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Updated: May 7, 2025

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Routine Prenatal cfDNA Screening for Autosomal Dominant Single-Gene Conditions.

Sophie Adams1, Olivia Maher Trocki1, Christina Miller1

  • 1Center for Fetal Medicine and Reproductive Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.

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|January 3, 2025
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Summary

Routine cell-free DNA screening for single-gene disorders (cfDNA-SGD) identified high-risk results in 0.51% of pregnancies. This enables early intervention but presents counseling challenges due to variant classification and expressivity.

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Area of Science:

  • Genetics
  • Reproductive Medicine
  • Molecular Diagnostics

Background:

  • Genetic screening has evolved from aneuploidy detection to single-gene disorders (cfDNA-SGD).
  • Clinical validation of cfDNA-SGD is promising in high-risk pregnancies but less studied in the general population.

Purpose of the Study:

  • To evaluate the utility and outcomes of routine cell-free DNA screening for single-gene disorders (cfDNA-SGD) in a general pregnant population.
  • To assess the concordance and clinical significance of cfDNA-SGD results.

Main Methods:

  • Retrospective chart review of pregnancies undergoing cfDNA-SGD screening for 25 autosomal dominant conditions.
  • Exclusion of pregnancies with ultrasound anomalies or known family history.
  • Analysis of screening concordance, pregnancy outcomes, and phenotypes.

Main Results:

  • 9.4% of pregnancies underwent cfDNA-SGD screening, with 78.9% being routine.
  • 0.51% of routine screenings yielded high-risk results (pathogenic/likely pathogenic variants).
  • Diagnostic testing confirmed variants in 11/14 affected pregnancies/newborns, with no false positives but two discrepant classifications.

Conclusions:

  • Routine cfDNA-SGD screening identifies 0.51% of pregnancies as high-risk, necessitating further evaluation.
  • Early identification through cfDNA-SGD allows for timely intervention.
  • Challenges include counseling due to variable expressivity, limited genotype-phenotype correlations, and classification discrepancies.