Werner-Lin Allison, Walser Sarah, Barg Frances K, Bernhardt Barbara A
School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania.
Translational Medicine and Medical Genetics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Med Genet A. 2017 Feb;173(2):444-451. doi: 10.1002/ajmg.a.38042. Epub 2016 Nov 7.
Chromosome microarray (CMA) testing is used widely in prenatal settings. Some copy number variants (CNVs) detected using CMA are associated with variable or uncertain phenotype and/or possible neurocognitive involvement. Little is known about parenting an infant following such findings. Researchers conducted interviews with 23 mothers of infants diagnosed prenatally with a potentially pathogenic CNV to elicit perspectives on the child's development and disclosure of results to others. Interviews were audiotaped and analyzed for common themes. Most respondents reported their infants were developing typically. The majority expressed concern about their child's future development given the CNV. They reassured themselves their child was unaffected by: comparing him/her to siblings, scrutinizing the child's appearance and behavior, or following provider reassurances. Even without developmental and neurological concerns, some remained acutely observant of their child's neurocognitive development, leading to enrollment in early intervention or ongoing medical assessments. Mothers who were unconcerned stated they would likely attribute atypical behavior or developmental to the CNV. All interviewees shared the result with pediatricians, relatives, or friends, and many shared across groups. Most shared information with pregnant friends considering prenatal testing, but withheld partial or full information from family members due to stigma, lack of understanding, inability to explain the CNV, or presumptions that the child was unaffected. Research must address the long-term consequences of returning uncertain results for parent-child bonding and costs of ongoing assessment and early intervention for typically developing children. Follow up appointments will permit providers to screen for anxiety and assuage worry in the absence of symptoms. © 2016 Wiley Periodicals, Inc.
染色体微阵列(CMA)检测在产前环境中被广泛应用。使用CMA检测到的一些拷贝数变异(CNV)与可变或不确定的表型和/或可能的神经认知受累有关。对于在发现此类情况后养育婴儿的情况,人们知之甚少。研究人员对23位产前被诊断出患有潜在致病性CNV的婴儿的母亲进行了访谈,以了解她们对孩子发育以及向他人披露检测结果的看法。访谈进行了录音,并分析了其中的共同主题。大多数受访者报告说他们的婴儿发育正常。鉴于CNV,大多数人对孩子的未来发育表示担忧。她们通过将孩子与兄弟姐妹比较、仔细观察孩子的外貌和行为,或听从医疗人员的保证来使自己确信孩子未受影响。即使没有发育和神经方面的担忧,一些母亲仍会敏锐地观察孩子的神经认知发育情况,从而让孩子参加早期干预或持续进行医学评估。不担心的母亲表示,她们可能会将孩子的非典型行为或发育归因于CNV。所有受访者都与儿科医生、亲戚或朋友分享了检测结果,许多人还在不同群体之间分享。大多数人会与考虑进行产前检测的怀孕朋友分享信息,但由于耻辱感、缺乏理解、无法解释CNV,或认为孩子未受影响等原因,她们会对家庭成员隐瞒部分或全部信息。研究必须解决返回不确定结果对亲子关系的长期影响,以及对发育正常的孩子进行持续评估和早期干预的成本问题。后续预约将使医疗人员能够在没有症状的情况下筛查焦虑情绪并减轻担忧。© 2016威利期刊公司