bone fractures. Moreover, KS has been associated with verbal processing and attention deficits as well as social skill impairments, leading KS individuals to academic and professional achievements inferior to those of their peers of comparable socio-economic status. Nevertheless, the majority fall within the average range regarding their intellectual abilities and adaptive functioning. Testosterone replacement therapy (TRT) is the mainstay of treatment in hypogonadal KS patients; however, randomized trials are needed to determine optimal therapeutic regimens and follow-up schedules.
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Affiliation(s)
- George A Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Greece.
| | - Eberhard Nieschlag
- University Hospital of Muenster, Center of Reproductive Medicine and Andrology, Domagkstraße 11, D-48149, Muenster, Germany
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Turriff A, Macnamara E, Levy HP, Biesecker B. The Impact of Living with Klinefelter Syndrome: A Qualitative Exploration of Adolescents and Adults. J Genet Couns 2016; 26:728-737. [PMID: 27832510 DOI: 10.1007/s10897-016-0041-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 10/20/2016] [Indexed: 11/28/2022]
Abstract
Klinefelter syndrome (XXY) is a common yet significantly underdiagnosed condition with considerable medical, psychological and social implications. Many health care providers lack familiarity with XXY, resulting in medical management challenges and a limited understanding of the personal impact of the condition. Genetic counselors benefit from understanding the challenges adolescents and men with XXY face to effectively address their medical and psychosocial needs. The purpose of this study was to understand the impact of living with XXY as an adolescent or an adult. Individuals aged 14 to 75 years with self-reported XXY were recruited from online support networks to complete a web-based survey that included open-ended questions. Open-ended responses were coded and analyzed thematically (n = 169 to 210 for each open-ended question). Over half of respondents to the open-ended questions reported challenges in finding health care providers who are knowledgeable about XXY, with many describing an extensive diagnostic odyssey and relief when receiving a diagnosis. Individuals sought support coping with the challenges they face and acknowledgement of the positive aspects of XXY. Recommendations are made for how genetic counseling can enhance quality of life for individuals living with XXY.
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Affiliation(s)
- Amy Turriff
- Ophthalmic Genetics & Visual Function Branch, National Eye Institute, National Institutes of Health, 10 Center Drive MSC 1860, Building 10, Room 10N226, Bethesda, MD, 20892, USA.
| | - Ellen Macnamara
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Howard P Levy
- Department of Medicine and McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barbara Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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18
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Wigby K, D'Epagnier C, Howell S, Reicks A, Wilson R, Cordeiro L, Tartaglia N. Expanding the phenotype of Triple X syndrome: A comparison of prenatal versus postnatal diagnosis. Am J Med Genet A 2016; 170:2870-2881. [PMID: 27644018 DOI: 10.1002/ajmg.a.37688] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/01/2016] [Indexed: 11/08/2022]
Abstract
Triple X syndrome (47, XXX) occurs in approximately 1:1,000 female births and has a variable phenotype of physical and psychological features. Prenatal diagnosis rates of 47, XXX are increasing due to non-invasive prenatal genetic testing. Previous studies suggest that prenatal diagnosed females have better neurodevelopmental outcomes. This cross-sectional study describes diagnosis, physical features, medical problems, and neurodevelopmental features in a large cohort of females with 47, XXX. Evaluation included review of medical and developmental history, physical exam, cognitive, and adaptive testing. Medical and developmental features were compared between the prenatal and postnatal diagnosis groups using rate calculations and Fisher's exact test. Cognitive and adaptive tests scores were compared using t-tests. Seventy-four females age 6 months-24 years (mean 8.3 years) participated. Forty-four (59.5%) females were in the prenatal diagnosis group. Mean age of postnatal diagnosis was 5.9 years; developmental delay was the most common indication for postnatal genetic testing. Common physical features included hypertelorism, epicanthal folds, clinodactyly, and hypotonia. Medical problems included dental disorders (44.4%), seizure disorders (16.2%), genitourinary malformations (12.2%). The prenatal diagnosis group had higher verbal (P < 0.001), general ability index (P = 0.004), and adaptive functioning scores (P < 0.001). Rates of ADHD (52.2% vs. 45.5%, P = 0.77) and learning disabilities (39.1% vs. 36.3%, P = 1.00) were similar between the two groups. These findings expand on the phenotypic features in females with Triple X syndrome and support that prenatally ascertained females have better cognitive and functional outcomes. However, prenatally diagnosed females are still at risk for neurodevelopmental disorders. Genetic counseling and treatment recommendations are summarized. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kristen Wigby
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Division of Genetics, Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Cheryl D'Epagnier
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Susan Howell
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado
| | - Amy Reicks
- Genetic Counseling Program, University of Colorado Denver, Colorado
| | - Rebecca Wilson
- eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado
| | - Lisa Cordeiro
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicole Tartaglia
- Department of Pediatrics, Developmental Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. .,eXtraordinarY Kids Clinic, Developmental Pediatrics, Children's Hospital Colorado, Aurora, Colorado.
