Fetal anomaly diagnosis and termination of pregnancy

Experiences of mothers who legally terminate a pregnancy due to fetal congenital defects

The legal termination of a pregnancy due to congenital defects is a complex and emotionally intense that significantly impacts the mother's personal life and causes considerable psychological distress for both parents. Despite its clinical and ethical implications, there is limited qualitative research exploring the lived experiences of women undergo this process. This study aimed to explore and understand the experiences of mothers who have legally terminated a pregnancy due to fetal congenital defects. A qualitative study was conducted based on Gadamer's philosophical hermeneutics. Eleven semi-structured in-depth interviews were conducted between February and March 2023 in Spain. Participants were selected through purposive sampling. Interviews were audio-recorded, transcribed verbatim and analyzed inductively to identify emerging themes. Three main themes emerged from the data: 1) The painful diagnosis of a congenital fetal defect and the moral dilemma of terminating a wanted pregnancy; 2) The internal conflict and distressing experience of undergoing legal pregnancy termination; 3) The dual emotional wound resulting from pregnancy loss. Participants described the diagnosis as an emotional shock and reported feeling unsupported both during and after the process, highlighting critical gaps in psychosocial care. The findings reveal that legal termination of pregnancy due to fetal congenital defects has a profound emotional impact on mothers, who experience not only perinatal grief but also social invisibility and insufficient psychological support. These results emphasize the need to implement comprehensive, empathetic, and multidisciplinary care protocols to support women throughout the decision-making and grieving process.

Evaluation of the Effectiveness of WeChat-Based Continuing Care Services on Maternal Parenting Competence

PURPOSE

To evaluate the effectiveness of WeChat-based continuing care services in enhancing maternal parenting competence.

DESIGN

This study included 524 primiparas who underwent obstetrics department from June 2022 to June 2023. 286 women were assigned to the intervention group, receiving WeChatbased continuing care services, while 238 women were assigned to the control group, receiving traditional care services.

METHODS

Key measures included neonatal health metrics, maternal caregiving knowledge, the incidence of postpartum depression, and self-25 efficacy scores.

FINDINGS

The intervention group showed significantly shorter neonatal jaundice duration (p = 0.005), reduced incidence of newborn adverse reactions such as diarrhea and eczema (p < 0.05), and higher maternal selfefficacy scores in both skills and inner activities (p < 0.01). Postpartum 30 depression was lower in the intervention group (p = 0.002). There was no significant difference in the duration of umbilical cord detachment, breastfeeding practices or maternal satisfaction with hospital care between groups. Knowledge of newborn care was improved in the intervention group (p < 0.01).

CONCLUSIONS

WeChat-based continuing care services enhanced maternal 35 self-efficacy, knowledge, and reduced postpartum depression.

CLINICAL EVIDENCE

WeChat-based continuing care services demonstrates promising potential in enhancing maternal parenting competence..

The fetal neurologist: Strategies to improve training, practice, and clinical care

Fetal neurology addresses counselling parents on the clinical significance of brain anomalies encountered in their fetus, including disruptive lesions (i.e. stroke, periventricular haemorrhagic infarction, and infection), and genetically based cortical (i.e. hemimegalencephaly, lissencephaly, cobblestone malformation, polymicrogyria, heterotopia) or posterior fossa anomalies (i.e. cerebellar agenesis and hypoplasia, rhombencephalosynapsis, Dandy-Walker syndrome, mega cisterna magna, Blake's pouch cyst). Unlike paediatric neurologists, fetal neurologists cannot examine the infant directly so they diagnose and prognosticate using imaging and other diagnostic studies. The integration of fetal neurologists into fetal multidisciplinary teams is essential for providing expert counselling and cohesive care. This review emphasizes the need for specialized training, multidisciplinary collaboration, and the development of comprehensive service designs to ensure consistent and effective care for families. Additionally, it emphasizes the critical role of fetal neurologists in identifying brain anomalies early and providing thorough counselling to parents, helping them to understand the prognosis, potential interventions, and long-term outcomes for their unborn child.

