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    New ACOG Committee Opinion: routine cfDNA screening not needed

    Conventional prenatal screening methods remain the most appropriate first-line screening choice for most women in the general obstetric population, according to updated recommendations on cell-free DNA (cfDNA) screening for fetal aneuploidy issued by The American College of Obstetricians and Gynecologists Committee on Genetics jointly with the Society for Maternal-Fetal Medicine.

    The Committee Opinion (Number 640) was released online in June 2015 and subsequently published in the September 2015 issue of Obstetrics and Gynecology.

    The primary motivation for undertaking the update was to review the role of cfDNA screening for all pregnant women, recognizing the increase in data on this topic since the original Committee Opinion (Number 545) was published in December 2012.

    See also: cfDNA testing shows promise as primary aneuploidy screen

    The revised document also newly provides recommendations for follow-up of women who have a “no call” result from a cfDNA screening test, stating that they should receive further genetic counseling and be offered comprehensive ultrasound evaluation and diagnostic testing because of an increased risk of aneuploidy.

    As another key recommendation, the Committee reaffirmed its original opinion that there is insufficient evidence to support use of cfDNA screening in women with multiple gestations.

    Joseph R Biggio, Jr, MD, Chair of the Committee on Genetics and Professor and Director of the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, told Contemporary OB/GYN, “The uptake of cfDNA screening into clinical practice has occurred much more quickly than anything else we have seen in obstetric medicine. The original Committee Opinion focused on use of this technology in high-risk women because they were the subjects included in the available studies that validated cfDNA testing. Since then, more studies came out providing data on the performance of this technology in lower-risk women who are seen in a general obstetric population.”

     

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    • Anonymous
      The headline is misleading: prenatal testing for fetal genetic and chromosomal anomalies is never "needed." In fact, some people, like people who have Trisomy 21, think that ACOG is irresponsible in advocating testing for their particular chromosomal makeup, since the point is to allow either continuance of pregnancy (in which case one would not need testing anyway) or abortion (the result of positive testing 90% of the time). Those with trisomy 21 think ACOG is playing god, deciding which lives are worthy of testing for and aborting, and which are not. It doesn't matter what ACOG recommends anyway, as the horse is out of the barn. We are now being bombarded by ads for cfDNA testing, and consumers also will demand it, especially as it becomes cheaper and more comprehensive. For those at ACOG who advocate offering testing to high risk patients to allow them "choice," it seems unfair to offer the same choices to average risk patients. It is a tough job to play god.
    • Anonymous
      The headline is misleading: prenatal testing for fetal genetic and chromosomal anomalies is never "needed." In fact, some people, like people who have Trisomy 21, think that ACOG is irresponsible in advocating testing for their particular chromosomal makeup, since the point is to allow either continuance of pregnancy (in which case one would not need testing anyway) or abortion (the result of positive testing 90% of the time). Those with trisomy 21 think ACOG is playing god, deciding which lives are worthy of testing for and aborting, and which are not. It doesn't matter what ACOG recommends anyway, as the horse is out of the barn. We are now being bombarded by ads for cfDNA testing, and consumers also will demand it, especially as it becomes cheaper and more comprehensive. For those at ACOG who advocate offering testing to high risk patients to allow them "choice," it seems unfair to withhold the same choices to average risk patients. It is a tough job to play god.

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