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Down syndrome blood test could cut invasive testing

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Date: Wednesday Jan. 12, 2011 7:39 PM ET

A blood test being developed to screen for Down syndrome could practically eliminate the need for more invasive testing procedures, such as amniocentesis, a new study suggests.

The test works by using something called "multiplexed maternal plasma DNA sequencing" to analyze genetic material in the blood from both the pregnant woman and her fetus. A new study in the British Medical Journal finds that the test is highly accurate in detecting Down's syndrome in unborn babies.

If the new test were used on all pregnancies at high risk of Down syndrome, "about 98 per cent of the invasive diagnostic procedures could be avoided," the authors write.

Amniocentesis and CVS (chorionic villus sampling) are the prenatal tests currently used to detect Down syndrome (technically called trisomy 21). The tests are performed between the 10th and 15th week of pregnancy and can also screen for other less common birth defects, such as trisomy 13 and trisomy 18.

The tests are performed by inserting a needle into the uterus to take a tiny sample of the amniotic fluid surrounding the fetus or the tissue that will develop into the placenta. While the tests are reliable, they carry a 0.5 to 1.0 per cent risk of sparking a miscarriage.

The tests are generally reserved for those who have already shown abnormal results on blood work conducted in the 11th week of pregnancy, or to couples who have another child with a birth defect. In Canada, about five per cent of pregnant women undergo amniocentesis or CVS.

The new blood test is much less invasive and requires just a blood sample. For this study, a research team led by Prof. Dennis Lo of The Chinese University of Hong Kong used the test on 753 pregnant women in Hong Kong, the U.K. and the Netherlands who were at high risk of having a baby with Down syndrome.

Eighty-six of the women were found to be carrying a fetus with Down's syndrome. The test was highly accurate in detecting the birth defect in the unborn babies. What's more, there were no false-negative results in the study.

Two forms of the test were used: 2-plex and 8-plex sequencing. "The performance of the 2-plex protocol was superior to that of the 8-plex protocol," the authors wrote.

"With the 2-plex protocol, trisomy 21 fetuses were detected at 100 per cent sensitivity and 97.9 per cent specificity, which resulted in a positive predictive value of 96.6 per cent and negative predictive value of 100 per cent," the write, meaning that there were no false negatives and 3.4 per cent false positives.

The authors conclude that the blood test could be used to accurately rule out Down syndrome among high-risk pregnancies before amniocentesis or chorionic villus sampling is considered, thereby reducing the number of women who would require the more invasive procedures.

Still, some doctors note there are still a few hurdles to cross before the test would be widely used.

Dr. Mark I. Evans, an obstetrician at Mount Sinai School of Medicine in New York City notes that the test can only screen for Down syndrome, but won't pick up other chromosomal birth defects.

"The bad news is that prenatal diagnosis is not just about Down syndrome," Evans told WebMD. "Down syndrome represents about 50 per cent of what we find, and this new test can help with that. But it may also give women a false sense of reassurance."

The other problem with the test is cost. Current early screening tests cost less than $100 a patient. A commercial version of this DNA test – being developed by a company called Sequenom Inc. – is expected to sell for about $700.

Comments are now closed for this story

Mei
said
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How can those women call herself "mother" after they killed their disabled babies. They are murderers. People with Down Syndrome may be a slow learner and need lots of trainings and helps. But they are human and loving people. For doctors and specialists should spend time to find a better way to help them instead of killing them.


Laurie
said
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WE are gettting precariously close to the mentality of the Third Reich when we begin to deem who is worthy of life.Shocking when we hear now that there are parents who are sueing because a Down's Syndrome baby was missed and they were not able to "terminate" the life of their child.


Laurie
said
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It is not right to target the handicapped for extermination in the womb. We are losing our humanity by discriminating against imperfect specimens. Remember Hitler was not handicapped and he didn't turn out to be so great for society. Let us welcome the handicapped too. They have a lot to teach us about life.