Improving prenatal diagnosis with combined karyotyping, CNV-seq and QF-PCR: a comprehensive analysis of chromosomal abnormalities in high-risk pregnancies

Objective

This study aims to assess the diagnostic efficacy of a combined approach integrating chromosomal karyotyping, copy number variation sequencing (CNV-seq), and quantitative fluorescence polymerase chain reaction (QF-PCR) in detecting chromosomal abnormalities in high-risk pregnancies.

Methods

This retrospective study analyzed 617 high-risk pregnancies undergoing prenatal diagnosis from February 2023 to August 2024, with amniotic fluid samples concurrently analyzed using karyotyping, CNV-seq, and QF-PCR. We evaluated clinical characteristics, diagnostic yields, and inter-method concordance rates. Longitudinal follow-up assessed pregnancy outcomes and neonatal phenotypes, with particular emphasis on cases demonstrating diagnostic discrepancies or variants of uncertain clinical significance.

Results

The integrated approach detected chromosomal abnormalities in 12.5% (77/617) of cases, significantly higher than the rates achieved by karyotyping alone (9.7%) and CNV-seq/QF-PCR alone (8.3%) (p < 0.05). Karyotyping showed full concordance with CNV-seq and QF-PCR in detecting major chromosomal aneuploidies, identifying 21 cases of trisomy 21 and 4 cases of trisomy 18. CNV-seq uniquely identified additional pathogenic copy number variations in 2.1% of cases and variants of uncertain significance (VUS) in 3.2% of cases, both undetectable by conventional karyotyping. Subjects with high-risk non-invasive prenatal testing (NIPT) results had the highest abnormality detection rate (57.6%, p < 0.05). Follow-up data revealed pregnancy termination in 44 of 97 cases with chromosomal abnormalities. Notably, neonates carrying pathogenic CNVs inherited from asymptomatic parents demonstrated normal phenotypes.

Conclusion

The integration of karyotyping, CNV-seq, and QF-PCR provides superior diagnostic yield compared to individual testing strategies in high-risk pregnancies. Although karyotyping remains the gold standard for detecting major chromosomal aberrations, CNV-seq and QF-PCR enhance diagnostic precision through detection of submicroscopic variations. Multi-center studies with larger cohorts are needed to confirm these findings and clarify the clinical significance of uncertain variants.

Polarization in research: What is it, why is it problematic, and how can it be addressed?

Background: Polarized research has become a problem for the trustworthiness and applicability of scientific results. Accordingly, this paper addresses three key questions: 1) What is polarization in scientific research? 2) Why is such polarization problematic? 3) How can the problem be addressed?Methods: The first question is addressed by describing how the polarization has been characterized in the literature and by analysing an example before assessing existing definitions and elaborating a definition of polarization. The second question is answered by describing challenges with polarization found in the literature. The third question is addressed by investigating different explanations for and relevant mechanisms behind polarization in research, such as psychological, structural, epistemic and ontological, evaluative, and social-constructionist explanations. Moreover, several approaches from the philosophy of science are investigated.Results: Polarization in research is characterized by opposing and incommensurable positions that tend to stem from differences in basic values, and that are used to define, differentiate, bolster, and demarcate between groups and for reinforcing their identity. The problem with polarization is that it violates a broad range of basic norms in science, and hampers scientific progress, represents large opportunity costs, undermines trust in science and, subsequently that it undercuts the application of scientific results as well as future funding. There are many potential measures to reduce polarization. However, there are no simple solutions, as polarization is a complex phenomenon deeply rooted in basic human characteristics.Conclusion: Polarization is a ubiquitous phenomenon and a basic challenge for scientific research. It is crucial to increase the awareness of polarization, and a clear definition is key to study and address the problem. However, while there are many ways to actively address the problem of polarization in scientific research, there are no easy solutions. More research is needed to move from what we can do to what we should do.

