Current Controversies in Prenatal Diagnosis-Conference Debate 2024: All Fetuses Undergoing Fetal Therapy Should Have Exome Sequencing.

This manuscript summarises the debate held at the 2024 annual meeting of The International Society for Prenatal Diagnosis (ISPD). Experts discussed whether all fetuses undergoing fetal therapy should undergo exome sequencing. Arguments in favor included that, with increasing experience and better clinical availability, exome sequencing can yield valuable diagnostic and prognostic information beyond what is available from karyotyping and microarray. This additional information is often helpful in counseling parents and provides a better understanding of fetal conditions, allowing for personalised medicine and supporting advancements in disease-focused fetal therapies. On the contrary, however, significant concerns regarding availability and health equity were raised. Moreover, potential delays in care incurred by exome sequencing may negatively affect outcomes of fetal intervention. Finally, as the information gathered from genetic testing may or may not affect pregnancy management decisions beyond termination of pregnancy, many families may choose not to undertake testing. The arguments of both debaters document current controversies in exome sequencing and genetic testing in general. This was also reflected in a divided audience vote at the end of the debate.