Clinical Review

2019 Update on prenatal exome sequencing

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What parents want

To ascertain the perceptions of couples who underwent prenatal WES, Wou and colleagues conducted semi-structured interviews with participants from the Fetal Sequencing Study regarding their experience. They interviewed 29 parents from 17 pregnancies, including a mix of those who had pathogenic prenatal results, terminated prior to receiving the results, and had normal results.

Expressed feelings and desires. Parents recalled feelings of anxiety and stress around the time of diagnosis and the need for help with coping while awaiting results. The majority of parents reported that they would like to be told about uncertain results, but that desire decreased as the certainty of results decreased.

Parents were overall satisfied with the prenatal genetic testing experience, but they added that they would have liked to receive written materials beforehand and a written report of the test results (including negative cases). They also would like to have connected with other families with similar experiences, to have received results sooner, and to have an in-person meeting after telephone disclosure of the results.

Health professionals articulate complexity of prenatal genomics

In a qualitative interview study to explore critical issues involved in the clinical practice use of prenatal genomics, Horn and Parker conducted interviews with 20 health care professionals who were involved in the previously described PAGE trial. Patient recruiters, midwives, genetic counselors, research assistants, and laboratory staff were included.

Interviewees cited numerous challenges involved in their day-to-day work with prenatal whole genome and exome sequencing, including:

  • the complexity of achieving valid parental consent at a time of vulnerability
  • management of parent expectations
  • transmitting and comprehending complex information
  • the usefulness of information
  • the difficulty of a long turnaround time for study results.

All the interviewees agreed that prenatal exome sequencing studies contribute to knowledge generation and the advancement of technology.

The authors concluded that an appropriate next step would be the development of appropriate guidelines for good ethical practice that address the concerns encountered in genomics clinical practice.

WHAT THIS EVIDENCE MEANS FOR PRACTICE
The prenatal experience can be overwhelming for parents. Pretest and posttest counseling on genetic testing and results are of the utmost importance, as is finding ways to help support parents through this anxious time.

Societies offer guidance on using genome and exome sequencing

International Society for Prenatal Diagnosis, Society for Maternal and Fetal Medicine, Perinatal Quality Foundation. Joint Position Statement from the International Society for Prenatal Diagnosis (ISPD), the Society for Maternal Fetal Medicine (SMFM), and the Perinatal Quality Foundation (PQF) on the use of genome-wide sequencing for fetal diagnosis. Prenat Diagn. 2018;38:6-9.

In response to the rapid integration of exome sequencing for genetic diagnosis, several professional societies—the International Society for Prenatal Diagnosis, Society for Maternal Fetal Medicine, and Perinatal Quality Foundation—issued a joint statement addressing the clinical use of prenatal diagnostic genome wide sequencing, including exome sequencing.

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