Counseling for pregnant women gets personalized

New chromosome study can lead to personalized counseling of pregnant women, claims a team of researchers.

Fetuses with a so-called new balanced chromosomal aberration have a higher risk of developing brain disorders such as autism and mental retardation than previously anticipated. According to a study conducted by the University of Copenhagen, the risk is 20 percent for fetuses with these types of aberrations.

These chromosomal aberrations are seen in the fetus in one out of 2,000 pregnant women. Until now, when such an aberration has been found, the medical doctors have told the pregnant woman that the fetus' risk of developing congenital malformations is 6-9 percent.

"We have identified all the people who, as fetuses, were diagnosed with such a chromosomal aberration in Denmark, and we can see that they more often have developed a disease. The previous study, which found a risk of 6-9 percent, mainly looked at congenital malformations and did not include neurocognitive diseases such as autism and mental retardation, which often emerge at a later stage. We have therefore been unaware of the extent of the total risk", said one of the authors of the study, Iben Bache.

'We call these aberrations balanced chromosomal rearrangements because all the genetic material is still there. There is neither a loss nor a gain of genetic material. The problem is that parts of the genetic material have been exchanged, and that might have caused disruption of an important gene', said Bache.

The study was the largest systematic survey of these rare chromosomal aberrations in fetuses, and it also evaluated the methods that can be used for examining them. These chromosomal abnormalities are diagnosed through chorionic villus sampling or amniocentesis by classical chromosomal analysis, where the genetic material is examined in a microscope.

This method has been used for the last 40 years, and it is still the method used in most pregnancies globally. However, in Danish hospitals, the method is increasingly being replaced with another method, chromosomal microarray, which exclusively tests for loss and gain of the genetic material.

Chromosomal microarray, therefore, cannot discover the rarely balanced aberrations studied here. In contrast, the study reveals that modern genome sequencing in most cases will be able not only to detect these balanced chromosomal aberrations but also show whether genes have been damaged.

The researchers carefully examined the Danish health records to find everyone born with a de novo balanced chromosomal aberration since 1975. Each time they found a person with the aberration, they established a control group of five individuals with normal chromosomes, who had been born more or less at the same time by a mother of the same age.

The researchers then visited the majority of the persons to do a health examination and collect blood samples for modern genetic analyses. By comparing the health data of the group with the chromosomal aberrations and the control group, the researchers found two-three times higher risk of developing a neurocognitive disorder in the group with the chromosomal aberrations.

In addition, the researchers found that the new whole-genome sequencing techniques are much better than any other techniques at assessing the health effect of a balanced chromosomal aberration. This is the conclusion after almost identical assessments made by two independent research groups, including a group from the Harvard Medical School.

"We have not known which analyses to use to discriminate the fetuses that will be healthy from those that will eventually develop disorders. Our study shows that by using the new sequencing technologies we can, in fact, discriminate in a number of cases. This may greatly affect the diagnosing and counseling of pregnant women carrying fetuses with this specific type of chromosomal aberration in the future," said Bache.

The study appears in the American Journal of Human Genetics.