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Dotters-katz SK, Humphrey WM, Senz KL, Lee VR, Shaffer BL, Caughey AB. The impact of prenatally diagnosed Klinefelter Syndrome on obstetric and neonatal outcomes. Eur J Obstet Gynecol Reprod Biol 2016; 203:173-6. [DOI: 10.1016/j.ejogrb.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/11/2016] [Indexed: 12/01/2022]
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Gruchy N, Blondeel E, Le Meur N, Joly-Hélas G, Chambon P, Till M, Herbaux M, Vigouroux-Castera A, Coussement A, Lespinasse J, Amblard F, Jimenez Pocquet M, Lebel-Roy C, Carré-Pigeon F, Flori E, Mugneret F, Jaillard S, Yardin C, Harbuz R, Collonge-Rame MA, Vago P, Valduga M, Leporrier N, Vialard F. Pregnancy outcomes in prenatally diagnosed 47, XXX and 47, XYY syndromes: a 30-year French, retrospective, multicentre study. Prenat Diagn 2016; 36:523-9. [DOI: 10.1002/pd.4817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/29/2016] [Accepted: 03/21/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Nicolas Gruchy
- Service de Génétique, Laboratoire de cytogénétique prénatale; CHU Côte de Nacre, UFR de Médecine Caen; Caen France
| | - Eleonore Blondeel
- Laboratoire d'Histologie, Embryologie, Biologie de la Reproduction, Cytogénétique et Génétique médicale; CHI Poissy Saint Germain; Poissy France
| | | | - Géraldine Joly-Hélas
- Laboratoire d'Histologie, cytogénétique et biologie de la reproduction, Fédération de Génétique, Faculté de Médecine; CHU de Rouen; Rouen France
| | - Pascal Chambon
- Laboratoire d'Histologie, cytogénétique et biologie de la reproduction, Fédération de Génétique, Faculté de Médecine; CHU de Rouen; Rouen France
| | - Marianne Till
- Service de cytogénétique; GHE, CBPE Hôpitaux de Lyon; Bron France
| | | | | | | | | | - Florence Amblard
- Service de Génétique Chromosomique; CHU de Grenoble; Grenoble France
| | | | - Camille Lebel-Roy
- Laboratoire de biologie médicale et cytogénétique; Fort de France France
| | | | - Elisabeth Flori
- Service de Cytogénétique; Hôpital de Hautepierre; Strasbourg France
| | | | - Sylvie Jaillard
- Service de cytogénétique et biologie cellulaire; CHU Pontchaillou; Rennes France
| | - Catherine Yardin
- Cytologie et Cytogénétique, Service d'Histologie; Hôpital de la Mère et de l'Enfant, CHU de Limoges; Limoges France
| | - Radu Harbuz
- Service de Génétique, Laboratoire de génétique biologique; CHU de Poitiers; Poitiers France
| | - Marie-Agnès Collonge-Rame
- Service de génétique biologique, histologie, biologie du développement et de la reproduction; CHRU Besançon, Hôpital Saint-Jacques; Besançon France
| | - Philippe Vago
- UFR Médecine, Histologie Embryologie Cytogénétique; Univ Clermont 1; Clermont-Ferrand France
- Cytogénétique Médicale; CHU Clermont-Ferrand; Clermont-Ferrand France
- UFR Médecine; Univ Clermont 1; Clermont-Ferrand France
| | - Mylène Valduga
- Laboratoire de génétique médicale, Service de cytogénétique et génétique moléculaire; CHU de Nancy; Vandoeuvre-Les-Nancy France
| | - Nathalie Leporrier
- Service de Génétique, Laboratoire de cytogénétique prénatale; CHU Côte de Nacre, UFR de Médecine Caen; Caen France
| | - François Vialard
- Laboratoire d'Histologie, Embryologie, Biologie de la Reproduction, Cytogénétique et Génétique médicale; CHI Poissy Saint Germain; Poissy France
- EA7404, GIG, UFR des sciences de la Santé,; Montigny le bretonneux
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Minear MA, Alessi S, Allyse M, Michie M, Chandrasekharan S. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues. Annu Rev Genomics Hum Genet 2015; 16:369-98. [DOI: 10.1146/annurev-genom-090314-050000] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mollie A. Minear
- Duke Science & Society, Duke University, Durham, North Carolina 27708
| | - Stephanie Alessi
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California 94305
| | - Megan Allyse
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota 55905
| | - Marsha Michie
- Institute for Health and Aging, University of California, San Francisco, California 94143
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Lalatta F, Tint GS. Response to "Prenatal genetic counseling in Klinefelter syndrome: comments on the article by Lalatta and Tint [2013] and a proposal of a new approach" by Pimpolari et al. Am J Med Genet A 2015; 167A:678-9. [PMID: 25691425 DOI: 10.1002/ajmg.a.36892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/30/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
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