Genetic Testing

Genetic Testing During Pregnancy

For genetic testing before birth, pregnant women usually undergo amniocentesis or chorionic villus sampling.

Amniocentesis is a test performed between weeks 16 and 18 of a woman's pregnancy. The doctor inserts a hollow needle into the woman's abdomen to remove a small amount of amniotic fluid from around the developing fetus. This fluid can be tested to check for genetic problems and to determine the sex of the child. When there's risk of cesarean section or premature birth, amniocentesis may also be done to see how far the child's lungs have matured. Amniocentesis carries a slight risk of inducing a miscarriage.

Chorionic villus sampling (CVS) is usually performed between the 10th and 12th weeks of pregnancy. The doctor removes a small piece of the placenta to check for genetic problems in the fetus. Because chorionic villus sampling is an invasive test, there's a small risk that it can induce a miscarriage.

When Do Doctors Recommend Genetic Testing?

A doctor may recommend genetic counseling or testing for any of the following reasons:

• A couple is planning to start a family and one of them or a close relative has an inherited illness. Some people are carriers of genetic illnesses, even though they don't show, or manifest, the illness themselves. This happens because some genetic illnesses are recessive -- meaning that they're only expressed if a person inherits two of the problem gene, one from each parent. People who inherit one problem gene from one parent but a normal gene from the other parent won't have symptoms of a recessive illness but will have a 50% chance of passing the problem gene on to their children.
• An individual already has one child with a severe birth defect. Not all children who have birth defects have genetic problems. Sometimes, birth defects are caused by exposure to a toxin (poison), infection, or physical trauma before birth. Even if a child does have a genetic problem, there's always a chance that it wasn't inherited and that it happened because of some spontaneous error in the child's cells, not the parents' cells.
• A woman has had two or more miscarriages. Severe chromosome problems in the fetus can sometimes lead to a spontaneous miscarriage. Several miscarriages may point to a genetic problem.
• A woman has delivered a stillborn child with physical signs of a genetic illness. Many serious genetic illnesses cause specific physical abnormalities that give an affected child a very distinctive appearance.
• A woman is pregnant and over age 34. Chances of having a child with a chromosomal problem (such as trisomy) increase dramatically when a pregnant woman is older. Older fathers are at risk to have children with new dominant genetic mutations, those that are caused by a single genetic defect that hasn't run in the family before.
• A child has medical problems that might be genetic. When a child has medical problems involving more than one body system, genetic testing may be recommended to identify the cause and make a diagnosis.
• A child has medical problems that are recognized as a specific genetic syndrome. Genetic testing is performed to confirm the diagnosis. In some cases, it also may aid in identifying the specific type or severity of a genetic illness, which can help identify the most appropriate treatment.

A Word of Caution

Although advances in genetic testing have improved doctors' ability to diagnose and treat certain illnesses, there are still some limits. Genetic tests can identify a particular problem gene, but can't always predict how severely that gene will affect the person who carries it. In cystic fibrosis, for example, finding a problem gene on chromosome number 7 can't necessarily predict whether a child will have serious lung problems or milder respiratory symptoms.

Also, simply having problem genes is only half the story because many illnesses develop from a mix of high-risk genes and environmental factors. Knowing that you carry high-risk genes may actually be an advantage, if it gives you the chance to modify your lifestyle to avoid becoming sick.

As research continues, genes are being identified that put people at risk for illnesses like cancer, heart disease, psychiatric disorders, and many other medical problems. As research continues, the hope is that someday it will be possible to develop specific types of gene therapy to totally prevent some diseases and illnesses.

Gene therapy is already being used with limited success to treat cystic fibrosis and ADA deficiency (an immune deficiency). Sickle cell anemia, thalassemias, and other blood disorders may be the next targets for a genetic cure. Although genetic treatments for major killers, like cancer, may be a long way off, there is still great hope that many more genetic cures will be found. The Human Genome Project, which was completed in 2003, identified and mapped out all of the genes (up to 25,000) carried in our human chromosomes. The map is just the start, but it's a very hopeful beginning.