Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population

J Perinat Med. 2021 Mar 16;49(7):847-852. doi: 10.1515/jpm-2021-0021. Print 2021 Sep 27.

Abstract

Thalassemias are among the most frequent genetic disorders worldwide. They are an important social and economic strain in high-risk populations. The benefit of β-thalassemia screening programs is growing evident but the capacity to diagnose fetal β-thalassemia exceeds the treatment possibilities and even when treatment before birth becomes feasible, difficult decisions about the relative risks will remain. This paper can be of practical and ethically justified aid when counseling women about screening, diagnosis, and treatment of β-thalassemia. It takes in consideration various social challenges, medical issues such as antenatal screening, preimplantation genetic diagnosis, prenatal diagnosis, non-invasive prenatal testing and prenatal therapy. We also describe the Sardinian experience in applying and promoting high-risk population screening and diagnosis programs and future trends in the management of β-thalassemia.

Keywords: cell free fetal DNA (cffDNA); ethics; non-invasive prenatal testing (NIPT); preimplantation genetic diagnosis (PGD); prenatal diagnosis; prenatal screening; β-thalassemia.

Publication types

  • Review

MeSH terms

  • Directive Counseling / ethics
  • Female
  • Fetal Therapies / ethics
  • Fetal Therapies / methods
  • Genetic Testing / ethics
  • Humans
  • Italy
  • Patient Acceptance of Health Care*
  • Patient Participation
  • Pregnancy
  • Prenatal Diagnosis / ethics*
  • Prenatal Diagnosis / methods
  • Professional-Patient Relations / ethics*
  • Risk
  • Social Determinants of Health*
  • Socioeconomic Factors
  • beta-Thalassemia / diagnosis*
  • beta-Thalassemia / genetics
  • beta-Thalassemia / therapy