Traditional pregnancy a thing of the past
Having a baby may never be the same again as increasingly sophisticated genetic testing is likely to raise thorny ethical issues, according to a new report.
The lead author of a New Zealand Law Foundation Report, Dr Jeanne Snelling of the University of Otago's Bioethics Centre and Faculty of Law, says pregnant women now face a bewildering world of genetic testing.
"Genetic testing in the reproductive context is a particularly high-stakes endeavour. It directly affects a woman's experience of pregnancy, and may contribute to a decision not to transfer an embryo or to terminate an established pregnancy," she says.
The report looks at a number of rapidly evolving genetic technologies that a woman may be offered, either during pregnancy or regarding embryos created by IVF (in-vitro fertilisation).
The technologies examined include:
- Non-invasive prenatal testing (NIPT), which enables foetal information to be gleaned from a maternal blood test as early as 10 weeks into pregnancy
- Chromosomal microarray testing that may be performed at about 18 weeks following invasive amniocentesis
- Preimplantation genetic testing of IVF embryos involving the latest high-resolution, next generation sequencing
"A common feature of all of these tests is that they enable an increasing and significant amount of health-related information to be derived, compared with traditional prenatal tests, and all are associated with particular technical, ethical and legal challenges.
"The report considers how this new landscape reignites debates about the implications of new technology for women and how it affects the experience of pregnancy.
"It also considers the potential for expanded screening and testing programmes becoming more routine, and the implications for informed consent, as well as concerns regarding the effects of extended reproductive genetic testing on people with disabilities."
Dr Snelling says there is a "common assumption" that more information is always better.
"That is not always borne out in the empirical studies of women's experiences.
"One recurring theme is the pressing need to ensure women and their partners have a genuine choice to accept or decline expanded screening or testing, and that those who do undertake it are provided with the necessary professional advice to ensure they are sufficiently informed, prepared and supported throughout.
"Expanded screening and testing is likely to not only affect reproductive outcomes, but also women's experiences of conception and pregnancy in the future. The major issue is how all these technologies should be integrated into clinical practice here," Dr Snelling says.