Clinical decisions in fetal-neonatal neurology I. reproductive and pregnancy health influence the neural exposome over multiple generations

Interdisciplinary fetal neonatal neurology (FNN) training requires integration of reproductive health factors into evaluations of the maternal-placental-fetal (MPF) triad, neonate, and child over the first 1000 days. Serial events that occur before one or multiple pregnancies impact successive generations. A maternal-child dyad history highlights this continuity of health risk, beginning with a maternal grandmother's pregnancy. Her daughter was born preterm and later experienced polycystic ovarian syndrome further complicated by cognitive and mental health disorders. Medical problems during her pregnancy contributed to MPF triad diseases that resulted in her son's extreme prematurity. Postpartum maternal death from the complications of diabetic ketoacidosis and her child's severe global neurodevelopmental delay were adverse mother-child outcomes. A horizontal/vertical diagnostic approach to reach shared clinical decisions during FNN training requires perspectives of a dynamic neural exposome. Career-long learning is then strengthened by continued interactions from al stakeholders. Developmental origins theory applied to neuroplasticity principles help interpret phenotypic expressions as dynamic gene-environment interactions across a person's lifetime. Debiasing strategies applied to the cognitive process reduce bias to preserve therapeutic and prognostic accuracy. Social determinants of health are essential components of this strategy to be initiated during FNN training. Reduction of the global burden of neurologic disorders requires applying the positive effects from reproductive and pregnancy exposomes that will benefit the neural exposome across the lifespan.

The science of uncertainty guides fetal-neonatal neurology principles and practice: diagnostic-prognostic opportunities and challenges

Fetal-neonatal neurologists (FNNs) consider diagnostic, therapeutic, and prognostic decisions strengthened by interdisciplinary collaborations. Bio-social perspectives of the woman's health influence evaluations of maternal-placental-fetal (MPF) triad, neonate, and child. A dual cognitive process integrates "fast thinking-slow thinking" to reach shared decisions that minimize bias and maintain trust. Assessing the science of uncertainty with uncertainties in science improves diagnostic choices across the developmental-aging continuum. Three case vignettes highlight challenges that illustrate this approach. The first maternal-fetal dyad involved a woman who had been recommended to terminate her pregnancy based on an incorrect diagnosis of an encephalocele. A meningocele was subsequently identified when she sought a second opinion with normal outcome for her child. The second vignette involved two pregnancies during which fetal cardiac rhabdomyoma was identified, suggesting tuberous sclerosis complex (TSC). One woman sought an out-of-state termination without confirmation using fetal brain MRI or postmortem examination. The second woman requested pregnancy care with postnatal evaluations. Her adult child experiences challenges associated with TSC sequelae. The third vignette involved a prenatal diagnosis of an open neural tube defect with arthrogryposis multiplex congenita. The family requested prenatal surgical closure of the defect at another institution at their personal expense despite receiving a grave prognosis. The subsequent Management of Myelomeningocele Study (MOMS) would not have recommended this procedure. Their adult child requires medical care for global developmental delay, intractable epilepsy, and autism. These three evaluations involved uncertainties requiring shared clinical decisions among all stakeholders. Falsely negative or misleading positive interpretation of results reduced chances for optimal outcomes. FNN diagnostic skills require an understanding of dynamic gene-environment interactions affecting reproductive followed by pregnancy exposomes that influence the MPF triad health with fetal neuroplasticity consequences. Toxic stressor interplay can impair the neural exposome, expressed as anomalous and/or destructive fetal brain lesions. Functional improvements or permanent sequelae may be expressed across the lifespan. Equitable and compassionate healthcare for women and families require shared decisions that preserve pregnancy health, guided by person-specific racial-ethnic, religious, and bio-social perspectives. Applying developmental origins theory to neurologic principles and practice supports a brain health capital strategy for all persons across each generation.

Interdisciplinary fetal-neonatal neurology training applies neural exposome perspectives to neurology principles and practice

An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype-genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene-environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders.