THE IMPORTANT ROLE of GENETIC SCREENING Making the Best Decisions for You and Your Family
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THE IMPORTANT ROLE OF GENETIC SCREENING Making the best decisions for you and your family A VARIETY OF SCREENING METHODS ARE USED TO DETERMINE RISK DURING PREGNANCY Noninvasive prenatal screening Chromosome conditions Carrier screening Inherited conditions Serum screening Ultrasound Hormone and protein levels Anatomical abnormalities associated with birth defects MORE INFO Screening overview Genetic screening Noninvasive prenatal screening Carrier screening Complementary Screens During Pregnancy Screening vs. Diagnostic Tests • Several different types of screening tests are offered during • Screening tests are different than diagnostic tests pregnancy • Screening tests do not give definitive answers. Instead, they • Each is performed with the goal of assessing for risks and provide information about whether there is an increased complications in the pregnancy chance of a problem being present • Some routine screening tests done during pregnancy • Diagnostic tests, such as chorionic villus sampling (CVS) or include: carrier screening, noninvasive prenatal screening amniocentesis, are available to provide definitive information using cell-free DNA, ultrasound and maternal serum screening • Screening tests are done at different points during pregnancy and for different purposes Carrier screening and noninvasive prenatal screening, two genetic screens done early PRENATAL SCREENING on, can inform the care of your pregnancy and baby. Noninvasive prenatal screening can help avoid the need for invasive IN EARLY PREGNANCY diagnostic tests (indicated by below). * * Carrier Screening Carrier Screening Dating Scan (Ultrasound) Noninvasive Prenatal Screening 1st Trimester Maternal Serum Screen Nuchal Translucency Ultrasound 1st TR BEFORE IME Chorionic Villus Sampling STE R 2nd Trimester Maternal Serum Screen Anatomy Scan (Ultrasound) 2 Amniocentesis n d *Can be done before T or early in pregnancy R I M E MORE INFO S T E R Screening overview Genetic screening Noninvasive prenatal screening Carrier screening Screening Tests • Screening tests are different than diagnostic tests • Screening tests do not give definitive answers. Instead, they provide information about whether there is an increased chance of a problem being present Carrier Screening Noninvasive Prenatal Screening • Ideally done preconception, but can be done during pregnancy • Done using a standard blood draw from the mother’s arm • Looks for irregularities, called mutations, in the mother’s and/or as early as 10 weeks father’s genes that can be passed down to a child • Assesses risk for chromosome conditions, including Down • In most cases both mother and father need to be carriers for the same syndrome and other more severe conditions condition for their children to be at risk of developing symptoms • Chromosome conditions generally happen by chance, instead of being inherited from the parents Dating Scan (Ultrasound) • Usually done at first prenatal visit 1st and 2nd Trimester Maternal Serum Screening • Performed at ~10-14 weeks and then at ~15-20 weeks • Sound waves are used to visualize the developing baby (this is completely safe!) • Estimates the chance for chromosome conditions and birth defects of the spine • Confirms a heartbeat – Looks at a variety of proteins in the mother’s blood – May include a nuchal translucency ultrasound Anatomy Scan (Ultrasound) • Performed at ~18-20 weeks • Used to check normal growth and development of the baby Invasive Diagnostic Tests • Diagnostic tests, such as chorionic villus sampling (CVS) or amniocentesis, are available to provide definitive information Chorionic Villus Sampling (CVS) Amniocentesis • Performed between 10 and 14 weeks • Generally performed between 16 and 22 weeks • Using ultrasound guidance, a small sample of the placenta is removed • A small sample of fluid is taken from the uterus without touching and analyzed the baby • There is a risk of miscarriage with this procedure, but this risk is less • Fetal cells in the fluid are analyzed to look for certain kinds of than 1% (less than 1 in 100) abnormalities, while the fluid itself is analyzed for certain proteins • There is a risk of miscarriage with this procedure, but this risk is less than 0.5% (less than 1 in 200) GENETIC SCREENS ARE LIKE ULTRASOUNDS FOR DNA Noninvasive Carrier screening prenatal screening Determines baby’s risk of having Determines risk of baby having a condition passed down from a chromosome condition the mother and father Cells Chromosomes DNA Genes MORE INFO Screening overview Genetic screening Noninvasive prenatal screening Carrier screening Cells DNA • The human body contains trillions of cells • Chromosomes are made up of tightly packed DNA • Cells in different