Micki
said
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This is a tough debate and regardless of which side you're on, i"m sure you'll probably disagree with me...there is no right choice when it comes to pro-life or pro-choice. I am, as one comment put it, a high functioning dsabled person. I'm well educated, professional and completely independent. Am I glad that my mother did not have a choice considering she did not know of my disability before my birth? I guess I'd have to answer yes. However, if you ask what I'd do presented with devastating results from prenatal testing and I honestly can't tell you. What I can say with certainty is that I would love to have the information beforehand so that I could make an informed decision and that is the benefit this testing affords us.


carol
said
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My daughter was forced into having an amnio when she was expecting. The results came positive for down syndrome. The doctors were pressuring her to terminate, but she stood her ground, and had our support to continue the pregnancy. We now have a beutiful granddaughter with Down Syndrome that has enriched our entire families lives more then words can ever express. I recently lost my husband and can honestly say that I truly don't think I could get thru this trying time without that precious child, and others in the family feel the same. She is the greatest gift and the most precious little girl I have ever known. Yes she is maybe a lot more 'work' to raise, but what she gives us more then makes any of that go away. We don't yet know how far she will be able to go, as she is only 3, but we will help her and care for her with all our love and support.A very proud Gran


Lynn
said
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@ Scott- I do not believe that the OB should be held responsible for costs of a life time of raising a child with Down's syndrome. Especially here in Canada where there are so many services that offer individualized service funding, tac credits, ODSP which children can begin collecting. If they are that concerned aboutthe cost perhaps 1) they should, if they have not already, spend time with people who Down's to discover what absolutely joyous and wonderful people they are, and 2) give the child up for adoption to a family who is more concerned about loving that child and experiencing one of the greatest people they will meet, rather than concerned over their bank accounts. Any child can cost extra money- and most health expenses are paid for through our system- what isn't covered a lot of times there is funding for. I would challenge them to show how a child who has Down's is more expensive than a child born without.


Lynn
said
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It's disgusting that people have the option of a "therapeutic" abortion because a child may be born not "normal". That train of thought is basically saying that having Down's Syndrome- or any other disability- means that you are sub-human. And that is wrong. PEOPLE who have disabilities are people FIRST. And those "people" can work jobs, they can drive cars, go to University... as can many, many other people who born differently- not abnormal- just differently.


David
said
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This research is good, now people can make informed decisions, based on fact not feelings. It will prepare the future of a family, depending on the choice they make, when it is only a fetus and not a living thing.


Johanna Hirons
said
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To Scott: If your clients wanted to know for sure if their child had T21 they should have had an amnio or CVS. Screening results are given as odds for a reason. Someone is always the "1" in the ratio. If your clients do not want a child with Down Syndrome, they should give it up for adoption. There are hundreds of people on waiting lists who would love to have a child with DS.


Tony
said
0 0

Let's be clear about this, Down's Persons are equal under the law and law and morality should be applied equally. There is no difference between a person with Down's and any other person with 'special talents', whatever they are! The UN convention on the rights of disabilities has given us a clear interpretation... Let's treat all of our fellow human beings as equals.


Gaunilon
said
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Let's just be clear: "screening out" Down Syndrome generally means "killing the babies that have Down Syndrome". .You can argue all you want about how tough it is to raise a disabled child, but there is always adoption rather than infanticide..These test could be good if used to help families prepare either for adoption or for the difficulties their child will have. As it is, they are almost always used to find and terminate the "defectives".


Redfern
said
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Doug and Layla are both incredibly naive, and somewhat fooled by arguments about who can and cannot cope with disabled children. Any parent who would abort a disabled child does not deserve to be a parent in the first place. Thousands of disabled people became disabled either while they were being born, or after they were born, and many other serious disabilities are diagnosed well after birth. Should we allow their "unprepared" parents to put these children to death because they won't be able to cope? It is truly bizzare to believe that a person should be put to death just because his/her disability was discovered before birth. How does this make that person any less worthy of the right to life.When you make those kinds of CHOICES you are saying that disabled people have no value on this earth. Also, remember that women who MAKE THE CHOICE to refuse this testing are often hounded by the medical profession. I know one 40 year old first time mom who had to change doctors 3 times because of the relentless pressure to have amnio. How does the concept of CHOICE fit into that scenario?If you are not prepared to accept a child with special needs, then don't have a child at all.


Bryanne
said
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SCOTT...as a mother of an awesome son with special needs I do NOT understand your clients' claim at all! How can they look at their child and wish they had terminated his/her life?
It is costly to raise ANY child, and in Manitoba there are agencies that can help out with costs related to raising a child with special needs. You just have to know where to go for support.
Our son is very popular in our community! He brings joy to everyone he meets. I cannot imagine our lives without him.


RealityCzech
said
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Doug in BC said: "It never ceses to amaze me how many people think they have a right to imposxe their values on somone else [sic]." Me too: it never ceases to amaze me how many people impose their right to choose by depriving a helpless fetus of the right to life.


