[NYTr] New Prenatal Tests Raise Hopes and Fears

[nytr at olm.blythe-systems.com]

Women's eNews - Nov 29, 2005
http://www.womensenews.org

New Prenatal Tests Raise Hopes and Fears

By Molly M. Ginty
WeNews correspondent

(WOMENSENEWS)--Sandy Redwanc knew the odds were stacked against her.

When she married a man with cystic fibrosis at the age of 24, Redwanc took a
blood test that revealed she also carried the gene for this incurable
disease. If she became pregnant, her baby would have a 50 percent chance of
developing cystic fibrosis, which causes breathing and digestion problems so
severe they can be fatal.

This month, Redwanc and her husband are hoping to beat those odds by
undergoing pre-implantation genetic diagnosis, a procedure that screens
embryos for cystic fibrosis and other diseases before embryos are implanted
in the womb through in vitro fertilization.

"This test is our one hope of having a healthy child," say Redwanc, now 31.
"And for us, that would be nothing short of a miracle."

Pre-implantation genetic diagnosis--which takes place before a pregnancy
even begins--is among a growing number of cutting-edge screening tests that
are changing the face of maternity care, and sparking ethical debate.

"The result of these tests is a better-educated, better-supported patient,"
says Dr. Randy Morris, the Redwancs' Chicago-based fertility doctor.

"The result is also a lot of discussion of designer babies," says Dan Brock,
a professor of medical ethics at Harvard Medical School in Boston.

While some health advocates applaud the new tests, others are concerned they
could increase the number of selective abortions among women with
less-than-perfect pregnancies.

New Tests Peg Sex, Birth Defects Early

Most standard prenatal tests that screen for chromosomal and developmental
abnormalities are offered at 15 to 18 weeks, well into the second trimester.

But in recent years, researchers have developed newer, much-earlier tests.

One is Instant Risk Assessment, or IRA, a home blood test that screens for
Downs Syndrome, a form of mental retardation affecting 1 in 800 births, and
trisomy-18, an even rarer disorder in which the fetus has a malformed heart,
brain and eyes and cannot live outside the womb. Available since January,
IRA is taken at nine weeks, with lab results sent to a woman's doctor at 11
weeks.

Another avant-garde test is the Baby Gender Mentor, which allows a woman to
determine the sex of her baby by taking a home blood test just five weeks
after conception. Available since June, this new test can peg gender 11
weeks earlier than routine ultrasound, in which a doctor passes a hand-held
device across a pregnant woman's belly and uses sound waves to create a
picture of the baby's genitals.

Alongside these commercial tests are coming changes in maternity care that
can help detect some conditions earlier. This month, the New England Journal
of Medicine published research on a new Downs syndrome screening that tests
the blood for two markers and uses ultrasound to measure the fetus's neck,
which is thicker in the case of Downs syndrome. Done as early as 11 weeks and
detecting 87 percent of Downscases (versus the standard, second-trimester
test that detects 80 percent of cases), this new test is prompting the
Washington-based American College of Obstetricians and Gynecologists to
update its prenatal screening guidelines.

While most new prenatal tests check for abnormalities at the first stages of
pregnancy, pre-implantation genetic diagnosis--the procedure Redwanc is
having--tests for gender and 50 health problems before pregnancy even
begins. Doctors analyze eggs that were fertilized the day before, and, after
consulting prospective parents, choose the healthiest embryos and implant
them in the womb.

New Tests Spark Concern

Not yet part of routine care and thus not typically covered by health
insurance, new prenatal screening tests can be prohibitively expensive for
many pregnant women. While IRA costs $160 and the Baby Gender Mentor costs
$275, pre-implantation genetic diagnosis can run $15,000 or more.

Like the expense of these new tests, their ethical ramifications also spark
concerns.

Until recently, most prenatal screening tests were offered well into the
second trimester, when abortion can pose health complications and may not be
readily accessible.

Experts say earlier screening measures may spur some women to have
first-trimester abortions if their fetuses test positive for major birth
defects, which affect 3 percent of pregnancies and are more common in
mothers over the age of 35.

"These tests could prompt insurance companies and physicians to pressure
parents to have elective abortions that will save medical costs down the
line," says Andy Imparato, director of the Washington-based American
Association of People with Disabilities. "And those decisions could be ones
that parents come to regret."

This year, after researchers estimated a record 80 percent of fetuses with
Downs Syndrome are being aborted, the American Association of People with
Disabilities stepped up its advocacy for congressional legislation that
would require doctors to explain a Downs Syndrome diagnosis to parents more
thoroughly than before, perhaps informing parents that life expectancy and
medical care have improved dramatically in recent years.

Concern About Sex Selection

Just as they are concerned about fetuses being aborted because of
chromosomal abnormalities, health advocates also worry about the new tests'
impact on sex selection, a practice that has led to widespread abortion of
girl babies in countries such as China, where there are now 83 women for
every 100 men, and India, where the city of New Delhi, for one, now welcomes
just 76 female babies to every 100 male babies.

"Studies show most Americans don't feel strongly enough about the sex of a
child to base an abortion on gender, but this could prove to be a problem in
some immigrant groups," says Stanley Henshaw, a senior fellow at New York
City's The Alan Guttmacher Institute.

In the wake of the 2003 mapping of the 3 billion-part human genetic code,
some health advocates say prenatal tests could even be used for the
selection of "preferred" traits such as brown eyes, broad shoulders or a
higher-than-average IQ.

"Potentially, these tests could select any trait a parent wants," says
Imparato.

In May, the Guttmacher Institute reported that while the number of abortions
is declining overall, the number of first-trimester procedures is rising
slightly.

Though the affect of prenatal testing on abortion rates had not been
carefully studied, it is possible that they are contributing to this
increase.

The Washington-based American College of Obstetrics and Gynecologists
approves of earlier prenatal screening tests, saying they can help "relieve
anxiety" in many cases.

Health advocates say they can only predict how new prenatal screening tests
will affect America's number of abortions and births, which now total 1.3
and 4 million respectively per year.

"It's anybody's guess how rapidly this science will develop," says Harvard's
Brock. "But even with more accurate information, these tests will still lead
to difficult choices."

[Molly M. Ginty is a freelance writer based in New York City.]

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