parts of the body have different functions, • DNA consists of bases named A,C,T and G but with only a few exceptions every cell contains the same • DNA is like the blueprint for a person genetic information Chromosomes Genes • Most of the genetic information in each cell is located in • Small segments of DNA that act as the recipes for individual the nucleus. It is organized into compact chunks called proteins are called genes chromosomes • The genes babies inherit from their parents pass along family • Typically cells contain 46 total chromosomes, organized into characteristics like hair and eye color. Sometimes they also 23 pairs pass on genetic diseases, even if the parents don’t have any • One member of each pair of chromosomes comes from the symptoms mother, and the other comes from the father • Carrier screening is used to determine if prospective parents • Noninvasive prenatal screening is used to determine if by carry mutations in genes that could cause an inherited chance there are any extra or missing chromosomes in a condition pregnancy CHROMOSOME CONDITIONS CAN HAVE VARYING OUTCOMES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 X Y Normally cells contain 23 pairs of chromosomes Trisomy Screening is also available for: A trisomy occurs when the cells of the body Sex chromosomes contain an extra chromosome Sometimes there may be too many or too few This screen can also determine the sex of the baby Trisomy 21 Down syndrome Trisomy 18 Edwards syndrome Microdeletions Trisomy 13 Patau syndrome In rare cases, a tiny piece of a chromosome is missing MORE INFO Screening overview Genetic screening Noninvasive prenatal screening Carrier screening Trisomies Trisomy 18: Edwards Syndrome • Typically cells contain 46 total chromosomes, organized into 23 • Individuals with Edwards syndrome have an extra copy of pairs. One member of each pair comes from the mother, and the chromosome 18 other comes from the father • Health problems in babies born with Edwards syndrome • Trisomic conditions occur when an individual has a total number are usually life-threatening, including heart defects and of 47 chromosomes, instead of the typical 46. This excess genetic breathing difficulties material can lead to specific conditions, depending on which • Edwards syndrome occurs in about 1 in 5,000 live births. chromosomal pair has an extra chromosome Miscarriages are common with affected pregnancies Trisomy 21: Down Syndrome Trisomy 13: Patau Syndrome • Individuals with Down syndrome have an extra copy of • Individuals with Patau syndrome have an extra copy of chromosome 21 chromosome 13 • People with Down syndrome typically have mild to moderate • Patau syndrome causes life-threatening birth defects and intellectual disability and may also have additional health conditions severe intellectual disability • Outcomes for people with Down syndrome have improved • Patau syndrome occurs in about 1 in 10,000 live births. significantly in the past 40 years with increased access to education, Miscarriages are common with affected pregnancies social supports, employment opportunities, and family support • Down syndrome occurs in about 1 in 800 live births Sex Chromosome Differences Microdeletions • The sex chromosomes determine whether the baby will be male • In addition to changes in the number of chromosomes (e.g., (XY) or female (XX) trisomies), there can be changes in the structure of the • Sometimes there may be too many or too few sex chromosomes, chromosomes resulting in potential health issues • Sometimes small pieces of genetic material are missing. This • In addition to assessing whether there are extra or missing sex is called a microdeletion chromosomes, noninvasive prenatal screening can also determine • Microdeletions can lead to developmental challenges and the sex of the baby health issues HOW IT WORKS Simple blood draw from the mother’s arm causing no risk to her or the pregnancy Maternal blood stream Red blood cell Maternal DNA Placental DNA Normal developmental processes cause small pieces of DNA from placenta to enter mother’s bloodstream. Analyzing these DNA fragments can indicate risk of chromosome conditions. MORE INFO Screening overview Genetic screening Noninvasive prenatal screening Carrier screening What is Cell-free DNA? Cell-free DNA is Used for Screening, Not Diagnosis • Normal developmental processes cause small pieces of DNA • Screening tests do not give definitive answers. Instead, they from the baby’s placenta to enter the mother’s bloodstream provide information about whether there is an increased • These fragments are called cell-free DNA chance of a problem being present • Noninvasive prenatal screening uses cell-free DNA to help • Diagnostic tests, such as chorionic villus sampling (CVS) or determine if a pregnancy is at heightened risk for a common amniocentesis,