Doug # BC
said
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Well said "Layla".It never ceses to amaze me how many people think they have a right to imposxe their values on somone else.And I can easily criticize that,regardless of which side of the argument about this they take. Forcing a woman to have a child she knows she can't take care of ic cruel.Disabled children require massive amounts of time and addition care.Some can do that,some cannot.Try doing it without at least one very good paying job in the family.Almost a necessity,becuse one parent will almost certainly have to be able to spend a lot more time with the child,and obviously will be less available to hold a full time job. That said,no one should ever be in a position to say a woman MUST abort,for any reason.It's jusy not in some peoples DNA to be able to do that, no matter what the disability is. I would say though,that expectant mothers should have all the information there is before they make THEIR OWN,PERSONAL choice.A lot of sacrifices come with raising a child with a disability.And they are life long scrifices.If there is even the remotest chance that you will one day resent having to make those sacrifices,your child will figure that out. But,as "Layla" points out.Each family has to make it's own choice.All that society has an obligation to do,is help ensure that it is a well informed decision.


monica
said
0 0

As a mother of one child with disabilities I know how hard it can be.It is exhausting! My oldest has very serious medical issues and is legally condidered disabled, so when I decided to have a second I took all the precautions. My doctor told me my results for Downs Syndrome were positive. I was devastated, so I decided to go through with further testing. My husband was terrified of the result, or of a possible miscarriage. I wanted to know and yet I would of never considered an abortion regardless of the result. The outcome, a false positive result. Our beautiful boy turns three this sunday, and I am a proud mommy of two growing boys! Results postive or negative, parents have the right to know, and prepare themselves in any which way possible. I am against abortion , and yet I know it IS MY RIGHT to do what is best for my family. There are many parents in waiting , and many folks who can not conceive on their own, and would be willing to adopt any child with or without medical conditions. Babies are a miracle, and both my son's are medical miracles! I know first hand!


Scott
said
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I am an attorney. I am defending a case filed by parents who had a baby with Down syndrome. They claim my client, an OB, failed to recognize a marker during testing at 20 weeks that could indicate the presence of the disorder. They claim they would have terminated the pregnancy if they had been told about the finding. They now want to recover the amount it will cost to care for their disabled child for life. I'm curious what people think of this claim. Sort of a straw poll, if you will, for jury research.


Layla
said
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Personal choice is just that - personal. While there are many happy and high functioning people with disabilities, and there are many parents who are fully prepared to love and raise a child with disabilities, the reality is that it is a very personal matter and presents a very difficult life. Just because YOU wouldn't choose to do something doesn't mean everyone will do the same. I think it is wonderful that more accurate and safer tests are being developed so that women (and men) have the CHOICE and are more reliably informed when making this CHOICE.


jessevch
said
0 0

Years ago, I was offered amnio as I have two family members with Downs Syndrome. I refused and explained to the very insistent doctor, that there was no point to subjecting myself to this test, as I would not choose abortion even if I was carrying a child with Downs Syndrome. The medical logic was I needed this information so that I could have a choice or at least prepare myself for the reality of having such a child. Personally, I just do not get it as there are no guarantees with children and I was prepared to love any child that I had.


Deiren
said
0 0

The trauma many parents experience when learning their child has a disability is very real and raising a disabled child means a massive need for a supportive community - it's our Collective Responsibility as fellow human beings whether we like it or not. But destroying and eradicating life because a child has Down syndrome is wrong and all we can point to are those amazing people with Down syndrome who have touched our lives for the better.

elly
said
0 0

I know Leslie.... and I am happy that you are a capable coping loving person to your child. But it's not fair to judge others as their abilities to cope would not be the same.


H MacLeod-Leslie
said
0 0

As a mother of two I am disgusted that people have the option of killing their child if they have Down's Syndrome. I have a wonderful, amazing family member with Down's Syndrome - it doesn't make her life worth less - she's beautiful, funny, kind and intelligent. Shame on the medical profession for encouraging mothers (and fathers, too) to consider "their options" and providing legalized murder as an option.....shame.


Ontario mother
said
0 0

It' about time. I had Amniocentesis done many years ago and almost lost my child because of the procedure. He was perfectly normal. It's very invasive and stressful- way too much for a pregnant woman to go through. And, at that time several of us having the procedure were in a waiting room together. The overwhelming consensus was, what will we do if the test is positive. No one wanted to then have an abortion. A very difficult decision.


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