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Chen HY, Lin SY, Shih JC, Kang J, Tai YY, Shaw SW, Chen KC, Mai K, Lee CN. Changing the standardised obstetric care by expanded carrier screening and counselling: a multicentre prospective cohort study. J Med Genet 2024; 61:176-181. [PMID: 37798098 DOI: 10.1136/jmg-2023-109268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Expanded genetic screening before conception or during prenatal care can provide a more comprehensive evaluation of heritable fetal diseases. This study aimed to provide a large cohort to evaluate the significance of expanded carrier screening and to consolidate the role of expanded genetic screening in prenatal care. METHODS This multicentre, retrospective cohort study was conducted between 31 December 2019 and 21 July 2022. A screening panel containing 302 genes and next-generation sequencing were used for the evaluation. The patients were referred from obstetric clinics, infertility centres and medical centres. Genetic counsellors conducted consultation for at least 15 min before and after screening. RESULTS A total of 1587 patients were screened, and 653 pairs were identified. Among the couples who underwent the screening, 62 (9.49%) had pathogenic variants detected on the same genes. In total, 212 pathogenic genes were identified in this study. A total of 1173 participants carried at least one mutated gene, with a positive screening rate of 73.91%. Among the pathogenic variants that were screened, the gene encoding gap junction beta-2 (GJB2) exhibited the highest prevalence, amounting to 19.85%. CONCLUSION Next-generation sequencing carrier screening provided additional information that may alter prenatal obstetric care by 9.49%. Pan-ethnic genetic screening and counselling should be suggested for couples of fertile age.
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Affiliation(s)
- Han-Ying Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
- Program for Precision Health and Intelligent Medicine, Graduate School of Advanced Technology, National Taiwan University, Taipei, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Chung Shih
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jessica Kang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Yun Tai
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuang-Cheng Chen
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Kevin Mai
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, USA
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
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Hu P, Tan J, Yu F, Shao B, Zhang F, Zhang J, Lin Y, Tao T, Jiang L, Jiang Z, Xu Z. A capillary electrophoresis-based multiplex PCR assay for expanded carrier screening in the eastern Han Chinese population. NPJ Genom Med 2022; 7. [PMID: 35079019 PMCID: PMC8789796 DOI: 10.1038/s41525-021-00280-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/20/2021] [Indexed: 12/05/2022] Open
Abstract
Expanded carrier screening, a type of reproductive genetic testing for couples, has gained tremendous popularity for assessing the risk of passing on certain genetic conditions to offspring. Here, a carrier screening assay for 448 pathogenic variants was developed using capillary electrophoresis-based multiplex PCR technology. The capillary electrophoresis-based multiplex PCR assay achieved a sensitivity, specificity, and accuracy of 97.4%, 100%, and 99.6%, respectively, in detecting the specific variants. Among the 1915 couples (3830 individuals), 708 individuals (18.5%) were identified as carriers for at least one condition. Of the 708 carriers, 633 (89.4%) were heterozygous for one condition, 71 (10.0%) for two disorders, 3 (0.4%) for three disorders, and 1 (0.1%) for four disorders. Meanwhile, 30 (1.57%) couples were identified as at‐risk couples. This study describes an inexpensive and effective method for expanded carrier screening. The simplicity and accuracy of this approach will facilitate the clinical implementation of expanded carrier screening.
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Richardson E, McEwen A, Newton-John T, Crook A, Jacobs C. Systematic review of outcomes in studies of reproductive genetic carrier screening: Towards development of a core outcome set. Genet Med 2021:S1098-3600(21)01119-9. [PMID: 34906455 DOI: 10.1016/j.gim.2021.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/09/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Current practice recommendations support the widespread implementation of reproductive genetic carrier screening (RGCS). These consensus-based recommendations highlight a research gap, with findings from current studies being insufficient to meet the standard required for more rigorous evidence-based recommendations. This systematic review assessed methodological aspects of studies on RGCS to inform the need for a core outcome set. METHODS We conducted a systematic search to identify peer-reviewed published studies offering population-based RGCS. Study designs, outcomes, and measurement methods were extracted. A narrative synthesis was conducting using an existing outcome taxonomy and criteria used in the evaluation of genetic screening programs as frameworks. RESULTS Sixty-five publications were included. We extracted 120 outcomes representing 24 outcome domains. Heterogeneity in outcome selection, measurement methods and time points of assessment was extensive. Quality appraisal raised concerns for bias. We found that reported outcomes had limited applicability to criteria used to evaluate genetic screening programs. CONCLUSION Despite a large body of literature, diverse approaches to research have limited the conclusions that can be cumulatively drawn from this body of evidence. Consensus regarding meaningful outcomes for evaluation of RGCS would be a valuable first step in working towards evidence-based practice recommendations, supporting the development of a core outcome set.
