Multilevel barriers and facilitators to widespread use of preconception carrier screening in the United States

Carrier screening and pregnancy

Recessive genetic conditions impose a significant burden, often leading to severe childhood disorders, many of which remain untreatable. It is estimated that 1-2 % of couples are at risk of having an affected child in the general population, with the risk being significantly higher in consanguineous couples. Understanding the increased risk of having a child with a recessive disorder empowers prospective parents to make informed reproductive choices. With technological advancements, genetic screening has evolved beyond identifying only a few common conditions. Expanded carrier screening (ESC) now offers a single test that covers a comprehensive list of recessive disorders, addressing those that contribute most significantly to the burden of these conditions within specific populations. ESC is recommended for all couples planning a pregnancy, with particular emphasis on consanguineous couples or those who are subfertile. To ensure responsible use of ESC, clinical service delivery should adopt a multidisciplinary approach, providing couples with the information they need to make voluntary, informed decisions. This includes access to high-quality genetic testing, genetic counseling, and psychosocial support. National professional societies and governments play a crucial role in shaping guidelines, policies, oversight, and funding to guarantee equitable access to high-quality ESC services.

Determinants of knowledge of preconception care among healthcare providers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To assess the determinants of knowledge of preconception care (PCC) among healthcare providers in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

Comprehensive literature searches were conducted in PubMed, Scopus and Health Internetwork Access to Research Initiative (HINARI) published until 20 March 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary studies that reported the prevalence, determinants or associated factors were included.

DATA EXTRACTION AND ANALYSIS

Three authors extracted all the relevant data using a standardised Joanna Briggs Institute data extraction format. Meta-analysis was done using a random-effects model. A funnel plot and Egger's test were done to assess publication bias, which was corrected by trim and fill analysis.

RESULT

Out of 102 studies, the final analysis included six studies involving 2758 healthcare providers. The pooled knowledge of PCC among healthcare providers in Ethiopia was determined to be 51.43% (Adjusted OR), with a 95% CI ranging from 41.21% to 61.65%. Several factors were identified as determinants of healthcare providers' knowledge based on the pooled estimate. These factors include having an educational qualification above a BSc degree (OR=2.36, 95% CI 1.46, 3.08), the presence of guidelines in their institution (OR=2.07, 95% CI 1.37, 2.77), working in hospitals (OR=2.68, 95% CI 1.83, 3.53) and receiving training on PCC and related topics (OR=4.05, 95% CI 2.52, 5.59).

CONCLUSION

Healthcare professionals exhibited limited knowledge of PCC in Ethiopia. Key elements influencing their comprehension encompass advanced educational credentials beyond a BSc degree, adherence to institutional guidelines, employment in hospital settings and exposure to specialised training. The ORs linked to these factors highlight the substantial influence of education, institutional procedures, hospital roles and specific training in enhancing healthcare providers' expertise. Enhancing awareness and understanding among healthcare practitioners through customised educational programmes, institutional structures and organised training efforts stands out as a crucial approach to improve healthcare services and results throughout Ethiopia.

PROSPERO REGISTRATION NUMBER

CRD42024516077.

Women's preferences for genetic screening in routine care: A qualitative study

OBJECTIVE

Examine decision-making regarding when women would prefer to receive reproductive carrier and cancer predisposition screening and from what clinician.

METHODS

20 women completed in-depth interviews via Zoom exploring their views on the provision of reproductive carrier and cancer predisposition screening. Our analysis identified themes related to what informs women's preferences for when they would like to receive a genetic screening offer and by which clinician.

RESULTS

Participants' responses to questions about when they would be interested in receiving genetic screening were best understood through the lens of the Extended Parallel Process Model. Specifically, personal utility of the information, a woman's family health history and cost were key factors in decision-making. Women considered their clinician's knowledge and their trust in and relationship with the clinician when deciding from whom they would prefer to receive an offer of genetic screening.

CONCLUSION

OB/GYN clinic patients may accept an offer of genetic screening from a knowledgeable and trusted clinician for carrier and cancer predisposition screening preconceptionally or prenatally.

PRACTICE IMPLICATIONS

Integrating genetic reproductive and cancer predisposition screening into the care provided to reproductive age OB/GYN patients may be acceptable to this population.

Aspiring toward equitable benefits from genomic advances to individuals of ancestrally diverse backgrounds

Advancements in genomic technologies have shown remarkable promise for improving health trajectories. The Human Genome Project has catalyzed the integration of genomic tools into clinical practice, such as disease risk assessment, prenatal testing and reproductive genomics, cancer diagnostics and prognostication, and therapeutic decision making. Despite the promise of genomic technologies, their full potential remains untapped without including individuals of diverse ancestries and integrating social determinants of health (SDOHs). The NHGRI launched the 2020 Strategic Vision with ten bold predictions by 2030, including "individuals from ancestrally diverse backgrounds will benefit equitably from advances in human genomics." Meeting this goal requires a holistic approach that brings together genomic advancements with careful consideration to healthcare access as well as SDOHs to ensure that translation of genetics research is inclusive, affordable, and accessible and ultimately narrows rather than widens health disparities. With this prediction in mind, this review delves into the two paramount applications of genetic testing-reproductive genomics and precision oncology. When discussing these applications of genomic advancements, we evaluate current accessibility limitations, highlight challenges in achieving representativeness, and propose paths forward to realize the ultimate goal of their equitable applications.