Monday, January 01, 2007

Down Syndrome Screening For All Pregnant Women?

The American College of Obstetrics and Gynecology has released a new practice bulletins for OB/GYNs that recommends Down Syndrome screening for all pregnant women before 20 weeks of gestation, regardless of the woman's age. In the past, this screening has been recommended for women 35 and older, but have changed in part because of the development of newer, less invasive tests (compared to amniocentesis) for the condition, and also because they assert that 35 is not a hard and fast cutoff age for risk. The publication is not freely available to the public, but here are some summary points:

The bulletin lists several methods of screening, but states that "It is not practical to have patients choose from among the large array of screening strategies that might be used," and recommends that physicians review the evidence before deciding which strategies to offer the woman.

Doctors are instructed to discuss false-positive rates (the chances that a test will detect a problem which does not exist), advantages, disadvantages, limitations, risk, and benefits so the patient can make an informed decision.

The bulletin also gives the following factors that affect the choice of a screening test: gestational age at first prenatal visit, number of fetuses, previous obstetric history, family history, availability of nuchal translucency measurement, test sensitivity and limitations, risk of invasive diagnostic procedures, desire for early test results, and options for earlier termination.

The guideline does not estimate how many additional women <35 might benefit from this screening, or otherwise discuss the implications of the change. Presumably, women under 35 who undergo the screening and receive information regarding a possible Down Syndrome diagnosis will need additional care in terms of pregnancy options; the Washington Post article linked below also mentions that babies born with this chromosomal abnormality may need specialized care when born that may affect hospital selection.

Citation: American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007 Jan;109(1):217-27.
Down screening urged for all pregnant women - CNN
Group Recommends Down Syndrome Testing - AP via Washington Post

Resources (note that these may not have been updated to reflect the new ACOG recommendation):
  • Prenatal testing and diagnosis - National Down Syndrome Society
  • Down Syndrome: what you need to know when you're pregnant - American Academy of Family Physicians
  • Down Syndrome: finding out your child has Down Syndrome - American Academy of Family Physicians
  • Is it possible to breastfeed my baby who was born with Down Syndrome? - La Leche League
  • Birth Defects & Genetics: Down Syndrome - March of Dimes
  • Down Syndrome - National Institute of Child Health and Human Development

    On December 1, ACOG also released revised recommendations for women's health screening and care, including (quoted from the release):
  • "HIV Testing: Routine HIV testing should be offered to women ages 19 to 64 regardless of personal risk factors, following the new Centers for Disease Control and Prevention (CDC) guidelines.
  • Preconception Care: Ob-gyns should encourage women of childbearing age to develop a reproductive health plan to help conscientiously assess the desire for a child or children or desire not to have children.
  • Colorectal Cancer Screening: Women age 50 and older should be screened for colorectal cancer using one of five recommended screening strategies.
  • HPV Vaccine: ACOG recommends that HPV vaccination be offered to all girls and women 9 to 26 who have not previously been vaccinated.
  • Meningococcal Vaccine: ACOG now recommends that adolescents not previously immunized receive meningococcal conjugate vaccination before entry into high school. Older women at high risk also should receive the vaccine."
    See the press release for more complete details.

    Technorati Tags: ; ; ; ; ; ; ; ; ; ;
    MeSH Tags: Colorectal Neoplasms; Down Syndrome; HIV; Meningococcal Vaccines; Papillomavirus Vaccines; Preconception Care
  • 2 Comments:

    Blogger BlondeMom said...

    Rachel:

    I had the test in the fall of 2004 at VUMC when it was relatively unheard of here in Nashville. I had just turned 35 and because it was noninvasive I decided to do it. I started listing some info on my blog because of this.

    One thing to note, my insurance (BC/BS) did NOT cover the screening, but perhaps with this recommendation, that will change.

    Here's the link:

    http://blondemomblog.com/nuchal-translucency-screening/

    Jamie

    8:47 AM  
    Blogger Leticia said...

    I was 39 when I was pregnant with my last child, Christina, and refused all invasive test, stating that I would carry my child to term regardless of test results. I gave birth to a little girl with Down Syndrome, and life has never been the same.
    My family and I have grown in compassion, patience, tolerance, understanding and knowlege. Christina has made us better people, and a tighter family. I mourn for the 90% of women who abort these children, and will miss out on the blessings such a child brings to her world.
    What are we so afraid of?

    10:25 PM  

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