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Guo Q, Chang YY, Huang CH, Hsiao YS, Hsiao YC, Chiu IF, Zhou Y, Zhang H, Ko TM. Population-based carrier screening and prenatal diagnosis of fragile X syndrome in East Asian populations. J Genet Genomics 2021; 48:1104-1110. [PMID: 34412977 DOI: 10.1016/j.jgg.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Identification of carriers of fragile X syndrome (FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the results of carrier screening of 39,458 East Asian adult women and prenatal diagnosis from 87 FXS carriers. The prevalence of FXS carriers and full mutation fetuses was estimated to be 1/581 and 1/3124 in East Asian populations, respectively. We confirmed the validity of the current threshold of CGG trinucleotide repeats for FMR1 categorization; the integral risks of full mutation expansion were approximately 6.0%, 43.8%, and 100% for premutation alleles with 55-74, 75-89, and ≥90 CGG repeats, respectively. The protective effect of AGG (adenine-guanine-guanine nucleotides) interruption in East Asian populations was validated, which is important in protecting premutation alleles with 75-89 CGG repeats from full mutation expansion. Finally, family history was shown not an effective indicator for FXS carrier screening in East Asian populations, and population-based screening was more cost-effective. This study provides an insight into the largest carrier screening and prenatal diagnosis for FXS in East Asian populations to date. The FXS-associated genetic profiles of East Asian populations are delineated, and population-based carrier screening is shown to be promising for FXS intervention.
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Affiliation(s)
- Qiwei Guo
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China.
| | - Yih-Yuan Chang
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Chien-Hao Huang
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Yu-Shan Hsiao
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China
| | - Yu-Chiao Hsiao
- Biofast Biotechnology Co., Ltd., Xiamen, Fujian 361102, China
| | - I-Fan Chiu
- Biofast Biotechnology Co., Ltd., Xiamen, Fujian 361102, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China
| | - Haixia Zhang
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen, Fujian 361102, China
| | - Tsang-Ming Ko
- Genephile Bioscience Laboratory, Ko's Obstetrics and Gynecology, Taipei 100, Taiwan, China.
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Tang R, Yu Q. The significance of FMR1 CGG repeats in Chinese women with premature ovarian insufficiency and diminished ovarian reserve. Reprod Biol Endocrinol 2020; 18:82. [PMID: 32787884 PMCID: PMC7422563 DOI: 10.1186/s12958-020-00645-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous studies have shown that there is an association between FMR1 CGG repeats and ovarian dysfunction. The aim of this study is to assess the association between the number of CGG repeats in FMR1 in Chinese patients with premature ovarian insufficiency (POI) and diminished ovarian reserve (DOR). METHODS This is a cross-sectional, case-control study, which enrolled 124 patients with POI, 57 patients with DOR and 111 normal menopausal controls. The demographic details along with other clinical data were recorded. The FMR1 CGG repeats were analyzed by polymerase chain reaction and microfluidic capillary electrophoresis. RESULTS We could detect two premutation carriers in the POI group (1.6%) and one in the control group (0.9%). No premutation carriers were identified in the DOR group. The frequency of FMR1 premutations was not different between POI or DOR and controls. The most common CGG repeat was 29 and 30, and the repeat length for allele 2 had a secondary peak around 36-39 repeats. The CGG repeats were divided into groups of five consecutive values, and the distribution of allele 1 in the POI group was different from that in the control group (P < 0.001). No statistically significant differences were found for allele 1 between DOR group vs. controls, and for allele 2 between three groups (P > 0.05). CONCLUSIONS The study shows that the frequency of FMR1 premutations is relatively low (1.6%) in Chinese women with POI. The distribution of allele 1 CGG repeat in patients with POI showed difference from that in healthy women.
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Affiliation(s)
- Ruiyi Tang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No 1 Shuaifuyuan, Wangfujing, Beijing, 100730, DongCheng District, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No 1 Shuaifuyuan, Wangfujing, Beijing, 100730, DongCheng District, China.
