Baby Elianna Constantino has made history. The world’s first in utero stem cell transplant trial has reported the birth of a baby with alpha thalassemia after giving the fetus a blood transfusion enriched with the mother’s blood stem cells. Elianna was born to Nichelle Obar and Chris Constantino in February. The couple, who are from Hawaii, are both carriers of alpha thalassemia, and their fetus was critically ill during the second trimester. But researchers at UC San Francisco and UCSF Benioff Children’s Hospital Oakland are conducting an early-stage trial that aims to help babies with alpha thalassemia using their mothers’ stem cells. Continue reading First baby born in stem cell transplant study
We are a bit late in reporting this ruling, but in March Natera settled with the US government for over $11 million to resolve claims of fraudulent billing for its Panorama prenatal cfDNA screening test. The government held that from 2013 through 2016, Natera knowingly submitted improper claims for payment from TRICARE (the insurance program for the US military), the Federal Employees Health Benefits Program, and Medicaid. By using improper billing codes, Natera misrepresented the services for which they were billing, causing these agencies to pay for testing that they would not otherwise cover – such as cfDNA screening for low-risk pregnancies and for microdeletion syndromes. Continue reading Natera pays $11M for fraudulent billing
Prenatal cfDNA screening, often called NIPT, has given rise to many differences of opinion among professional societies. Recommendations about using cfDNA for prenatal screening have evolved slowly as studies have validated these tests – and, of course, as the tests themselves have changed and expanded over time. ACMG, representing medical genetics and laboratories, has tended to make the most expansive recommendations in favor of cfDNA screening, while ACOG, representing the bulk of obstetricians, has tended to be the most conservative group. Others, like ISPD, have usually fallen between the two extremes.
Commercial cfDNA labs, for their part, have grumbled about what they see as an overly slow pace of accepting this new technology (although, by historical medical standards, it’s actually been quite fast). One of their long-standing complaints has been revived in a just-published commentary in Prenatal Diagnosis. Adam Wolfberg, formerly employed by Ariosa (the makers of the Harmony™ cfDNA screen), argues in this new commentary that professional bodies have an inherent conflict of interest that has led them to resist more enthusiastic recommendation for prenatal cfDNA screening. Maternal-fetal medicine (MFM) specialists, he argues, see their livelihood endangered by this new technology, which threatens to undermine the fetal ultrasounds that are their bread and butter. Continue reading Are professional societies conflicted about cfDNA?
Genome-wide sequencing is increasingly being conducted on fetal tissues, either as whole exome sequencing (WES), whole genome sequencing (WGS), or targeted analysis that uses clinical panels. These kinds of prenatal sequencing are sometimes done when more standard genetic tests have not yielded helpful results to explain structural anomalies, or if a specific genetic condition is suspected that would not be detected through other prenatal tests. While such sequencing is more likely to yield a positive result, it comes with its own set of risks and challenges – for instance, it is more likely to detect variants of unknown significance and other results that lead to excessive testing and stress on parents without significant benefit.
The International Society of Prenatal Diagnosis (ISPD), in conjunction with the Society of Maternal Fetal Medicine (SMFM) and the Perinatal Quality Foundation (PQF), just issued a joint position statement on the use of genome-wide sequencing for fetal diagnosis. While they recognize that sequencing can be useful in some instances, they generally take a cautionary approach. Based on “lessons learned from existing prenatal testing,” along with currently available literature and a panel discussion at the most recent annual ISPD meetings, their consensus opinion includes the following points. Continue reading ISPD issues new guidelines for prenatal genome-wide sequencing
Hello from Kansas City, the geographical center of the US, where the American Society for Bioethics and Humanities is holding its annual meeting! Several PIRCers are here presenting research and learning from colleagues in bioethics.
Michelle McGowan is speaking on reproductive ethics to the Reproduction Affinity Group of ASBH, Saturday October 21st at 6pm. Marsha Michie is delivering a paper, “Scaffolding Translation: A Model for Ethical and Social Guidance of Translational Genomic Medicine,” Saturday at 2pm, based on her research on prenatal cell-free DNA screening. Jessica Mozersky and Stephanie Kraft are speaking on other topics: Jessica on “How Do Clinical Research Coordinators Actually Gain Knowledge of Good Clinical Practice?” Sunday at 11am, and Stephanie as part of a panel on “Beyond the Therapeutic Misconception: The Challenges of New Misconceptions About Research,” Thursday at 4pm.
You can peruse the whole program for the 2017 ASBH meetings at asbh.org.
Megan Allyse is representing PIRC at the 2017 annual meeting of the American Congress of Obstetrics and Gynecology (ACOG) in San Diego, with a poster presenting preliminary findings from the ERRORS (Errors in Reading and Reporting On Results of Screening) study. She presented the ERRORS poster, titled “Decisional Regret in Women Receiving High-risk or Inconclusive Results from Non-invasive Prenatal Genetic Screening,” in ePoster Session B on Saturday (Poster 24B).
She is also presenting a poster on ethical considerations in uterine transplantation surgery, in ePoster Session P on Tuesday (Poster 30P). Congratulations Megan!