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Gao F, Huang W, You Y, Huang J, Zhao J, Xue J, Kang H, Zhu Y, Hu Z, Allen EG, Jin P, Xia K, Duan R. Development of Chinese genetic reference panel for Fragile X Syndrome and its application to the screen of 10,000 Chinese pregnant women and women planning pregnancy. Mol Genet Genomic Med 2020; 8:e1236. [PMID: 32281281 PMCID: PMC7284044 DOI: 10.1002/mgg3.1236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023] Open
Abstract
Background Fragile X syndrome (FXS) is the most common inherited form of intellectual disability caused by a CGG repeat expansion in the 5′ untranslated region of the FMR1 gene. When the number of repeats exceeds 200, the gene becomes hypermethylated and is transcriptionally silenced, resulting in FXS. Other allelic forms of the gene that are studied because of their instability or phenotypic consequence include intermediate alleles (45–54 CGG repeats) and premutation alleles (55–200 repeats). Normal alleles are classified as having <45 CGG repeats. Population screening studies have been conducted among American and Australian populations; however, large population‐based studies have not been completed in China. Methods and Results In this work we present FXS screening results from 10,145 women of childbearing age from China. We first created and tested a standard panel that was comprised of normal, intermediate, premutation, and full mutation samples, and we performed the screening after confirming the consistency of genotyping results among laboratories. Conclusion Based on our findings, we have determined the intermediate and premutation carrier prevalence of 1/130 and 1/634, respectively, among Chinese women.
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Affiliation(s)
- Fei Gao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,National Institutes for Food and Drug Control, Beijing, China
| | - Wen Huang
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Yanjun You
- National Institutes for Food and Drug Control, Beijing, China
| | - Jie Huang
- National Institutes for Food and Drug Control, Beijing, China
| | - Juan Zhao
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jin Xue
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Huaixing Kang
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Yingbao Zhu
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Zhengmao Hu
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Emily G Allen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peng Jin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kun Xia
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, Hunan, China
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Ma Y, Wei X, Pan H, Wang S, Wang X, Liu X, Zou L, Wang X, Wang X, Yang H, Wang F, Wang K, Sun L, Qiao X, Yang Y, Ma X, Liu D, Ding G, Ma J, Yang X, Zhu S, Qi Y, Yin C. The prevalence of CGG repeat expansion mutation in FMR1 gene in the northern Chinese women of reproductive age. BMC Med Genet 2019; 20:81. [PMID: 31096929 PMCID: PMC6521407 DOI: 10.1186/s12881-019-0805-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of CGG repeat expansion mutation in FMR1 gene varies among different populations. In this study, we investigated the prevalence of this mutation in women of reproductive age from northern China. METHODS A total of 11,891 pre-conceptional or pregnant women, including 5037 pregnant women and 7357 women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos, were recruited. The number of CGG repeats in FMR1 was measured by the TRP-PCR method. We also offered genetic counseling and prenatal diagnosis to the women carrying pre-mutation or full mutation alleles. RESULTS The prevalence of pre-mutation in reproductive women in northern China was 1/410, higher than that in southern China and Korea but lower than that in western countries. We also found that the prevalence of pre-mutation was relatively high (1/320) in women with abortion history. CONCLUSION Screening for CGG repeat expansion mutation in FMR1 should be recommended to the women with the history of spontaneous abortion or induced abortion due to delayed growth of the embryos.
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Affiliation(s)
- Yinan Ma
- Department of Central Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Xing Wei
- Beijing Huanuo Aomei Gene Biotech Co. Ltd., Beijing, 100070, China
| | - Hong Pan
- Department of Central Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Songtao Wang
- Department of Central Laboratory, Peking University First Hospital, Beijing, 100034, China
| | - Xin Wang
- Department of Obstetrics & Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, 100006, China
| | - Xiaowei Liu
- Department of Obstetrics & Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, 100006, China
| | - Liying Zou
- Department of Obstetrics & Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, 100006, China
| | - Xiaomei Wang
- Department of Obstetrics & Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, 100006, China
| | - Xiaorong Wang
- Department of Obstetrics & Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, 100006, China
| | - Hua Yang
- Department of Obstetrics & Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Fengying Wang
- Department of Obstetrics & Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Kefang Wang
- Department of Obstetrics & Gynecology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Lifang Sun
- Department of Obstetrics & Gynecology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xiaolin Qiao
- Department of Obstetrics & Gynecology, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, 100022, China
| | - Yue Yang
- Department of Obstetrics & Gynecology, Civil Aviation General Hospital, Beijing, 100025, China
| | - Xiuhua Ma
- Department of Obstetrics & Gynecology, People's Hospital of Beijing Daxing District, Beijing, 102600, China
| | - Dandan Liu
- Department of Obstetrics & Gynecology, Beijing Changping Hospital, Beijing, 102200, China
| | - Guifeng Ding
- Department of Obstetrics & Gynecology, Xinjiang Urumqi City Maternal and Child Care Health Hospital, Urumqi, 830001, China
| | - Junqi Ma
- Department of Obstetrics &Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Xiuli Yang
- Department of Obstetrics &Gynecology, Peking University First Hospital, Beijing, 100034, China
| | - Sainan Zhu
- Department of Statistics, Peking University First Hospital, Beijing, 100034, China
| | - Yu Qi
- Department of Central Laboratory, Peking University First Hospital, Beijing, 100034, China.
| | - Chenghong Yin
- Department of Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
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